[Thrombocytopenia purpura, myositis and cytolitic hepatitis: a rare association linked with atorvastatin]. / Purpura thrombopenique, myosite et hepatite cytolytique : une association rare d'incidents lies a l'atorvastatine.

Statins are generally well tolerated molecules. However, some cases have seen potentially lifethreatening consequences. We report a case of a 70-year-old woman with high blood pressure who was treating hypercholesterolemia by atorvastatin. Two weeks after beginning this new treatment, the patient developed muscular weakness in all four limbs with myalgias; and a purpura in the upper limbs and abdomen. A biological study revealed the presence of severe thrombocytopenia, myolysis and cytolytic hepatitis. Stopping the atorvastatin intake resulted in an improved situation within twenty days. This suggests that the medical anomalies found in the patient were drug-induced. The literature confirms the rarity of this association. The severity of some side effects of statins should remain in the minds of medicine prescribers.

Les statines sont des molécules généralement bien tolérées. Des accidents pouvant mettre en jeu le pronostic vital peuvent survenir avec leur utilisation. Nous rapportons l'observation d'une patiente de 70 ans hypertendue, chez qui l'on a découvert une hypercholestérolémie traitée par atorvastatine. Deux semaines après ce nouveau traitement sont apparus une faiblesse musculaire des quatre membres avec des myalgies; et un purpura aux membres supérieurs et à l'abdomen. La biologie révélait une thrombopénie sévère, une myolyse et une hépatite cytolytique. L'arrêt de l'atorvastatine a permis une évolution favorable en vingt jours. Cela suggère l'origine médicamenteuse des anomalies constatées. Les données de la littérature confirment la rareté de cette association. La gravité de certains effets secondaires des statines doivent rester à l'esprit des médecins prescripteurs.

[Thrombosis of the inferior vena cava and right atrium: a rare complication of an amebic liver abscess in Dakar, Senegal]. / Thrombose de la veine cave inférieure et de l'oreillette droite : complication rare d'un abcès amibien du foie à Dakar (Sénégal).

The liver is the most common site of extra-intestinal amebiasis. Amebic liver abscesses can be complicated by rupture, migration to adjacent organs or, more rarely, vascular thrombosis. The purpose of this report is to describe the case of a 52-year-old Senegalese man hospitalized for painful hepatomegaly associated with asymmetric bilateral pulmonary consolidation and fever. Abdominal ultrasound revealed a large abscess in the left lobe of the liver with a non-obstructive thrombus extending from the inferior vena cava to the right atrium. Doppler cardiac ultrasound depicted extensive right atrial thrombus formation. Chest radiography showed opacities in both lungs. Sputum smear tests for tuberculosis were negative, but amebic serology was positive. Treatment consisted of a combination of antibiotics (metronidazole/amoxicillin/clavulanic acid), curative heparin therapy, and abscess drainage. Complications during treatment included thrombosis of the right chambers of the heart and a suspected pulmonary embolism. Outcome was favorable and the thrombi disappeared. The available literature confirms the rarity of this complication, which can have severe consequences due to embolism.

[Vulvar pathology]. / La pathologie vulvaire.

We evaluated the main causes of vulvar dermatoses; in 785 patients with a vulvar diseases who visited Ibn Rochd Hospital Centre, Casablanca between January 1991 and December 2002. The average age was 31 years (range 2 months to 81 years); 362 patients (41.52%) had vulvar pruritus, 273 patients (34.77%) had warts and 157 (20%) had one or more vulva ulcers. The most common infectious pathology was papillomavirus infection, found in 273 cases (34.77%), followed by vulvovaginal candidiases in 102 cases (12.99 %), syphilitic chancre in 18 cases (2.29%) and herpes genitalis in 17 cases (2.16%). The most common non-infectious pathology was vulvar dermatosis: 259 cases (32.99%); idiopathic pruritus vulvae: 61 cases (7.7%); and tumour-related conditions: 45 cases (5.6%). The frequency of infectious conditions was over 50% and these were generally sexually transmitted infections.

[Vulvar pathology]

We evaluated the main causes of vulvar dermatoses; in 785 patients with a vulvar diseases who visited Ibn Rochd Hospital Centre, Casablanca between January 1991 and December 2002. The average age was 31 years [range 2 months to 81 years]; 362 patients [41.52%] had vulvar pruritus, 273 patients [34.77%] had warts and 157 [20%] had one or more vulva ulcers. The most common infectious pathology was papillomavirus infection, found in 273 cases [34.77%], followed by vulvovaginal candidiases in 102 cases [12.99%], syphilitic chancre in 18 cases [2.29%] and herpes genitalis in 17 cases [2.16%]. The most common non-infectious pathology was vulvar dermatosis: 259 cases [32.99%]; idiopathic pruritus vulvae: 61 cases [7.7%]; and tumour-related conditions: 45 cases [5.6%]. The frequency of infectious conditions was over 50% and these were generally sexually transmitted infections

[Comparison of diagnostic criteria in Moroccan patients with Behçet's disease]. / Comparison des critères diagnostiques de la maladie de Behçet chez des malades marocains.

BACKGROUND: Behçet's disease is a vasculitis with diverse systemic manifestations usually involving the skin, eyes, joints and nerves. Clinical diagnosis is based on several signs, generally using the criteria established by the International Group for the Study of Behçet's disease, by O'Duffy, by Hamza, by Mason and Barnes and by the Japanese Committee. The purpose of this retrospective study was to assess the frequency of clinical manifestations in Behçet's disease and to apply the five diagnostic criteria scorings cited above to our patients to determine their sensitivity. PATIENTS AND METHODS: Between January 1988 and December 1997, 110 cases of Behçet's disease were seen at our Dermatology Unit in Casablanca as inpatients or outpatients. Complete history and clinical data including results of the ophthalmology exam and skin tests were available for 70 patients (29 men and 41 women, mean age 31 years). RESULTS: All 70 patients had buccal aphtosis and 88 p. 100 had genital aphtosis. Ocular signs were found in 36 p. 100 of the patients and the skin test was positive in 57 p. 100. According to the criteria of the International Group for the Study of Behçet's disease, 65 patients (93 p. 100) had Behçet's disease. For the Japanese Committee criteria there were 63 (90 p. 100), for the O'Duffy criteria 48 (68 p. 100), for Hamza criteria 45 (64 p. 100) and for Mason and Barnes criteria 35 (50 p. 100). DISCUSSION: Our series is comparable to other Mediterranean series observed in dermatology units, but our patients had fewer systemic manifestations compared with another Moroccan series reported from an internal medicine ward. This could be due to recruitment bias and different medical education. For positive diagnosis of Behçet's disease, the criteria established by the International Group for the Study of Behçet's disease, the Japanese Committee, O'Duffy and Hamza enabled the diagnosis in the majority of the cases. Fifty percent of the patients had all the criteria described in these scores. These criteria would appear to be both overly descriptive, with the risk of confounding other disease states such as enterocolopathy, or underly descriptive, making it impossible to classify certain patients as having Behçet's disease.