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2.
Rev Med Interne ; 39(10): 816-819, 2018 Oct.
Article in French | MEDLINE | ID: mdl-29731191

ABSTRACT

INTRODUCTION: Adult-onset Still's Disease is a rare multisystemic inflammatory disease characterized by fever, maculo-papular erythematous rash and arthralgia. Adult-onset Still's disease is a diagnosis of exclusion. CASE REPORT: We report the case of a 33 years old man, hospitalized for fever, arthralgia and throat manifestations, leading to Adult-onset Stills's Disease diagnosis. Cardiac ultrasound revealed tricuspid vegetation. Once infectious causes were ruled out, the vegetation was related to Adult-onset Still's Disease according to Fautrel and Yamaguchi criteria. The patient was treated with systemic high doses corticosteroid and cardiac surgery. Histological examination excluded infection and neoplasia, and showed cruoric and fibrinous vegetation. CONCLUSION: Non-infectious endocarditis, with a vegetation made of cruoric and fibrinous material, is a rare complication of Adult-onset Still's disease.


Subject(s)
Endocarditis, Non-Infective/diagnosis , Still's Disease, Adult-Onset/complications , Still's Disease, Adult-Onset/diagnosis , Tricuspid Valve Insufficiency/diagnosis , Adult , Endocarditis, Non-Infective/etiology , Humans , Male , Tricuspid Valve Insufficiency/etiology
3.
Eur J Clin Microbiol Infect Dis ; 37(7): 1231-1240, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29218468

ABSTRACT

Cryptococcal meningitis (CM) is mostly seen in immunocompromised patients, particularly human immunodeficiency virus (HIV)-positive patients, but CM may also occur in apparently immunocompetent individuals. Outcome analyses have been performed in such patients but, due to the high prevalence of HIV infection worldwide, CM patients today may be admitted to hospitals with unknown HIV status, particularly in underdeveloped countries. The objective of this multicenter study was to analyze all types of CM cases in an aggregate cohort to disclose unfavorable outcomes. We retrospectively reviewed the hospitalized CM patients from 2000 to 2015 in 26 medical centers from 11 countries. Demographics, clinical, microbiological, radiological, therapeutic data, and outcomes were included. Death, neurological sequelae, or relapse were unfavorable outcomes. Seventy (43.8%) out of 160 study cases were identified as unfavorable and 104 (65%) were HIV infected. On multivariate analysis, the higher Glasgow Coma Scale (GCS) scores (p = 0.021), cerebrospinal fluid (CSF) leukocyte counts > 20 (p = 0.038), and higher CSF glucose levels (p = 0.048) were associated with favorable outcomes. On the other hand, malignancy (p = 0.026) was associated with poor outcomes. Although all CM patients require prompt and rational fungal management, those with significant risks for poor outcomes need to be closely monitored.


Subject(s)
Antifungal Agents/therapeutic use , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/mortality , Adult , Cerebrospinal Fluid/microbiology , Comorbidity , Cryptococcus/classification , Cryptococcus/isolation & purification , Female , HIV Infections/complications , Humans , Immunocompromised Host , Male , Meningitis, Cryptococcal/diagnosis , Middle Aged , Retrospective Studies , Surveys and Questionnaires , Treatment Outcome
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