Successful treatment of massive ascites due to lupus peritonitis with hydroxychloroquine in old- onset lupus erythematosus.

Systemic lupus erythematous (SLE) is an auto-immune disease with multiple organ involvements that occurs mainly in young women. Literature data suggest that serositis is more frequent in late-onset SLE. However, peritoneal serositis with massive ascites is an extremely rare manifestation. We report a case of old-onset lupus peritonitis treated successfully by Hydroxychloroquine. A 77-year-old Tunisian woman was hospitalized because of massive painful ascites. Her family history did not include any autoimmune disease. She was explored 4 years prior to admission for exudative pleuritis of the right lung without any established diagnosis. Physical examination showed only massive ascites. Laboratory investigations showed leucopenia: 3100/mm3, lymphopenia: 840/mm3 and trace protein (0.03 g/24 h). Ascitic fluid contained 170 cells mm(3) (67% lymphocytes), 46 g/L protein, but no malignant cells. The main etiologies of exudative ascites were excluded. She had markedly elevated anti-nuclear antibody (ANA) titer of 1/1600 and a significantly elevated titer of antibody to double-stranded DNA (83 IU/mL) with hypo-complementemia (C3 levl was at 67 mg/dL). Antibody against the Smith antigen was also positive. Relying on these findings, the patient was diagnosed with SLE and treated with Hydroxychloroquine 200 mg daily in combination with diuretics. One month later, there was no detectable ascitic fluid and no pleural effusions. Five months later she remained free from symptoms while continuing to take chloroquine. This case was characterized by old age of onset of SLE, the extremely rare initial presentation with lupus peritonitis and massive painful ascites with dramatic response to only hydroxychloroquine treatment.

[Evaluation of the renal function in type 2 diabetes: clearance calculation or cystatin C?]. / Évaluation de la fonction rénale chez le diabétique de type 2 : calcul des clairances ou cystatine C ?

Screening for diabetic nephropathy is usually done by albuminuria/24h and the use of creatinine clearance. The objective of this study was to evaluate the renal function in Type 2 diabetes by using different formulas of creatinine clearance and to assess the contribution of cystatin C; 83 adults with type 2 diabetes (23 men and 60 women) and 83 adult controls (40 men and 43 women) were studied. Biochemical parameters were determinated on Coba 6000™ (Roche diagnostics). Diabetics showed a significant increase in blood glucose, cholesterol, triglycerides, LDLc, the ApoB, Lp(a), urea, uric acid, creatinine and cystatin C and lower HDLc. Cystatin was increased in patients with degenerative complications and in hypertensive patients. We found strong correlations of cystatin C with creatinine (r = 0.9454), urea (r = 0.8999) and uric acid (r = 0.8325). We found a significant exponentially increase of creatinine and cystatin C from one stage to another. Cystatin C has a strong association with MDRD (r = 0.8086) and CG (r = 0.7915) and a low one with creatinine clearance (r = 0.1044). In conclusion, the use of cystatin C for screening and early treatment of incipient diabetic nephropathy appears to be adequate. CG and MDRD formulas still hold their place, in regards to the classical determination of creatinine clearance, to monitor patients.

Graves' disease associated with cerebrovascular disease and antiphospholipid antibody syndrome.

Thyroid disorders are commonly associated with coagulopathy. Patients with hyperthyroidism have increased risk for developing thromboembolic accidents, which are favoured by a simultaneous presence of antiphospholipid antibodies syndrome. in this paper, we describe the case of a patient with Graves' disease, who developed strokes with antiphospholipid antibodies syndrome.

HLA-B27 and HLA-B51 determination in Tunisian healthy subjects and patients with suspected ankylosing spondylitis and Behçet's disease.

The aim of this retrospective study is to assess the frequency of HLA-B27 and HLA-B51 in healthy subjects from the center of Tunisia and to investigate their usefulness in the diagnosis of ankylosing spondylitis (AS) and Behçet's disease (BD), respectively. Microlymphocytotoxicity test was used to perform serologic HLA typing in a group of 124 healthy volunteers and a group of 365 patients suffering from clinical manifestations of AS and/or BD. HLA-B27 was found in 3.2% of healthy subjects and in 42.9% of patients with AS (P < 0.00006). HLA-B51 is, however, found in 16.1% of healthy subjects and in 30.0% of patients with BD (P > 0.05). Unlike HLA-B51, which seems to be as frequent in Tunisian patients with BD as in healthy subjects, HLA-B27 is more frequent in patients with AS than in controls. This highlights the usefulness of HLA-B27, rather than that of HLA-B51, in the diagnosis of the respective diseases.

[Ischemic colitis as a first sign of primary antiphospholipid antibody syndrome. A case report]. / Colite ischémique révélant un syndrome des anti-phospholipides primitif. A propos d'un cas.

BACKGROUND: The primitif antiphospholpid antibody syndrome is a clinico-biologic entity characterized by the artério-venous thromboses and the presence of circulating antibodies against membranous phospholipids. The systemic demonstrations and in particular ulcerated and ischemic colitises are brought back unusually during this affection. AIM: Report a new case. CASE REPORT: We bring back one observations of ischemic colitis complicated of perforation revealing a primitif antiphospholpid antibody syndrome at a male patient aged of 45 and requiring the surgical intervention. CONCLUSION: This observation recall an exceptional étiology but often unrecognized of ischemic colitises.

[The Budd-Chiari syndrome and Buerger's disease: a case report]. / Syndrome de Budd-Chiari et maladie de Buerger: à propos d'un cas.

BACKGROUND: Buerger's disease is an inflammatory non atheromatous distal arteriopathy affecting mainly young male smokers. There is some controversy about the existence of visceral localisations of the disease. AIM: Report a new case. OBSERVATION: We report the case of a 40-years-old man who developed a Budd Chiari syndrome with thromboses of the right hepatic venous. Later, he presented with rheumatic and distal occlusive arterial manifestations diagnosed as Buerger's disease. CONCLUSION: We underline the fact that digestive manifestations and hepatic involvement are less known and sometimes misdiagnosed.

Association between apolipoprotein E polymorphism, lipids, and coronary artery disease in Tunisian type 2 diabetes.

BACKGROUND: The relationship between apolipoprotein E (ApoE) polymorphism, fasting lipid parameters, and coronary artery disease (CAD) is controversial. METHODS: We studied this relationship, for the first time, in Tunisian type 2 diabetic patients. The studied population comprised 157 type 2 diabetic patients (145 of them were not on any lipid-lowering drugs). Fasting lipids were measured by enzymatic methods and ApoE genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: Our results showed that the alleles E2, E3, and E4 were found in 4%, 88%, and 8% of patients, respectively. In the total type 2 diabetic population, no association was found between ApoE polymorphism, lipid parameters, and CAD. However, the E4 allele was associated with elevated low-density lipoprotein cholesterol concentration and with CAD in type 2 diabetic men. CONCLUSION: The effect of ApoE polymorphism on CAD is gender-dependent in the Tunisian type 2 diabetic population. ApoE 4 allele may enhance atherogenesis indirectly by a strong effect on low-density lipoprotein cholesterol.

Relationship between thiolactonase activity and hyperhomocysteinemia according to MTHFR gene polymorphism in Tunisian Behçet's disease patients.

BACKGROUND: Behçet's disease (BD) is a multisystemic immuno-inflammatory disorder. Inflammatory processes may cause lipid peroxidation, alteration of lipid profile and increase the risk of atherosclerosis. The aim of this study was to evaluate the association between thiolactonase (HTLase) activity and plasma homocysteine levels (tHcy) in a BD population and to investigate their association with methylenetetrahydrofolate reductase (MTHFR) 677C-->T genotype. METHOD: A total of 35 BD patients were compared to 39 healthy volunteers. RESULTS: Significantly higher tHcy levels associated with lower HTLase activities were found in BD patients as compared to healthy controls (p<0.001). These patients also exhibited lower values of triglycerides and high-density lipoprotein cholesterol (HDL-C). Homozygosity for the T allele of the MTHFR gene was more frequent in BD patients (14.3% vs. 7.7%). It was associated with significantly higher tHcy levels (16.9 micromol/L for n=17 vs. 13.1 micromol/L for n=18; p<0.05) and markedly lower HTLase activity (362.6+/-156.7 U/L vs. 414.2+/-180.2 U/L) for the (TT+CT) and CC genotypes, respectively. Moreover, HDL-C levels were inversely correlated with tHcy (r=-0.5; p=0.004) but positively associated with HTLase activity (r=0.374; p=0.038). These correlations were also present in several clinical manifestations, such as ocular, neurological involvement or thrombosis. CONCLUSIONS: Homozygosity of the T allele of the MTHFR gene is prevalent in BD patients. High levels of tHcy associated with low HTLase activities may be one of the causes leading to thrombosis in BD patients.

Orbital inflammation associated with Behçet's disease.

Herein a case of a 35-year-old woman with a history of Behçet's disease, who presented with swelling and redness of her right eye with increasing pain, is reported. Computed tomography and magnetic resonance imaging showed enlargement of the right lacrimal gland and contrast enhancement of the extraocular muscles. A diagnosis of orbital inflammation was made and the patient was treated with corticosteroids, with prompt resolution of symptoms and clinical signs. Orbital inflammation should be considered as an ophthalmic manifestation of Behçet's disease.

[Cardiac amyloidosis revealing multiple myeloma]. / Amylose cardiaque révélatrice d'un myélome multiple.

INTRODUCTION: Amyloidosis is a rare disease characterized by an extracellular accumulation of a protein polysaccharid complex (Amyloid). Cardiac involvement is considered as a major prognostic factor. OBSERVATIONS: We report the case of two women, hospitalized for heart failure. The diagnosis of cardiac amyloidosis was suggested by echocardiography: Left ventricular concentric hypertrophy and typical amyeloid infiltration with hyperechoic, shiny and granite-like aspect of the interventricular septum. The histological confirmation was obtained by gastric biopsy in the first case and biopsy of the salivary glands in the second revealing an amyloidosis AL. This cardiac amyloidosis was secondary to multiple myeloma: monoclonal Gammopathy with immunoglobulin Lambda in the first and Kappa in the second, and the presence of a plasmocyte infiltration in the sternal puncture. CONCLUSION: Amyloidosis is a rare pathology, the cardiac involvement is frequent in the type AL and can occur with or without clinical manifestations. Echocardiography should be systematic in patients with confirmed amyloidosis.

Association of SNP3 polymorphism in the apolipoprotein A-V gene with plasma triglyceride level in Tunisian type 2 diabetes.

BACKGROUND: Apolipoprotein A-V (Apo A-V) gene has recently been identified as a new apolipoprotein involved in triglyceride metabolism. A single nucleotide polymorphism (SNP3) located in the gene promoter (-1131) was associated with triglyceride variation in healthy subjects. In type 2 diabetes the triglyceride level increased compared to healthy subjects. Hypertriglyceridemia is a risk factor for coronary artery disease. We aimed to examine the interaction between SNP3 and lipid profile and coronary artery disease (CAD) in Tunisian type 2 diabetic patients. RESULTS: The genotype frequencies of T/T, T/C and C/C were 0.74, 0.23 and 0.03 respectively in non diabetic subjects, 0.71, 0.25 and 0.04 respectively in type 2 diabetic patients. Triglyceride level was higher in heterozygous genotype (-1131 T/C) of apo A-V (p = 0.024). Heterozygous genotype is more frequent in high triglyceride group (40.9%) than in low triglyceride group (18.8%); p = 0.011. Despite the relation between CAD and hypertriglyceridemia the SNP 3 was not associated with CAD. CONCLUSION: In type 2 diabetic patients SNP3 is associated with triglyceride level, however there was no association between SNP3 and coronary artery disease.

[Role of cholesteryl ester transfer protein activity and genetic polymorphism in ischemic heart disease in type 2 diabetic patients]. / Rôle de l'activité et du polymorphisme génétique de la protéine de transfert des esters de cholestérol (CETP) dans les cardiopathies ischémiques chez les diabétiques type 2.

Cholesteryl Ester Transfer Protein (CETP) facilates the exchange of triglycerides (TG) and cholesteryl ester between lipoproteins particles. Diabetic subjects have been reported to have higher TG levels and lower high density lipoprotein-cholesterol (HDL-C) levels which contribute to the increased cardiovascular risk observed in some of these patients. The CETP activity was shown to be more important in a group of 93 non insulino-dependant diabetics with coronary artery disease than in a group of 92 healthy subjects (p = 0.033). Several polymorphisms have been reported in the CETP gene. The common Taq IB polymorphism is associated with decreased CETP activity and increased HDL-C. We have observed a frequency of 0.31 for B2 allele in deference to those reported in subjects from Caucasian population. An association between the presence of the B2B2 genotype, decreased CETP activity and increased of plasma HDL-C was observed in healthy subjects but not in diabetics with coronary artery disease.

Antioxidant effects of zinc supplementation in Tunisians with type 2 diabetes mellitus.

OBJECTIVE: To determine the effects of zinc (Zn) supplementation on oxidative stress in persons with type 2 diabetes mellitus (type 2 DM). DESIGN: Tunisian adult subjects with HbA1c >7.5% were supplemented for six months with 30 mg/day of Zn as Zn gluconate or placebo. The effects of supplementation on plasma zinc (Zn), copper (Cu), urinary Zn, plasma thiobarbituric acid reactive substances (TBARS), Cu-Zn superoxide dismutase (SOD) and glutathione peroxidase activities (GPX) in red blood cells, blood lipids and lipoproteins, HbA1c and fasting glucose were measured at the beginning of the study and after three and six months. RESULTS: At the beginning of the study, more than 30% of the subjects exhibited plasma Zn values less than the normal minimum of 10.7 micro mol/L, whereas levels of plasma Cu and antioxidant RBC Cu-Zn SOD and GPx enzyme activities were in the normal ranges. Oxidative stress, monitored by plasma TBARS, was increased in individuals with diabetes compared with healthy Tunisian subjects (3.32 +/- 0.05 micro mol/L vs. 2.08 +/- 0.04 micro mol/L) and an inverse correlation was found between Zn plasma levels and plasma TBARS. After three and six months of Zn supplementation, all of the subjects exhibited plasma Zn values greater than 10.7 micro mol/L. There was a decrease of plasma TBARS in Zn supplemented group after six months (15%) with no significant changes in the placebo group. Supplementation did not alter significantly HbA1c nor glucose homeostasis. No adverse effects of Zn supplementation were observed on Cu status or HDL cholesterol. CONCLUSIONS: These data suggest the potential beneficial antioxidant effects of Zn supplementation in persons with type 2 DM. These results are particularly important in light of the deleterious consequences of oxidative stress in persons with diabetes.