[Meningitis and interferon-alpha in the cereprospinal fluid. What diagnostic and therapeutic approach? A case report]. / Méningite et présence d'interféron alpha dans le liquide céphalorachidien. Quelle attitude diagnostique et thérapeutique? A propos d'un cas.

BACKGROUND: In meningitis without germs, the existence of an inflammatory syndrome leads toward a bacterial etiology while the detection of interferon-alpha (IFN-alpha) in the cerebrospinal fluid (CSF) argues for a viral meningitis. The coexistence of the inflammatory syndrome and the presence of IFN-alpha in the CSF makes this differentiation difficult. The reported case yields the picture and begs the question on the diagnostic approach and the required therapeutic attitude. CASE REPORT: A six-week-old infant, exclusively breast-fed, was hospitalized for fever. The examination showed an important inflammatory syndrome and meningeal attempt with a cellularity at 94/mm3 with 53% polymorphonuclear neutrophils, contrasting with normal proteinorrhachia and glycorrhachia. The IFN-alpha in the CSF was present at 4 UI/mL while the bacteriological culture and the viral search by PCR were negative. The clinical and biological worsening within the first 36 hours, in spite of the parenteral dispensation of a triple antibiotic therapy (amoxicillin, ceftriaxone, netilmicin), then a favorable clinical and biological response after adjunction of vancomycin, led toward a pneumococcal meningitis with reduced sensitivity to beta-lactams. The maternal antibiotic therapy by amoxicillin and its presence in the maternal milk favored the hypothesis of a decapitated bacterial meningitis. CONCLUSION: In the presence of a meningitis without germs, the coexistence of a sizable inflammatory syndrome and the detection of IFN-alpha in the CSF must be considered as an unusual phenomenon and motivate the pursuit of antibiotic therapy until viral identification.

[Acute necrosis of the thoracic esophagus and ileum complicating rheumatoid purpura]. / Necrose aigue de l'oesophage thoracique et de l'ileon au cours d'un purpura rhumatoide.

A child is described who developed acute ischaemic necrosis of the oesophagus complicating an otherwise typical case of anaphylactoid purpura. This episode was preceded by a necrotising ileitis requiring intestinal resection and ileostomy. The histological similarities of the lesions in the oesophagus and the ileum suggest a common cause connected with the anaphylactoid purpura.

[Ischaemic stenosis of the ureter during Henoch-Shoenlein purpura (author's transl)]. / Sténose ischémique de l'uretère au cours d'un purpura rhumatoïde.

Involvement of the ureters (rigid and segmented) and bladder was seen in a 6-year-old child whose clinical lesions were typical of Henoch-Schoenlein purpura. Infrapelvic left uretic stenosis developed secondarily whilst the other lesions disappeared. Histological study and in particular cutaneous and renal immunofluorescence made it possible to eliminate the possible diagnosis of polyarteritis nodosa, and to confirm that of Henoch-Schoenlein purpura. An ischaemic vasculitis was the cause of the ureteric and bladder lesions, and of the progression to stenosis. The existence of this possibility should lead to routine examination to detect such lesions. Sequential radiological studies are necessary whenever such lesions are recognised.

[Dumping syndrome, a serious complication of Nissen's opération a report of four cases (author's transl)]. / Une complication grave de l'opération de Nissen: le dumping-syndrome. A propos de 4 observations.

A rare complication of Nissen's operation is described on the basis of four cases. Appearing secondarily, its Clinical signs are hyperperistaltic diarrhea, without bacterial infection and a fall or levelling of the weight curve. Its constant features are:--acceleration of intestinal transit and principally of gastric evacuation;--a characteristic modification of glucose absorption and of the curve of the oral glucose tolerance test compared with the normal intravenous glucose tolerance test. Overload of dissacharides in the intestine and hypervagotony could explain the symptomatology, which responds with difficulty and sometimes only partially to a diet excluding rapidly absorbed surgars. This complication supervenes often in babies operated on at less than six months, and is an indication for post ponement of operation.