Multispecific anti neutrophil cytoplasm antibodies: a case report

To report the presence of ANCA with an unusual polyreactivity. 50 year-old woman with pulmonary fibrosis whose immunological investigations showed the presence of ANCA with an unusual polyreactivity against several neutrophil proteins [PR3,MPO, BPI, lysozyme, elastase and cathepsine G] which could be related to a polyclonal hypergammaglobulinemia occurring in this patient. The international consensus on the testing of ANCA recommends seeking major specificities like MPO and PR3 which are good markers of ANCA-associated vasculitides. The use of multiantigenic ELISA can be helpful to detect various target antigens at the same time and may thus explain some atypical fluorescent patterns observed when searching for ANCA by Indirect immunofluorescence, these results, however, must be interpreted with caution

[Predictive factors of obstructive sleep apnea syndrome in obesity]

Obstructive sleep apnea [OSA] syndrome is frequent, and misdiagnosed. Of this study is to assess the prevalence of OSA syndrome in a Tunisian population of obese [body mass index>or=30 Kg/m[2]] and to determine its predictive factors. It's a transversal study. One hundred patients [63 females, 37 males] were inculded. All patients underwent nocturnal polysomnography or respiratory polygraphy. Sixty-five patients had an OSA syndrome: mild [24.6%], moderate [30.7%] and severe [44.6%]. We compared, by a statistical analysis, the group with OSA syndrome and the group without OSA syndrome. There was a predominance of men [81%of men vs 55.5 of women had OSA]. Age was higher in the group with OSA syndrome [56.8 years +/- 10vs 48.1 +1-12, P=0.04]. Clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses were more frequent in the group with OSA syndrome. Morphological abnormalities such as retrognathy and/or short neck were significantly more frequent in the group with OSA syndrome [p=0.05 and 0.02 respectively]. Cardiopathies and diabetes were more frequent in obese with OSA syndrome. In obese persons, male gender, comorbidities and diabetes clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses, retrognathy and/or short neck are predictive of OSA syndrome. So, we propose a nocturnal recording in obese presenting at least one of these predictive factors

Last discovery of a congenital broncho-oesophageal fistula

Broncho-oesophageal fistula is rare and occurs mostly in acquired condition. Report of a new case. We report a case of a 58-years-old woman which has, since 38 years ago, a chronic cough, recurrent bronchopulmonary suppurations and hemoptysis. Clinical examination let to the diagnosis of a broncho-oesophageal fistula. Surgical treatment resulted in complete recovery. There was no evidence of any aetiology. Congenital origin of the fistula was deduced

Late onset systemic lupus erythematosus

Late onset systemic lupus erythematosus [SLE] after 50-year-old is rare. We report a case of 84-year-old woman presenting with systemic lupus revealed by pleural effusion associated with renal involvement. The pleural effusion, renal abnormalities and the immunological abnormality improved within 4 weeks after prednisone therapy [1 mg/kg/day]. The late onset lupus differs from those with early onset, in terms of mild clinical presentation and favourable prognosis. Our observation is exceptional due to the very late onset of the lupus and involvement of a major organ, the kidney, which is usually exceptional in this age