Thrombotic thrombocytopenic purpura sine purpura occuring simultaneously with systemic lupus erythematosus. A case Report

The association between thrombotic thrombocytopenic purpura and systemic lupus erythematosus has been rarely described, especially when the occurrence of both situations is simultaneous. We report the case of a 21-year-old young woman who presented with this association. The simultaneous diagnosis of these two diseases is difficult because both share similar features. Treatment must be given early. It relies on therapeutic plasma exchange, systemic glucocorticoids or other immunosuppressive agents. The prognosis is very much related to the rapidity of the diagnosis and subsequent treatment

Fievre typhoide

Objectives: Present clinical features of typhoid fever in Lebanon. Methods: Retrospective study of 70 patients admitted to a university hospital center between 1995 and 2002. The criteria for inclusion were a positive Salmonella typhi or paratyphi hemoculture and/or a Widal serodiagnosis >/= 1/160 for O agglutinin, in the presence of evocative symptoms. Results Among the 70 patients, 25 pediatric cases were noted. The patients were aged a mean of 28 +/- 22 years. Average duration of symptoms before the diagnosis was 10 +/- 7 days. Fever were observed in 97% of cases and the other predominant symptoms were abdominal pain [41%], diarrhoea [36%], chills [31%] and headache [29%]. Febrile gastroenteritis was a frequent manifestation in children [52%]. Complications were noted in 31% of cases and were predominantly digestive. Leucopenia was not a helpful diagnostic marker. S. typhi was the most frequent [87%] serotype identified. Resistance to ampicilline was 10%, to cotrimoxazole and chloramphenicol 7% for each and to ofloxacine 2%. One death was reported [1%] of an immunosuppressed patient. Typhoid fever is still an endemic disease in Lebanon and should be systematically evoked in the case of prolonged fever, febrile gastroenteritis and/or headache. The appearance of bacteria resistant to antibiotics makes ceftriaxone or ciprofloxacine the empirical treatment of choice