[Intracardiac thrombosis during celiac disease]. / Thrombose intracardiaque au cours d'une maladie cœliaque.

Thrombotic events occurring in the course of celiac disease are frequently reported in the literature. The localization is often unusual, mainly affecting the hepatic veins. To our knowledge, this is the first report of intracardiac thrombosis occurring in a patient with celiac disease. A 32-year-old patient with celiac disease adhered poorly to his gluten-free diet. He suffered an ischemic stroke revealing an intracardiac thrombus, which, on radiological imaging, simulated a multiple myxoma. Histological examination of the resected tumor enabled the correct diagnosis. Biological findings revealed severe protein C and S deficiency. The patient improved with anticoagulant therapy and gluten-free diet.

[Chronic intestinal pseudo-obstruction in systemic lupus erythematosus]. / Pseudo-obstruction intestinale au cours du lupus érythémateux systémique.

Intestinal pseudo-obstruction (IPO) is an uncommon and severe complication of systemic lupus erythematosus (SLE). We report a 24-year-old female with a 2 year SLE duration who presented with abdominal pain, vomiting, constipation and abdominal distention. Plain abdominal radiograph showed multiple air-fluid levels of the small bowel. Computed tomographic scan of the abdomen revealed dilated small bowel loops without mechanical obstruction. Urinary tract involvement was also demonstrated. IPO was diagnosed and the patient responded well to immunosuppressive treatment. IPO is a recently recognized manifestation of SLE that may be the presenting manifestation of the systemic disease or occur more commonly during disease course. Early recognition of IPO is necessary to institute appropriate medical treatment and to avoid inappropriate surgical intervention.

[Takayasu's disease in central Tunisia: 27 cases]. / La maladie de Takayasu dans la région centre de la Tunisie. A propos de 27 cas.

BACKGROUND: Takayasu's arteritis is a rare inflammatory disease and few data are available in Tunisia. The aim of this study is to evaluate clinical and radiological features of the disease in the centre of Tunisia. METHODS: We retrospectively studied medical records of patients treated in departments of internal medicine or cardiology from three university hospitals in Sousse and Monastir over the period 1985-2005. The criteria for inclusion were those proposed by the American College of Rheumatology. RESULTS: Twenty-seven patients were identified. The mean age at presentation was 33.2 years (range 16-68 years) and 88.9% were female. The mean delay from the onset of the symptoms to the time of diagnosis was 4.2 years. Intermittent claudication was the most common presentation (81.5%) and hypertension was noted in 40.7% of cases. Arterial localization most frequently involved was subclavian artery. The aorta was involved in 52.3% and renal arteries in 36.3% of cases. Stenosis or occlusions was constant but aneurysms were noted in 7.4%. Functional difficulty was the main complaint in the follow-up, death related to Takayasu's disease was noted in 3.7%. The mean follow-up time was 75.8 months (6.3 years). CONCLUSION: There is no epidemiologic particularity of Takayasu's disease in Tunisia, however involvement of the subclavian artery was more frequent than the aortic localization.

Actinomycose abdominale. A propos de quatre cas

L'actinomycose abdominale (AA) est une maladie chronique suppurative; rare et souvent meconnue. Elle est due a une bacterie anaerobie Gram positif ; Actinomyces sp. le plus souvent Israelii. L'actinomycose abdominale est responsable dans la plupart du temps d'un syndrome pseudotumoral conduisant; dans le doute d'une neoplasie; a une chirurgie d'exerese large et mutilante alors qu'une antibiotherapie prolongee aurait permis de guerir la maladie. C'est generalement l'examen anatomopathologique des pieces operatoires qui redresse le diagnostic. Nous rapportons 4 cas d'actinomycose abdominale dont le mode de revelation etait un syndrome eudotumoral. Le diagnostic n'a ete pose qu'en post operatoire sur les pieces d'exerese. Malgre une antibiotherapie de plusieurs mois; deux de nos patientes ont eu une recidive de leur actinomycose. Ces 4 observations confirment ainsi les difficultes diagnostiques et therapeutiques deja rapportees par d'autres auteurs

[Abdominal actinomycosis: four cases]. / Actinomycose abdominale: à propos de quatre cas.

The abdominal actinomycosis (AA) is a rare and often unrecognised suppurative chronic illness. It is caused by an anaerobic Gram positive bacteria, Actinomyces israelii. Abdominal actinomycosis is responsible for pseudotumoral syndrome often leading, to a large and mutilating surgery whereas a prolonged treatment by antibiotics would have permitted to cure the disease. The diagnosis is obtained generally from anatomopathologic exam. We report four cases of abdominal actinomycosis being revealed by a pseudotumoral syndrome. The diagnosis was only made after surgery. In spite of an active treatment by antibiotics during several months, two of our patients had a relapse of the infectious process. These four observations confirm the diagnostic and therapeutic difficulties previously reported by other authors.