Iatrogenic Kaposi's Sarcoma: A Unique Case Unraveling Gastrointestinal Manifestations and Therapeutic Implications.

Kaposi's sarcoma (KS), linked to human herpesvirus 8 (HHV8), manifests in various clinical forms with iatrogenic KS uniquely tied to immune dysregulation induced by medical interventions. This study describes a 58-year-old male of sub-Saharan origin with a medical history of segmental and focal hyalinosis treated with methylprednisolone and mycophenolate mofetil. The patient developed skin lesions on both thighs, accompanied by post-prandial vomiting and abdominal pain. Clinical examination revealed flesh-colored nodules on the thighs and inguinal lymphadenopathy. Biopsy confirmed the diagnosis of KS, exhibiting positive nuclear labeling to anti-HHV8 and negative HIV serology. Additionally, radiological findings from the thoracic-abdominal-pelvic computed tomography (CT) scan significantly contribute to our understanding of the multiorgan involvement associated with KS in this case, providing valuable insights for diagnosis and therapeutic considerations. This case highlights the iatrogenic subtype of KS, linked to immunosuppression from prior medical interventions. Notably, gastrointestinal involvement was evident, with lesions in the stomach and small intestine. Intravenous paclitaxel administration resulted in a positive clinical response. This study underscores the importance of clinical vigilance, endoscopic evaluation, and early intervention in the nuanced diagnosis and management of iatrogenic KS.

Resurfacing Versus Non-resurfacing Patella in Total Knee Replacement: When and What to Choose.

INTRODUCTION: The opinion on the necessity of patella resurfacing has been deeply divided in the scientific community. There are three approaches to the management of the patella in total knee arthroplasty (TKA). The first method involves always resurfacing the patella, the second method involves never resurfacing it, and the third method involves resurfacing the patella only under specific circumstances. Different data support each of these strategies, but no consensus on the best management has been reached. METHODS: This is a retrospective study of 106 cases of TKA (including 29 resurfaced patellas and 77 non-resurfaced patellas), over 5 years, at the Trauma-Orthopedics Department of the Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco. Our objective is to conduct a comparative study between TKA with patella resurfacing and those without resurfacing, by analyzing the functional and radiological results obtained after the operation, to show each technique's advantages and disadvantages. RESULTS: The average age of our patients was 65 years with extremes ranging from 46 to 80 years. There was a clear female predominance with a sex ratio of 0.2. The left side was predominantly affected. Primary gonarthrosis was the main diagnosis. Our results showed no significant difference between the two groups in terms of patient satisfaction and Knee Society Score (KSS). Nevertheless, complications generated by resurfacing, such as infection, anterior pain, stiffness, and loosening of the patellar component, as well as additional costs and increased operative time, were observed. In the majority of meta-analyses, there was no discernible difference in clinical and functional results between the resurfaced and non-resurfaced groups, suggesting that patellar resurfacing is not beneficial and, therefore, unnecessary. CONCLUSION: It appears that regular resurfacing is not necessary. However, there is agreement that resurfacing the patella is the best course of action for patients with inflammatory arthropathy, considerable patella malalignment, and severe patellofemoral osteoarthritis. There are arguments in favor of each of the patella resurfacing techniques, but none of them are particularly compelling, each of these strategies has its advantages and should not be considered bad. The final decision, therefore, rests on each surgeon's practice, training, and experience.

Report of a Case of Creutzfeldt-Jakob Disease With an Unusual Quick Evolution.

Creutzfeldt-Jakob disease is a rare, transmissible neurodegenerative disorder, most prevalent between the ages of 50 and 70 years old, that is incurable and fatal. It's caused by a slow, infectious protein agent-designated prion. The most common clinical presentations are sleep disturbances, personality changes, ataxia, aphasia, visual disturbances, weakness, and myoclonus combined with progressive dementia. Here we report the case of a patient with disturbance of consciousness, restlessness, and myoclonia who died two weeks after admission. The analysis of his cerebrospinal fluid reveals that the presence of 14-3-3 protein was positive, which supports the diagnosis of Creutzfeldt-Jakob disease. Our observation underscores the importance of the quick fatality of this case.

Anti-Ri-Associated Paraneoplastic Neurological Syndrome Revealing Breast Cancer: A Case Report.

Neurological paraneoplastic syndromes are a rare entity that affects patients with cancer. Anti-Ri antibodies affect the brain stem and produce a heterogeneous rapidly progressive subacute syndrome depending on the involvement of the different regions concerned. The most common clinical presentation is opsoclonus-myoclonus syndrome and paraneoplastic cerebellar degeneration. Here we report a case of a 60-year-old woman with a subacute static-kinetic cerebellar syndrome, cervical dystonia, and multiple cranial nerve palsies revealing a mammary adenocarcinoma. Anti-Ri antibodies were positive in her blood. Our observation underscored the importance of the identification of the tumor for early treatment management to avoid irreversible neurological manifestations.

Hemiballismus Secondary to Metastatic Lung Cancer: A Case Report.

Hemiballismus is an unusual complication of brain metastasis of lung cancer. A 62-year-old woman suddenly presented with an acute movement disorder characterized by irregular, involuntary, and large-amplitude movements of the left half of her body. Brain magnetic resonance imaging (MRI) revealed metastasis in the right thalamic region. A whole-body CT scan revealed a lung tumor, while a biopsy showed small cell lung carcinoma. Vascular lesions that affect the basal ganglia, particularly the subthalamic nucleus, are the most common cause of hemiballismus. Hemiballismus is generally treated with antipsychotics such as tetrabenazine and haloperidol, but the primary treatment is the causal one. This was demonstrated in our patient since, after completion of the radio-chemotherapy sessions, the hemiballismus gradually decreased.