[Legionella myopericarditis]. / Myopéricardite à Legionella.

Cardiac involvement in legionella infection is rare but it is the most common extra-pulmonary complication. It usually takes the form of pericarditis, but a case of legionella myoparicarditis with global left ventricular hypokinesia on echocardiography has been described. The authors report a case of myopericarditis with massive pulmonary oedema and respiratory distress which regressed clinically and on echocardiography with reduction in chamber dilatation and complete recovery of left ventricular function. Legionellosis was confirmed on serology. The infection was probably contracted during a previous hospital admission, therefore, probably a nosocomial infection. Following the description of this case, a review of the literature is proposed.

[Anaphylactic reaction with coronary spasm following coronarography]. / Réaction anaphylactique avec spasme coronarien. Au décours d'une coronarographie.

The authors report a case of anaphylactic shock following the injection of iodinated contrast medium for coronary angiography and complicated by two spasms affecting segments II and III of the right coronary. Vasospasm was relieved by the injection of linsidomine, revealing an angiographically healthy segment III. Such complications associated with various substances, notably iodinated contrast media, are rare. They should nevertheless always be borne in mind when evaluating anaphylactic type reactions. Vasoactive mediators (histamine, serotonin, arachidonic acid metabolites) released by the allergic reaction appear to play a major role. Treatment based upon pathogenesis can be proposed.

[Encephalopathy and memory disorders during treatments with mefloquine]. / Encéphalopathie et troubles mnésiques au cours des traitements par la méfloquine.

Benign psychiatric side effects have been frequently associated with mefloquine therapy. On the other hand, severe psychiatric disorders due to mefloquine are rare but must be detected by physicians. Two such cases are reported. In the first case, excessive curative mefloquine therapy caused an acute psychotic state which ultimately regress without treatment. The second report concerns a transient memory failure following prophylactic mefloquine treatment. The causative role of this compound is being discussed and the importance of a differential diagnosis of neuropsychiatric disorders from toxic or parasitic origin is underlined. Circumstances aggravating such neuropsychiatric side effects and actual recommendations concerning the prescription of mefloquine are recalled.

[Hepatic involvement in the course of ovarian hyperstimulation syndrome]. / Atteinte hépatique au cours d'un syndrome d'hyperstimulation ovarienne.

The authors report the case of hepatic damage with a favorable outcome, occurring during severe ovarian stimulation which had anatomico-clinical features which distinguished it from the three cases previously reported due to its exclusively cytolytic nature and the histological lesions produced. The physiopathological mechanisms involved are discussed.

Renal complications of intravesical bacillus Calmette-Guérin therapy.

We report 3 patients who developed signs of systemic infection and renal insufficiency after intravesical bacillus Calmette-Guérin (BCG) instillations for a bladder cancer. Renal biopsy showed tubulo-interstitial nephritis with or without epithelioid granulomas in 2 cases, and mesangial glomerulonephritis in the last case. All patients had granulomatous hepatitis in association. It seems that hematogenous dissemination via a traumatic instillation of BCG and/or an immune-complex mechanism may have contributed to the renal damage, which was only partially reversible in 2 patients.

[Acute respiratory distress syndrome caused by tuberculosis]. / Syndrome de détresse respiratoire aiguë d'origine tuberculeuse.

The adult respiratory distress syndrome (ARDS) is rarely due to tuberculosis. Two new cases are reported here. Both were female patients, aged 33 and 41 years. The first, of North African origin, was admitted for epigastralgia, hyperpyrexia and intestinal problems. She underwent an exploratory laparotomy, which only showed oedematous mesenteries. Hepatic and lymph node biopsies revealed an ongoing tuberculosis. On the 4th postoperative day, she developed ARDS. Despite an initial period of improvement after proper treatment (antituberculous drugs, steroids, positive pressure ventilation) had been started, she died 27 days later. In the other patient, smoker and alcoholic, the diagnosis of tuberculosis relied only on bacterial culture of various excretions. She also died after 8 days of treatment. In both patients, the symptoms were atypical. The febrile non cardiogenic pulmonary oedema of sudden onset masked the typical miliary mottling pattern on chest X-rays. The life-threatening character of this condition requires that rapid histological studies are carried out to obtain an early diagnosis. Indeed, the precociousness of appropriate treatment seems to be the essential element of the prognosis.

[Primary ulcerations of the small intestine]. / Les ulcères primitifs du grêle.

The authors report a recent case of primary ulceration of the small intestine revealed by spontaneous perforation. This is a rare condition with a non specific semiology which only exceptionally permits diagnosis before complications occur. The latter are dominated by perforation, gastrointestinal hemorrhage and a sub-acute obstructive syndrome. The lesion, generally single, is found on the anti-mesenteric border of the jejunum or terminal ileum on a short only slightly inflammed segment and pathological examination does not reveal any specific process. Treatment is surgical. It confirms the diagnosis and enables a segmentary resection or simple suture to be carried out. The condition does not recur. A complete etiological investigation is required to exclude other causes of small intestinal ulceration before its "spontaneous" nature may be inferred. Infectious and vascular theories are most often proposed among the pathophysiological hypotheses. Far from being exclusive, these theories may interact and enable a coherent multi-factorial mechanism to be proposed as to the origin of the ulceration (regardless of its initial cause). Spontaneous ulcers are therefore included in a wider nosological classification ranging from stress ulcer to necrosing enteritis.

[Multiple sclerosis disclosed by spinal anesthesia]. / Sclérose en plaques révélée par une rachianesthésie.

A case is reported of an acute onset of previously undiagnosed multiple sclerosis, revealed by an oculomotor paralysis following spinal anaesthesia performed for minor orthopaedic surgery. The need for a complete preoperative physical examination is underlined by this case, looking for latent neuromuscular disorders before undertaking such techniques, and for a thorough neurological work-up should such a complication arise. The harmlessness of regional anaesthesia in multiple sclerosis patients is controversial; without entering into such a debate, the direct relationship between spinal anaesthesia and acute exacerbation of the disease in our patient seemed more than likely.

[Polyradiculoneuritis and pregnancy. Apropos of 1 case]. / Polyradiculonévrite et grossesse. A propos d'une observation.

The authors report a case of severe Guillain-Barre syndrome that appeared during the eighteenth week of a second gestation which evolved to full term without complication. The particularity of this observation was that the follow-up of the foetus was made possible for the first time by echography which showed normal active foetal movements even during maximum maternal paralysis. From of review of thirty three cases recorded in the literature, it seems clear that the interrelationship between the neurological disorder and pregnancy is nil or minimal beside an increased risk of prematurity childbirth can proceed normally and cesarean section is not indicated. Plasmapheresis proposed as an early treatment is discussed in the case of pregnant women. Today pregnancy is no longer a particular contraindication of such management.