[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

[Generalized pustular psoriasis activated by Klebsiella pneumoniae septicaemia]

Generalized pustular psoriasis is a severe form of psoriasis. The pustular dermatosis complicates a known psoriasis frequently after a medicinal taking or infection. It exceptionally inaugurates the psoriatic disease. We report a case of generalized pustular psoriasis triggered by Klebsiella pneumoniae septicaemia and discuss the characteristics of this association. A 43-year-old man, was hospitalized for a profuse pustular eruption evolving for one week with altered general state, fever and liquid diarrhea. The patient ate a tuna sandwich 48 hours prior to the onset of symptoms. The biology showed a hyperleucocytosis, elevated C Reactive Protein and hepatic cytolysis. The skin histology demonstrated a pustular psoriasis. Three blood samples, a coproculture and a catheter culture showed Klebsiella pneumoniae. The patient was treated with antibiotics. The pustular psoriasis was treated by acitretin. The evolution was gradually favourable. Generalized pustular psoriasis is a rare and severe affection. Its prognosis is mainly conditioned by infectious complications

[ 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

[Psoriasis indicative of HIV infection progress to aids]

Psoriasis is a chronic inflammatory dermatosis which can appear before HIV infection in a patient with personal or family histories of psoriasis or which can be triggered by the HIV infection in a previously unaffected subject. The psoriasis with HIV is often more severe and refractory to classic psoriasis treatments. We report a case of psoriasis that revealed an HIV infection at the AIDS stage, and shall discuss the clinical and therapeutic characteristics of this association. A 40-year-old female has presented with a non pruriginous erythemato-squamous face and scalp eruption with palomplantar keratoderma and onychodystrophy of all toe nails evolving for one ear. On physical examination, an oral candidosis and chronic diarrhea were also noted. The diagnosis of common psoriasis was evoked and the investigations had revealed a lymphopenia at 610/mm[3]. The HIV serology was positive with CD4 at 31/mm[3] and viral load at 31,000 copies/ ml. A chest radiography had shown an apical left opacity due to pulmonary tuberculosis. In few days, the psoriasis extended to the whole integument. The patient was treated by antiretroviral therapy, antituberculosis drugs and local corticosteroids and ointments for her psoriasis. The evolution was quickly favourable. The recent psoriasis developed in an unaffected subject or the exacerbation of a former psoriasis can be associated with immune-suppression. HIV serology is required in such cases