[Inaugural diabetic acido-ketosis: rare endocrine complication in thalassemia child]

Diabetes is a sparse endocrine complication of f3 thalassemia major. We report the case of a 14year-old boy with beta thalassemia major, who was polytransfused without regular iron-chelation therapy. He was admitted to hospital with acidosic dyspnoea and severe deshydratation without signs of cardiac failure. Urine examination showed glucosuria and acetonuria. On laboratory exams, glycemia was 39 mmol/l with severe metabolic acidosis. The diagnosis was a diabetic acido-ketosis requiring insulin therapy. Diabetes was hardly controlled; serum ferritin level was 4500 mg/l. Serum ferritin level is the main risk factor for diabetes in patients with beta thalassemia. Thus, an adequate iron-chelation therapy can prevent this complication

[Hyperlipemia and lymphoma]

While the concept of developing hypocholesterolemia during myeloma or lymphoma is not unusual, the existence of developing hyperlipemia is rare. The authors report the case of a sixty-one year old diabetic patient treated by oral medication. This patient does not have a family history of hyperlipemia. He was hospitalized for degradation of his general condition, and a pain of the right shoulder and bilateral pleural effusion. A major hyperlipidemia [total cholesterol = 13.5 mmol/l, triglycerides = 16.8 mmol/l] was noted during his hospitalization and persisted in spite of a fibrate treatment and a controlled diabetes. The radiography of the upper right limb showed lytic images of the extremity of the humerus. The thoracic CT scan showed bilateral pleural effusion and a hyperdense paravertebral image of ganglion metastasis. The myelograme and the pleural biopsies showed a malignant non hodgkin lymphoma. An immunosuppressor treatment was prescribed resulting in a spectacular improvement of the hyperlipidemia since the first chemotherapy. This is probably an autoimmune hyperlipidemia associated with a lymphoma. Further investigations like the study of the lipoprotein lipase activity, the search of antibodies related to the apo E or the apo B would be useful in order to confirm this assumption

pseudo-phlebitis of inferior members

The authors present 18 cases, and study the publications. The hematome of mollet [9 cases], the break of popliteal cyst [5 cases], the superficial phlebitis [3 cases], the venous insufficiency [1 case], are the four differential diagnosis found. The clinical syndroms evoque the diagnosis, but are not specific