[B cell prolymphocytic leukemia with poor prognosis]

B cell prolymphocytic leukemia is a rare disease with poor prognosis compared with chronic lymphocytic leukemia. Patient aged 75 years old, diabetic and hypertensive, with a massive splenomegaly associated with leukocytosis exceeding 100000/mm3 predominantly prolymphocytic, invading the bone marrow. Immunophenotyping showed CD19 +, CD20 +, CD22 +, CD5 part, CD23+ CD79b + FMC7 stronger and stronger, Smg + in vafour for a type B-cell prolymphocytic leukemia. The evolution was rapidly unfavorable despite an first line treatment of eight cycles of COP [cyclophosphamide, vincristine and prednisone]. Partial remission was short, followed by the reappearance of the splanomegaly, new increase in the of Prolymphocyte tate with thrombocytopenia and profound anemia. The patient had received two courses of Fludarabine. Dath occurred after eighteen months of follow up due to a state of septic shock and tumor lysis syndrome. This malignancy accounts for 2% of all chronic lymphocytic leukemia with 80% phenotype B. It frequently affects patients of 70 years old with a clear male predominance. The prognosis is more severe than that of chronic lymphocytic leukemia. Anemia <11g/dl and lymphocytosis > 100000/mm3 are the factors of poor prognosis. The median survival was 65 months reported by Shvidel et al. in a series of 35 observations. Promising results are reported with new treatments. The antibady anti-CD20 has been used successfully for the second type of B-cell prolymphocytic leukemia after relapse. The allograft or autograft are indicated, but it is mostly used in patients, who have contraindications to a heavy treatment

[Human immunodeficiency virus [HIV] associated arthritis]

Infection with human immunodeficiency virus [HIV] may be associated with different types of arthritis. The oligoarthritis related to human immunodeficiency virus is less frequent, rarely revealing the retrovirus. We report a case illustrating this association with a review of the literature. Patients aged 38 years, followed for myelodysplastic syndrome who developed a subacute oligoarthritis of the knees characterized by functional impairment. The radiograph of both knees were normal. The joint aspiration revealed sterile exudative fluid with lymphocytic predominance. Rheumatoid factor, antinuclear antibodies and HLA B27 were negative. A significant lymphopenia was found, justifying the implementation of serology for human immunodeficiency virus type 1, which returned positive. The CD4 count was a 128/mm3, the viral load of 4,000,000 copies/ ml. the patient was classified as stage C disease and has been received AZT+ 3 TC + Efavirenz, ketoprofen and paracetamol, with disappearance of oligoarthritis after 4 weeks. Aseptic arthritis can occur at any stage of HIV infection, most frequently described in an advanced stage of disease. They are found in 7.8% of cases and are rarely revealing as is the case with our patient, characterized by functional impairment and bone response to anti-inflammatory drugs. The serological testing must be systematic in an etiologic oligoarthritis

[Immune thrombocytopenic purpura]

It is characterized by a low platelet count < 150000/mm[3], which is the result of both increased platelet destruction and insufficient platelet production. In this paper, we will focus on current aspects of geoepidemiology, pathophysiology, diagnosis and management of primary immune thrombocytopenia in adult. The development of autoantibodies against platelet glycoproteins remains central in the pathophysiology of immune thrombocytopenic purpura, several abnormalities involving the cellular mechanisms of immune modulation have been identified. The goal treatment is to raise the platelet count to high enough levels to prevent bleeding. Corticosteroids, intravenous immune globulin, and splenectomy remain mainstays of treatment; however, newer therapies including rituximab and the thrombopoietin receptor agonists are remodeling conventional treatment algorithms. Effective treatments are aimed at different steps in the pathophysiologic process including the reduction of autoantibody production, interference with FcR uptake and signaling, suppression of B and T cells, and increase in TPO activity. The development of biologic therapies, particularly anti-CD20 and the emergence of new drug to increase platelet production rather than modulating the immune response, however, may radically change the management of immune thrombocytopenic purpura and make the information rarest of splenectomy

Severe asthma crisis in the infant. 17 cases

Seventeen children were admitted in the intensive care unit of the Children Hospital for severe asthma crisis between 1980 to 1985. The underlying asthmatic illness occurs early in childhood and has a dreadful evolution. The severe asthma crisis is particularly serious especially because of the major signs of hypercapnia. Corticosteroids and bronchodilators have been proved very potent in this serie. These very encouraging results are in accordance with literature data. Therapeutic guidance is well codified now

Salmonella typhi meningitis. About one case

Authors report a case of salmonella typhi meningitis observed in the unity of intensive care of Casablanca Children Hospital. It is a rare affection with a dreadful prognostic especially occurring in infancy. Clinical, bacteriological aspects and the difficulty of treatment choice are reviewed

Escherichia Coli Ki neonatal meningitis

The authors report on a case of neonatal meningitis caused by a strain of E. coli K1. The interest of rapid technics for detection of bacterial antigens is emphasized and the place of third generation cephalosporins discussed

Purpura fulminans. Report of 18 cases

The authors report 18 cases of fulminant purpura assembled in the intensive care unit of the Children Hospital in Casablanca. This affection is still life-threatening as showed by the 5 deaths, 2 amputations and 4 arthritis. One part of the failures is due to a very late diagnosis and to a very late or insufficient initial treatment. The authors emphasize the necessity of considering the myocardial incompetence during septic shock, and insist on continuing medical education

[Infantile convulsive illness. report of 37 cases]

The authors report on 37 cases of convulsive illness, observed in 4 years, and they emphasize the necessity of a rapid diagnosis, a codified quick hold in charge. The bad prognostic elements are: the new native period, the duration of convulsive ill superior to 12 hours, the major hyperthermy and the meningoence phalitis. They also insist on the necessity to inform the parents in the frame of the sanitary education in order to prevent the state of convulsive illness

[Idiopathic pulmonary hemosideros. report of a 3 cases]

Idiopathic pulmonary hemosiderosis, one of the "pneumo-anemic" syndroms is a very rare disease of unknown etiology and pathogeny. The study of three personal cases associating both an anemic and respiratory syndrom and the study of the literature have led to the description of the clinical manifestations of the disease. Particular attention should be paid to monosymptomatic cases. The presence of macrophages loaded with iron in bronchial secretions, and pulmonary sequestration of radioactive iron [iron 59], revealed by isotopic exploration should be enough to lead to the diagnosis; however a histo-pathological study of pulmonary biopsy, particularly after thoracotomy, seems to be necessary both for a better diagnosis and prognosis. The aetiopathogeny of this affection seems to depend from an immunological mechanism, which is not actually well known. Treatment by corticoids and/or immunosupressive drugs is controversed, and generally the disease evolves towards death within four years usually

Oxalosis: a familial case report

A case of "familial oxalosis" discovered after routine necropsy, is reported. The discovery of two other cases in the same family brought us to review the main features of the disease

Infantile tuberculosis: a study of 187 cases

187 cases of child's evolutive tuberculosis were diagnosed during 6 years in the Pediatrics department of the children's hospital of Casablanca. Among these observations 107 are pleuro-pulmonary and 80 extra-respiratory forms including mainly ganglionic [39 cases] and abdominals [37 cases] lesions. The frequency of the child's tuberculosis justifies an energitic policy of eradication of this illness which is based on preventive vaccination and treatment of contagious patients