Vertebral metastasis of hepatocellular carcinoma secondary to viral hepatitis B: case report of 2 patients.

Bone metastases from liver cancer are rare. We report two cases of bone metastases revealing HBV-induced HCC. A 26-year-old african man presented with 4 months of low back pain in the context of general deterioration. Examination revealed a lumbar spinal syndrome and hepatomegaly. Abdominal ultrasound revealed a multinodular liver, and a CT scan of the spine revealed osteolytic lesions. Biological tests revealed a hepatic cytolysis syndrome, hepatic cholestasis and hepatocellular insufficiency. Alpha foetoprotein levels were elevated and hepatitis B serology was positive. We adopted the diagnosis of HCC of viral B origin with bone metastasis. The second case involved a 44-year-old African man admitted for 10 days with back pain. Examination revealed a spinal syndrome, paraplegia and hepatomegaly. A thoracic-abdominal-pelvic CT scan revealed typical HCC lesions and osteolytic lesions on the ribs, pelvis and vertebrae. The biology revealed a biological inflammatory syndrome, hepatic cytolysis, a hepatocellular insufficiency syndrome and a cholestasis syndrome. Alfa-feto proteins were elevated and HBV serology was positive. The diagnosis of bone metastasis of HCC secondary to HBV infection was accepted.

Myalgia-induced discovery of rhabdomyolysis complicating generalized varicella in an immunocompetent patient: Case report and review of the literature.

Key clinical message: In a rare occurrence, primary varicella infection led to rhabdomyolysis in a 24-year-old with no medical history. Presenting with rash, fever, and weakness, he developed diffuse myalgia at 72 h. Elevated muscle enzymes confirmed rhabdomyolysis secondary to varicella zoster virus (VZV) infection. Treatment with acyclovir and hydration resulted in significant improvement within a month. Abstract: Primary varicella infection is rarely complicated by rhabdomyolysis. In this study, we describe a case of rhabdomyolysis complicating a VZV infection in a black subject. The patient was a 24-year-old black African with no particular medical history and was immunocompetent. He presented with an acute onset of generalized rash, fever, and generalized weakness. Physical examination revealed vesicular lesions typical of chickenpox. Antipyretic treatment combined with acyclovir was instituted in hospital. At the 72nd hour, diffuse myalgia developed. Muscle enzyme tests revealed CPK elevated to 40 times the upper limit of normal, LDH elevated to 2 times the upper limit of normal, ASAT and ALAT elevated to 7 times the upper limit of normal, and 2.5 times the upper limit of normal, respectively. We accepted the diagnosis of rhabdomyolysis secondary to VZV infection. The patient was given saline hydration and showed clinical and biological improvement 1 month later. A patient presenting with muscular symptoms during a VZV infection should be considered for rhabdomyolysis.

Aortic dissection-Pulmonary embolism association: A therapeutic dilemma.

Aortic dissection is a rare but serious condition. Its association with pulmonary embolism is exceptional and produces a real therapeutic dilemma. We are discussing the case of a 67-year-old male patient who presented with paraplegia with infectious syndrome. The chest X-ray performed to screen for an infectious site led to the suspicion of an aortic aneurysm and the CT angiography showed Stanford type B aortic dissection associated with bilateral proximal pulmonary embolism. The treatment was symptomatic and resulted in the patient's death 48 hours after diagnosis. Management of this pathological association is not standardized between establishing anticoagulant therapy and therapeutic abstention. This management depends on the teams and has a very cautious prognosis.

Prevalence and factors associated with self-medication in rheumatology in Sub-Saharan Africa.

OBJECTIVE: We sought to determine the prevalence of and factors associated with self-medication in patients with rheumatic diseases. MATERIAL AND METHODS: An analytical cross-sectional study was conducted from February to July 2013 in the rheumatology department. We included all patients who consulted for a rheumatic disease during the study period and who gave their consent. RESULTS: In total, 203 patients were included; of these, 146 patients (71.92%) had practiced self-medication. Furthermore, 99 patients (48.8%) had practiced self-medication for rheumatologic problems. The mean age of the patients was 45.5 years (range: 18-75 years). State officials accounted for 44.4% of patients. Eighty-one patients were schooled. Low back pain (29.29%) was the main reason for consultation, followed by polyarthralgia (12.12%). Using a visual analogue scale, the level of pain for which patients had used self-medication was rated as >70 out of 100 in 57.6% of patients. Fifty-five patients often self-medicated and 28 patients rarely. Drugs were bought from the pharmacy in 97% of cases. The main channel of self-medication was word of mouth (43.4%). The drugs used were mainly anti-inflammatory drugs (diclofenac: 54.54% and ibuprofen: 57.57%). Ten patients were unaware of the risks of self-medication. In multivariate analysis, sex, education level, and occupation were statistically associated with self-medication. CONCLUSION: Self-medication for a specific rheumatologic symptom appears less common than self-medication in general. The procedures for responsible self-medication should be defined in Burkina Faso in order to minimize the risks.