[Acute coronary syndrome during antiretroviral treatment]

The aim of this study is to determine epidemiological, clinical, therapeutic and outcome characteristics of acute coronary syndrome in AIDS patients under HAART. The charts of 5 patients were reviewed. The mean age, at the time of the discovery of HIV infection, was 35 years. Three patients were smokers and one had a family history of diabetes and acute coronary syndrome [ACS]. Three patients received 2 nucleoside reverse transcriptase inhibitors [NRTIs] with indinavir. The 2 others received 2 NRTIs with efavirenz with good immunovirologic response. Four patients developed mixed dyslipidemia after an average period of 26 months. Tow patients developed diabetes and one a hypertension. A specific treatment was initiated in all cases. These five patients developed an ACS after respectively 51, 95, 96,103 and 145 months of ART [median=98 months]. ACS occurred in 3 patients receiving 2 NRTIs and PI and two others 2 NRTIs with efavirenz. The mean age at the onset of ACS was 46 years. One patient underwent a triple bypass surgery, tow a stenting of the stenotic coronary and the last 2 patients received medical treatment with a good clinical outcome. The PI was replaced by efavirenz in two patients. Four patients had a recurrence of ACS respectively after 2months, 3 months, 12 months, and 62 months after the first episode. The five patients are still followed with good clinical and biological outcome

[ case of pyomyositis tuberculosis]

Pyomyositis is a muscular infection that is frequently due to commonplace bacteria particularly in immunocompetent patients. However, infections with specific germs can arise even without preliminary risk factors. We report the case of a young non-immunosuppressed patient, who has a sub acute painful tumefaction of a thigh without infectious signs. The clinical examination was in favour of thigh collection. The MRI confirmed this hypothesis and showed an associated osteo-arthritis of the knee. The pus microbiological examination was postitive for Mycobacterium tuberculosis. She favourably evolved under antituberculous treatment and surgical drainage of the collection. As tuberculosis is endemic in our country, we should always consider this diagnosis even in young patients without predisposing factors