[Disseminated histoplasmosis revealed by peripheral blood smear in an African immigrant with AIDS]. / Histoplasmose disséminée révélée par un frottis sanguin chez un immigré africain atteint du sida.

We report a case of disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum in an African patient with AIDS (born in Ghana) and living in France. This opportunistic fungal infection has never been reported in Ghana, maybe because of limited means of investigation or ignorance. Nevertheless, it was reported in a Ghanaian immigrant living in Italy. In our patient, the first diagnosis was suggested by a peripheral blood smear, which is not a classical biological diagnostic method. The diagnostic interest and the frequency of positive peripheral blood smears in the course of disseminated histoplasmosis are probably under estimated.

[Cutaneous vasculitis with renal impairment complicating interferon-beta 1a therapy for multiple sclerosis]. / Vascularite cutanée avec atteinte rénale compliquant un traitement par interféron bêta-1a pour une sclérose en plaques.

INTRODUCTION: Cutaneous tolerance of the interferon beta used in the treatment of relapsing-remitting multiple sclerosis is good. However, among the rare adverse effects, vasculitis and glomerular impairment have been described for interferon beta-1b. CASE REPORT: A 36-year-old woman had been given subcutaneous injections of interferon beta 1-1a (Rebif, Serono) three times a week for ten weeks. A local transient cutaneous erythema was observed at the injection's sites. A few days after a new injection a erythematous plaques developed at the injection sites followed by pruritus, then purpura with edema on the leg in addition to an increase in body weight of 3 kg. Biological data showed proteinuria and hematuria. The histology study of skin specimens suggested non-specific lymphocytic vasculitis. Outcome was favorable after discontinuing interferon beta-1a. CONCLUSION: The etiology of the cutaneous and renal impairment is not formally established but the drug-induced hypothesis is proposed for interferon beta-1a.

[A classical form of actinomycoses involving the mouth, face bones, orbit and base of the cranium in an African patient]. / Une forme historique d'actinomycose impliquant la cavité buccale, les os de la face, l'orbite et la base du crâne chez un patient africain.

Osteitis due to actinomycosis is now an uncommon clinical entity in industrialized countries. This report describes a classic case of imported actinomycosis involving the buccal cavity, facial bones, orbit and skull base. For two years after the onset, various diagnoses followed by different medical as well as surgical treatments were unsuccessfully attempted first in Senegal then in Italy. Proper diagnosis was finally established in Marseille, France, on the basis of histological findings after extensive surgical biopsy. The patient was treated with high-dose intravenous penicillin G for four weeks followed by daily oral administration of amoxicillin for one year. Surgical reconstruction could not be carried out before the patient's return to Senegal. The pitfalls of diagnosis and treatment of actinomycosis are discussed.

[Immunosuppression and vaccinations]. / Etats d'immunodépression et vaccinations.

Immunocompromised subjects have a higher risk of infection. Some infectious risks could be controlled by vaccination, carried out according to normal schedules, in the absence of effective curative treatment. According to the type of immunodeficiency and its severity, certain vaccines may be recommended, others should be avoided and still others may be used with no particular risk. Thus, in immuno-compromised subjects, vaccines consisting of inactivated, inert or dead microorganisms are indicated. In contrast, those consisting of live microbes are not recommended for several reasons: 1) there is a risk that the immunocompromised host will be unable to control infection with the vaccine; 2) there is a risk of an increase in viral replication, particularly in HIV-infected subjects and 3) there is a risk that the response of the immune system will be poor. HIV-infected individuals now account for most of the cases of secondary immuno-deficiency, following the emergence of AIDS in 1980. They are increasing in number, especially in developing countries, where antiretroviral treatment is not widely available. In this context, vaccinations against transmissible childhood viral and bacterial diseases (e.g. measles and polio) with a high prevalence is advisable, with modifications according to the risk of contagion and the degree of immunodeficiency. However, these vaccines do not target opportunist infections, the prognosis of which is poor and against which we have no vaccines. Other vaccines are recommended only for immunocompromised subjects visiting countries with specific epidemiological situations (endemic or epidemic diseases) or if vaccination is required by the country visited.

[Multiple and bilateral nodular opacities revealing primary pulmonary lymphoma of the Burkitt-like type in AIDS]. / Opacités nodulaires multiples et bilatérales révélatrices d'un lymphome pulmonaire primitif de type Burkitt-like au cours du SIDA.

We report the observation of AIDS patient with a history of cough, dyspnea, fever, cachexia and bilateral nodular opacities at the chest X-ray. Infectious etiologies were initially suspected but the recovery was not obtained with their treatment. Only lung biopsy established the precise diagnosis of primary pulmonary Burkitt's-like lymphoma (BBL). The sole extranodal site of BBL at the lungs is an unusual finding. Generally, this lymphomatous proliferation is observed at the early period of the HIV infection. Immunodepression and Epstein-Barr virus (EBV) infection are the major pathogenic basis for BL as indicated by the high prevalence of EBV genomes found in malignant cells. The lack of EBV sequences in a significant proportion of Burkitt's lymphoma or BBL and AIDS-associated non-Hodgkin malignant lymphoma suggest that alternative pathogenic mechanisms may be involved. This observation permit to show the difficulties observed before the multiple and bilateral opacities whom the etiologies are varied. The prognosis of AIDS-associated BLL is very severe.

[Endobronchial tuberculosis presenting as an obstructive tumor in an HIV-1-positive patient. Apropos of a case and review of the literature]. / Tuberculose endobronchique se présentant comme une tumeur obstructive chez une patiente VIH-1 positive. A propos d'un cas et revue de la littérature.

INTRODUCTION: A rare case report of endobronchial tuberculosis is reported in an HIV-1 positive patient of black African origin. EXEGESIS: A 38-year-old woman of Guinean origin, HIV-1 positive, presented with persistent right upper lobe opacity at chest X-ray. Computerized tomography of the chest after injection confirmed this finding and revealed right laterotracheal and Barety space adenopathy. Investigations of acid-fast bacilli in the biological media were negative. Fiberoptic bronchoscopy showed endobronchial lesion on the wall of the ventral part of the right upper lobe, which had the appearance of bronchogenic carcinoma, and infiltrates in the dorsal mucosa. Biopsy of the lesion revealed granuloma formation, but no evidence of caseation necrosis. Identification of Mycobacterium tuberculosis in sputum culture helped arrive at a diagnosis of endobronchial tuberculosis similar to obstructive bronchial tumor. CONCLUSION: This case of endobronchial tuberculosis is the first described in an HIV-1 positive patient of black African origin. Mediastinal lymph node revealed by chest computerized tomography after injection could be the site of spreading of mycobacteria by fistulization of tuberculosis lymph node into the right main bronchus. Only the histology of lesions carried out during bronchial fibroscopy permitted the exclusion of endobronchial neoplasia. In addition, the sensitivity of direct microscopy for acid-fast bacilli is poor. Identification of Mycobacterium tuberculosis by sputum culture helped guide the diagnosis which was further confirmed by a good therapeutic response. This case of endobronchial tuberculosis in an immunodepressed patient underlines the difficulty in determining the etiology of pulmonary opacities.

[Calcified splenic abscess, colonic fistula and ascites in a chronic carrier of Salmonella typhi]. / Abcès splénique calcifié, fistule colique et ascite chez un porteur chronique de Salmonella typhi.

We report the unusual case of a patient with chronic carriage of Salmonella typhi who presented with partially calcified splenic abscess linked to colic fistula and ascitis. The colic fistula could be secondary to ischemic necrosis by left colon compression due to spleen large abscess. Fistula was evidenced by abdominal computed tomography scan and confirmed by barium enema. The possible etiologies of ascitis are either tuberculosis or ascitic peritonitis secondary to the fistulisation; nevertheless, the role of segmentary portal located hypertension cannot be completely excluded. The splenic abscess was probably due to Salmonella typhi which was only isolated from stool specimens. The calcified splenic abscess was the evidence that the infection had occurred first. In addition, the isolation of Salmonella typhi in stool cultures six months after the subject had returned from the Comores proved the chronic carriage. Treatment by splenectomy and left colectomy was successful in this patient.

[Periarteritis nodosa disclosed by epilepsy in a drug addict with hepatitis B and C virus carrier state]. / Périartérite noueuse révélée par une épilepsie chez un toxicomane porteur des virus de l'hépatite B et C.

The authors report a case of periarteritis nodosa (PAN) with an inaugural symptom of febril epilepsy. The patient was drug addict with hepatitis B and C virus. A toxoplasmic lesion originally noted on the cranial computed tomography scan was confirmed by cerebral magnetic resonance imaging showing encephalitis, and a diagnosis of periarteritis nodosa was suggested by clinical signs and laboratory data. The responsibility of hepatitis B virus in the genesis of this PAN seems quite certain whereas possible others factors such as hepatitis C virus or cocaine are discussed.

[Necrotizing hepatic granuloma of brucellosis origin. Apropos of a case]. / Granulome nécrosant hépatique d'origine brucellienne. A propos d'un cas.

The authors report on a case of febrile necrotizing brucellosis hepatic granulomatosis in a patient living in brucellosis endemia areas. This hepatic localization of brucellosis is rare: to our knowledge only 28 cases have been described in the literature. The bacteriological diagnosis was not established by blood or abscess pus cultures, but by Brucella serology only. Surgery completed by biantibiotherapy have permitted a complete recovery.