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2.
Rev Med Interne ; 19(8): 542-7, 1998 Aug.
Article in French | MEDLINE | ID: mdl-9775069

ABSTRACT

INTRODUCTION: RS3PE syndrome (remittive symmetrical seronegative synovitis with pitting edema) was first described by MacCarthy in 1985. It is a rare type of seronegative polyarthritis occurring in the elderly. METHODS: Retrospective report of 13 cases (including eight male and five female patients; mean age 76.7 +/- 3.7 years) and search for previously reported cases, using the Medline database. RESULTS: Pitting edema was present at onset of disease in nine cases. Joint arthritis was bilateral, occurring in the wrist (13 cases), shoulder (six cases), elbow (six cases), knee (six cases), ankle (four cases), metacarpophalangeal (four cases) and hip (one case). Radiographies were normal. Mean erythrocyte sedimentation rate was 62 +/- 19 mm at the first hour and mean C-reactive protein level was 73 +/- 35 mg/L. Mild cholestasis was present in four of the seven patients for whom data were available. HLA B7 was present in five out of 12 cases (42%). Improvement was favorable, occurring over 7 months. Mean follow-up was 22.2 months. Fifty-nine other cases have been described in the literature. This syndrome, which affects the elderly, appears to be rare. Its clinical presentation is quite constant, with sudden onset, symmetrical polyarthritis and pitting edema. Its evolution, often long, is favorable. Rheumatoid arthritis and polymyalgia rheumatica are the main differential diagnoses. CONCLUSION: Due to its favorable outcome and the usefulness of a mild corticotherapy, this syndrome, though rare, should be diagnosed where necessary in elderly patients.


Subject(s)
Edema/diagnosis , Synovitis/diagnosis , Aged , Aged, 80 and over , Ankle Joint/physiopathology , Anti-Inflammatory Agents/therapeutic use , Arthritis/diagnosis , Arthritis, Rheumatoid/diagnosis , Blood Sedimentation , C-Reactive Protein/analysis , Cholestasis/complications , Diagnosis, Differential , Elbow Joint/physiopathology , Female , Follow-Up Studies , Glucocorticoids/therapeutic use , HLA-B7 Antigen/analysis , Hip Joint/physiopathology , Humans , Knee Joint/physiopathology , Male , Metacarpophalangeal Joint/physiopathology , Polymyalgia Rheumatica/diagnosis , Prednisone/therapeutic use , Prognosis , Retrospective Studies , Shoulder Joint/physiopathology , Wrist Joint/physiopathology
4.
Rev Med Interne ; 18(12): 939-44, 1997.
Article in French | MEDLINE | ID: mdl-9499997

ABSTRACT

Seventy-two cases of primary Sjögren's syndrome, according to the European classification criteria, were studied looking for a correlation between anatomic criteria and clinico-biological signs in this disease. Labial salivary gland biopsy was performed in all patients and anatomic criteria were evaluated according to both Chisholm and Chomette scales. Work-up included recording of functional and clinical signs. Our study shows no clinico-histological correlation in Sjögren's syndrome. Moreover, we did not find any correlation between the two histological scales. We think, therefore, that labial salivary gland biopsy appears to be an important step in Sjögren's syndrome diagnosis according to European criteria. However, it does not present any benefit in patient treatment.


Subject(s)
Sjogren's Syndrome/pathology , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Salivary Glands, Minor/pathology , Sensitivity and Specificity , Sjogren's Syndrome/classification , Sjogren's Syndrome/physiopathology
5.
Rev Rhum Engl Ed ; 64(12): 849-51, 1997 Dec.
Article in English | MEDLINE | ID: mdl-9476277

ABSTRACT

Systemic lupus erythematosus is uncommon in elderly individuals. A 72-year-old woman developed parvovirus B19 infection followed by a systemic lupus erythematosus-like syndrome with persistent thrombocytopenia and Raynanud's phenomenon. Few cases of systemic lupus erythematosus after parvovirus B19 infection have been reported, and none had thrombocytopenia.


Subject(s)
Lupus Erythematosus, Systemic/etiology , Parvoviridae Infections/complications , Parvovirus B19, Human , Aged , Female , Humans , Thrombocytopenia/etiology
6.
Eur J Clin Microbiol Infect Dis ; 15(12): 943-7, 1996 Dec.
Article in English | MEDLINE | ID: mdl-9031879

ABSTRACT

A case of disseminated infection due to Nocardia nova with subcutaneous popliteal and retrosternal abscesses and lung involvement in an immunocompromised patient is reported. The patient did not respond to sulfonamide therapy. Clinical recovery was obtained upon treatment with imipenem then clarithromycin. Western blot studies revealed an antibody response to a known Nocardia-specific 55-kDa antigen in four successive sera samples collected in the period from the time of admission to seven months later. The resolution of the disseminated nocardiosis and efficacy of the clarithromycin treatment were assessed on the basis of disappearance of the antibodies to the 55-kDa antigen, without invasive sampling.


Subject(s)
Blotting, Western/methods , Nocardia Infections/complications , Nocardia Infections/diagnosis , Nocardia/immunology , Anti-Bacterial Agents/therapeutic use , Antigens, Bacterial/isolation & purification , Clarithromycin/therapeutic use , Drug Therapy, Combination , Glucocorticoids/therapeutic use , Humans , Imipenem/therapeutic use , Immunocompromised Host , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/drug therapy , Male , Middle Aged , Nocardia Infections/drug therapy , Prednisone/therapeutic use , Thienamycins/therapeutic use
7.
Rev Med Interne ; 17(1): 21-4, 1996.
Article in French | MEDLINE | ID: mdl-8677381

ABSTRACT

Differential diagnosis between infective endocarditis and septicemia without endocarditis remains a crucial clinical difficulty. Value of immunological data during those pathologies has been evaluated in a 2 year prospective study. Sixty-one patients, admitted in an internal medicine and infectious diseases unit for a documented infectious disease, were included. They were separated in three groups: group I (n = 21): demonstrated infective endocarditis; group II (n = 19): septicemia without endocarditis and group III (n = 21): non septicemic well-defined infectious disease. Following parameters were studied: immune circulating complexes, C reactive protein, erythrocyte sedimentation rate, fibrinogen, rheumatoid factor, antinuclear antibodies, Treponema pallidum serodiagnostic and cryoglobulinemia. There were no differences between the three studied groups. In particular, immune circulating complexes were present in respectively 67%, 58% and 62% of the patients of the three groups. So, presence or absence of immunologic abnormalities does not provide help for diagnosis of endocarditis in a febrile patient.


Subject(s)
Bacteremia/immunology , Endocarditis, Bacterial/immunology , Adult , Aged , Aged, 80 and over , Antigen-Antibody Complex/analysis , Bacteremia/diagnosis , Diagnosis, Differential , Endocarditis, Bacterial/diagnosis , Female , Humans , Infections/immunology , Male , Middle Aged , Prospective Studies , Rheumatoid Factor/analysis
8.
Rev Med Interne ; 17(1): 66-9, 1996.
Article in French | MEDLINE | ID: mdl-8677387

ABSTRACT

We report the case of a 53 year-old woman with paroxystic hypertension and digital ischemia. The only triggering factor was chronic intoxication by a nasal vasoconstrictor:fenoxazoline. The worsening of the lesions required amputation of the third phalanx of the 3rd and 5th finger and the pulp of the 4th finger of the left hand. The review of literature exhibits association between fenoxazoline intoxication and paroxystic hypertension, myocardial ischemia or stroke, but association between fenoxazoline intoxication and digital ischemia has never been reported. We emphasize the extreme caution necessary with the prescription and the chronic consumption of this kind of drug.


Subject(s)
Fingers/pathology , Imidazoles/poisoning , Ischemia/chemically induced , Nasal Decongestants/poisoning , Female , Fingers/blood supply , Humans , Middle Aged , Necrosis , Toes/blood supply , Toes/pathology
9.
Rev Med Interne ; 16(9): 658-61, 1995.
Article in French | MEDLINE | ID: mdl-7481152

ABSTRACT

The aim of this study was to determine if evolution of fever after administration of indomethacin to febrile patients could separate those with fever of infectious origin from those with non-infectious origin. All patients with a rectal body temperature superior than 38 degrees C for at last 5 days and without any antibiotic or antipyretic therapy for more than 48 hours, were included in a 1 year prospective study. Each patient received one time 50 mg of indomethacin and rectal body temperature was obtained every 3 hours for 12 hours. Forty-five patients were included, 20 in group I (fever of infectious origin) and 25 in group II (fever of non-infectious origin). The mean age and mean initial body temperature were similar in the two groups. After administration of indomethacin, mean duration and mean amplitude of abatement of fever were similar in the two groups. Hypothermia was observed more frequently in group II (28%) than in group I (10%) (p < 0,05) and was preferentially associated to a malignant lymphoma. Also, diagnostic procedure with indomethacin is of little interest to separate fever of infectious origin from other, but hypothermia would suggest a fever due to a malignant lymphoma.


Subject(s)
Fever/etiology , Indomethacin , Infections/diagnosis , Lymphoma/diagnosis , Adult , Aged , Aged, 80 and over , Body Temperature , Diagnosis, Differential , Female , Fever/diagnosis , Humans , Hypothermia, Induced , Male , Middle Aged , Prospective Studies
10.
Gastroenterology ; 105(1): 272-3, 1993 Jul.
Article in English | MEDLINE | ID: mdl-8514044

ABSTRACT

Hepatic fibrin-ring granulomas were found in a 70-year-old man with prolonged fever and inflammatory syndrome. Diagnosis of giant cell arteritis was confirmed by temporal artery biopsy. Other diseases usually associated with fibrin-ring granulomas in liver, such as Q fever, cytomegalovirus hepatitis, infectious mononucleosis, Hodgkin's disease, non-Hodgkin's lymphoma, allopurinol treatment, and visceral leishmaniasis, were ruled out. This report suggests that giant cell arteritis should be considered as an additional cause of hepatic fibrin-ring granulomas.


Subject(s)
Fibrin/analysis , Giant Cell Arteritis/complications , Granuloma/etiology , Liver Diseases/etiology , Liver/pathology , Aged , Granuloma/pathology , Humans , Liver Diseases/pathology , Male
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