[Horton's disease in the course of chronic hepatitis C]. / Maladie de Horton au cours d'une hépatite C chronique.

BACKGROUND: Vascularitis is a well-known extrahepatic manifestation of chronic hepatitis C. Mixed cryoglobulinemia is the most common form. To our knowledge, the present case is the first report associating chronic hepatitis C and temporal arteritis. CASE REPORT: A 56-year-old man with chronic hepatitis C in the precirrhogenic phase presented with fever and weight loss. The patient complained of pain of the scapular and pelvic girdles and headache and physical examination revealed claudication of the jaw and abolition of the upper limb pulses. Biopsy of the temporal artery confirmed the diagnosis of Horton's disease. The patient also had bilateral stenosis of the sub-clavian arteries. DISCUSSION: This observation of Horton's disease involving large vessels in a patient with chronic hepatitis C suggests that an infectious factor might trigger vascularitis.

[Hepatitis B virus reactivation after allogeneic bone marrow transplantation in a patient previously cured of hepatitis B]. / Réactivation virale B après greffe de moelle allogénique chez un malade précédemment guéri d'une hépatite virale B.

The presence of antibodies to HBs and HBc antigens indicates previous infection with hepatitis B virus but does not necessarily reflect viral clearance. Immunosuppression such as that observed in patients with bone marrow transplantation may be responsible for viral reactivation followed by acute exacerbation after withdrawal of immunosuppressive therapy. We report a case in a patient with natural immunity to hepatitis B who had undergone allogenic bone marrow transplantation with an identical sibling donor one year before for the chronic myelogenous leukemia in the first chronic phase. Ganciclovir treatment resulted in control of hepatitis virus B replication and in biochemical remission. We suggest that prevention relies on serological evaluation and therapy with active or passive immunisation or antiviral drugs in case of a rapid decline of anti-HBs Ab titers to undetectable levels.

[Primary chronic ulcerative jejunoileitis complicated by hemophagocytic syndrome]. / Jéjuno-iléite ulcérée chronique primitive compliquée d'un syndrome hémophagocytaire.

An observation of chronic ulcerative ileo-jejunitis associated with a hemophagocytic syndrome leading to death is described. It was not associated with coeliac disease. The hemophagocytic syndrome had no other etiology than chronic ulcerative ileo-jejunitis. The relations between these two disorders are discussed.

[Angina-like chest pain and exertional esophageal ph monitoring]. / Douleurs thoraciques pseudo-angineuses et pH-métrie oesophagienne d'effort.

OBJECTIVES: Spontaneous chest pain attacks are uncommon during 24-hour esophageal pH monitoring in patients suffering from angina-like chest pain suspected to be acid-related. The aim of this study was to assess the diagnostic value of exertional esophageal pH monitoring and to prove that exercise testing induces chest pain and gastro-esophageal reflux and therefore improves symptomatic correlation study. METHODS: Forty three patients suffering from angina-like chest pain underwent treadmill exercise testing during a 24-hour esophageal pH monitoring. Symptom analysis was made using the symptom-association probability described by Weusten. RESULTS: During the 24-hour pH monitoring, 10 patients (23%) had a pathologic esophageal acid exposure, 20 (46%) experienced chest pain and 3 (7%) had a symptom association probability > 95%. During the exercise testing on a treadmill, 19 patients (44%) had gastro-esophageal reflux, and 14 (32%) experienced chest pain, coinciding with a gastro-esophageal reflux in 8 (19%). After exercise testing, the symptom-association probability analysis was significantly changed in 9 patients (21%), > 95% in 6 patients (14%). CONCLUSION: Exercise testing on a treadmill induces chest pain episodes during a 24-hour esophageal pH monitoring and therefore improves symptomatic correlation study in patients suffering from angina-like chest pain.

[Abdominal tuberculosis of pseudotumor aspect]. / Tuberculose abdominale d'allure pseudo-tumorale.

BACKGROUND: Abdominal tuberculosis is rarely encountered in developed countries, representing less than 1% of all forms of tuberculosis. There has however been a revival over the last few years. CASE REPORTS: The initial diagnoses suspected in two young multiparous patients who had immigrated to France were malignant lymphoma and ovarian carcinoma. After the final diagnosis of abdominal tuberculosis was made, the clinical course rapidly improved. DISCUSSION: Any abdominal organ may be involved in this localization of tuberculosis, but symptoms are not specific and diagnosis can often be missed. Tumor-forming abdominal mass is an exceptional finding and often mimics malignancy. Clinicians should be aware of this localization, particularly in light of epidemiological features, and examine all modern diagnostic procedures.