[Bone lesions due to endemic African Kaposi sarcoma: a case report]. / Les atteintes osseuses au cours du sarcome de Kaposi endémique africain: à propos d'une observation.

Based on clinical and epidemiological data Kaposi's sarcoma (KS) can be divided into four subtypes: classical KS, immunodepression-related KS (IKS), epidemic AIDS-associated KS (AKS), and endemic KS (EKS). EKS is the most common entity in intertropical Africa. The authors of this report describe a case of invasive KS of the extremities associated with metatarsal osteolysis in a 43-year-old man from Central Africa. The patient was seronegative for HIV. Osteolytic lesions associated with EKS are uncommon and present few specific symptoms. They are always associated with skin lesions and are sensitive to radiation therapy and/or systemic chemotherapy. With the growing HIV epidemic, the clinical features of EKS and AKS now overlap and distinction is no longer possible in Black Africa. However AKS rarely involves osteolytic lesions without unfavorable prognosis or unconventional therapeutic modalities. In patients who are seropositive for HIV, it is important to distinguish KS from bacillary angiomatosis. Since these two entities present similar clinical and radiological features, differentiation is usually achieved on the basis of histological findings but active therapeutic testing for bacillary angiomatosis may be necessary.

[Cyst of the lumbar posterior longitudinal ligament. An unusual cause of non-discal sciatica]. / Kyste du ligament commun vertébral postérieur. Une cause originale de sciatique non discale.

Ganglion cyst of the longitudinal posterior ligament of the spine is a rare entity, only described in 11 cases. This lesion occurs in young subjects suffering from classical lombosciatica, and has perhaps a traumatic origin. Computerized tomography and MRI provide the diagnosis.

[HIV infection manifesting as a pneumococcal spondylodiscitis]. / Spondylodiscite à pneumocoques revélátrice d'une infection par le VIH.

In this report the authors describe a patient in whom pneumococcal spondylitis was the presenting manifestation of HIV infection and discuss bone and joint infections during HIV infection. The case report involves a 43-year-old man from Mali who was admitted for fever and back pain that occurred during upper airway infection. Pneumococcal spondylitis was diagnosed based on MRI images showing an epidural effusion and on positive hemocultures for Streptococcus pneumoniae. Initial standard x-ray findings were normal but repeat imaging revealed the disco-vertebral lesions. HIV serology was positive but there was no evidence of immunodepression or decreased CD4 lymphocyte levels. Since the introduction of antibiotics bone and joint involvement in pneumococcal disease has become uncommon in developed countries. In patients with HIV infection pyogenic arthritis is rare but the risk of pneumococcal disease is greatly enhanced and arthritic lesions can occur. Only eleven cases of pneumococcal arthritis associated with HIV infection have been reported in the literature. However the incidence of these infections seems higher in Black Africa where they account for 50% of pyogenic arthritis. The authors emphasize the lack of correlation between the stage of HIV infection and the onset of pneumococcal osteoarthritic infections which could account for occurrence of the latter as presenting manifestations of retroviral seropositivity.

[Bone and joint sites of African histoplasmosis (Histoplasma duboisii). Apropos of a case and review of the literature]. / Localisations ostéo-articulaires de l'histoplasmose africaine (Histoplasma duboisii). A propos d'un cas et revue de la littérature.

The authors report a case of disseminated African histoplasmosis with bone and joint involvement in a black 28-year-old citizen of the Central African Republic who presented with a 17-month history of multiple osteoarticular lesions (sternoclavicular joints, humerus, ribs), cutaneous lesions (face, scalp, thorax), and lymphadenopathy. Clinical manifestations resolved rapidly under treatment with ketoconazole (600 mg/d for 10 days then 400 mg/day for nine months). Persistent yeast cells were then found upon examination of a lymph node biopsy specimen. The characteristics and diagnosis of osteoarticular lesions due to African histoplasmosis are discussed on the basis of a review of the literature. Bone and joint lesions due to African histoplasmosis have not yet been reported in patients with the acquired immunodeficiency syndrome. However, the expanding epidemic of human immunodeficiency virus infection in Africa can be expected to result in an increase in the incidence of African histoplasmosis. Imidazole derivatives are easier to use on a long-term basis than amphotericin B and have significantly improved our ability to treat African histoplasmosis.

[Demonstration of subclinical pulmonary alveolitis in spondylarthropathies]. / Mise en évidence d'une alvéolite pulmonaire infraclinique au cours des spondylarthropathies.

Restrictive ventilatory dysfunction, lowered diffusing capacity, and apical fibrosis have been reported in ankylosing spondylitis. To investigate the pathogenesis of these abnormalities, we studied distal airspace cytology by performing bronchoalveolar lavage in 34 spondyloarthropathy patients (ankylosing spondylitis, n = 16; reactive arthritis, n = 4; axial psoriatic arthritis, n = 2; and undifferentiated spondyloarthropathy with HLA B27-positivity in every case but one, n = 12). Mean age was 32.4 +/- 13.7 years. None of the study patients had apical fibrosis, lower respiratory tract infection, or exposure to airborne pollutants other than tobacco smoke. The control group was composed of nine subjects who had no lung or inflammatory diseases and were not using medications. Significantly higher proportions of lymphocytes were found in bronchoalveolar lavage specimens from patients, as compared with controls. This difference was not influenced by smoking or medication use (non steroidal antiinflammatory drugs, sulfasalazopyridine). Alveolar lymphocytosis was not correlated with laboratory tests for disease activity (erythrocyte sedimentation rate, serum IgA levels) or with the presence of restrictive ventilatory dysfunction. Increases in the proportion of lymphocytes were of similar magnitude in patients with ankylosing spondylitis and in those with other spondyloarthropathies. Absolute total cell counts and relative neutrophil counts were similar in patients and controls. However, among the patients with spondyloarthropathies, those with a disease duration of more than five years had a significantly higher proportion of neutrophils than those with a disease duration of less than five years. These findings demonstrate that spondyloarthropathy patients have subclinical lymphocyte alveolitis. Although of unclear significance, this alveolitis may be related to the development of apical fibrosis in some patients with ankylosing spondylitis.

[Ganglioneuroma of the mediastinum. Apropos of a case]. / Ganglioneurome du médiastin. A propos d'une observation.

The authors report a case of a large ganglioneurinoma located in the mediastinum. The clinical course of this rare benign neurogenic tumour of the posterior mediastinum includes a low risk of medullary compression. The treatment is surgical resection.

[Cytological study of deep lung in spondyloarthritis. Apropos of 34 cases]. / Etude cytologique du poumon profond au cours des spondylarthropathies. A propos de 34 observations.

Bronchoalveolar lavage (BAL) was performed in 34 consecutive patients with spondyloarthropathy (SA) compared with 9 controls. Lymphocytic alveolitis was found in the SA group with decrease in the ratio of the CD4/CD8 subsets in both lung and blood. Neutrophilic alveolitis was also found in 5 patients with SA of long duration. As with other inflammatory diseases, it seems that a subclinical alveolitis is present in SA patients.

[Value and limits of tomodensitometry applied to the diagnosis of sacroiliitis in young adults: study of 200 cases]. / Valeur et limites de la tomodensitométrie appliquée au diagnostic des sacro-iliites chez l'adulte jeune: etude de 200 dossiers.

Diagnosis of sacroiliitis may be difficult to establish in patients under 25 years of age since growth is not yet completed and joint damage is often still minor. A prospective study of 200 subjects with a median age of 22 years was carried out to compare the value of CT scan and conventional radiology. The study population included 32 healthy subjects and 168 consecutive patients with presumptive spondylarthropathy including 36 with bilateral sacroiliitis and 8 with unilateral sacroiliitis. Conventional roentgenograms and CT scans were performed in every patient. Blind reading of roentgenograms and CT scans was carried out by two pairs of observers with differing experience. CT scan provided no additional information when reading was done by experienced observers: rates of mistaken and doubtful results were similar with both investigations (10%); specificity of both tests was comparable (90%) but sensitivity was significantly greater for CT scan (91.2%) than for conventional roentgenograms (71.6%), reflecting improved detection of roentgenographically occult sacroiliitis. Less experienced observers obtained better results with CT scans, illustrating the ease of interpretation of CT scan images. Analysis of false-positive CT scans revealed that normal variations and, above all, features due to as yet uncompleted growth were the main sources of mistakes. These mistakes cancelled the advantage of increased sensitivity of CT scan studies and explained why CT scan failed to improve diagnosis.

[Post-traumatic osteolysis of the distal extremity of the clavicle. Anatomopathological study of 2 cases]. / Ostéolyse post-traumatique de l'extrémité distale de la clavicule. Etude anatomopathologique de deux observations.

Two patients with post-traumatic osteolysis of the distal end of the clavicle undergoing surgery 5 months and 22 months respectively after the initial trauma were evaluated histopathologically. The lysed zone was replaced by tissue of fibrous appearance, with little blood supply and non-inflammatory, the presence of which could be suspected by magnetic resonance. The synovial membrane, non-inflammatory but hypervascularised, participated in the process but did not appear to be directly responsible for the osteolysis. The osseous tissue of the patient, operated upon early, showed signs of osteoclastic resorption but there was neither stasis, vasodilatation nor signs of osteogenesis. These various findings suggest that post-traumatic osteolysis of the distal end of the clavicle does not result from local ischemic events. These appearances seem identical to those described in multifocal primary osteolysis, the cause of which also remains unknown.