[ case of seriuos group a streptococcal meningitis in adult]

Streptococcus pyogenes is a well-known cause of a variety of clinical infections including local symptoms such as tonsillopharyngitis, cervical lymphadentitis, otitis media, cellulites, erysipelas, as well as more severe diseases such as scarlet fever, osteomyelitis, necrotizing fasciitis, sepsis, and toxic shock syndrome. However, acute bacterial meningitis caused by this pathogen is unusual. Group A streptococcus meningitis is uncommon in adults. The incidence of this disease represents less than 1% of the cases of meningitis. We report a case of group A streptococcus [GAS] meningitis in an adult patient complicated with consciousness trouble, neurological deficiency and triventricular hydrocephalus, which improve under antibiotics and ventricular derivation

[Tumoral cutaneous form of kaposi's sarcoma: Diagnosis difficulties case report]

Kaposi's sarcoma is the most frequent neoplasia related to AIDS. We report here the difficulties of diagnosis and therapeutic of an atypical cutaneous form of Kaposi's sarcoma. A 31-year-old woman HIV- infected with severe immunodeficiency [CD4 cell count is 50 cell/mm[3] and HIV RNA viral load is 539000 copies /ml] was admitted for an atypical cutaneous kaposi's sarcoma. She was first treated by antiretroviral therapy combined stavudine, lamivudine and indinavir added to bleomycm monochimiotherapy. One month after, she developed persistent cough and new lesions of Kaposi sarcoma which a big pseudotumoral frontal one. Bronchoscopy showed pulmonary Kaposi's sarcoma. Polychimiotherapy [bleomycin, donorubicin et vinblastin], and local treatment were instituted with regression of lesions. Combined antiretroviral therapy, by increasing immune restoration, leaded to recovery

[Bilateral aseptic osteonecrosis of fernoral head in an HIV-infected patient]

The incidence of osteonecrosis has increased in HIV-infected patients. The femoral head is the most frequent localization and bilateral in the 60% of cases. Common risk factors include the use of corticosteroids, ethanol and the hyperlipidemia. We report one case of bilateral femoral head of osteonecrosis in an HIV-infected patient. A 40-years-old HIV-infected patient, with advanced immunodeficiency [CD4+ cell count of 55/mm3]. His past medical history included cervical zoster, significant alcohol abuse, chronic smoking and use of corticosteroids by himself in 1992. He is currently treated with antiretroviral therapy combined Zidovudine, Lamivudine and Efavirenz. He was admitted to hospital in December 2003 with progressive bilateral hip pain and limp without fever. Osteonecrosis was diagnosed by magnetic resonance imaging and skeletal scintigraphy .Laboratory test showed hypercholesterolemia, positive antiphospholipid and antinuclear antibody. He was treated with nonsteroidal anti-inflammatory drugs. Total joint arthroplasty was not realised due to severe immunodeficiency and high risk of infection. In accordance with the literature, the risk factors for osteonecrosis are multiple in our patient. This fact, a large vigilance is necessary among HIV-infected patients having a dyslipidemy and/or received corticosteroids