[Severe hepatitis with hypogammaglobulinaemia IgA of non-alcoholic origin]. / Le cas clinique du mois - Hépatite sévère avec hypergamma-globulinémie à IgA d'origine non alcoolique.

This clinical case describes a severe liver insufficiency associated with an IgA hypergammaglobulinaemia. The search for an etiology excluded all classical causes of hepatopathy and led to the diagnosis of celiac disease. Liver impairment improved with a gluten-free diet. This observation emphasizes the need for a careful etiological diagnosis of any hepatopathy; this may result in the discovery of a potentially reversible cause amenable to a simple therapeutic strategy.

Ce cas clinique décrit une hépatopathie sévère avec présence d'une hypergammaglobulinémie à IgA. La recherche étiologique a exclu les causes classiques d'hépatopathie et abouti au diagnostic de maladie coeliaque. L'atteinte hépatique a régressé avec le respect d'un régime alimentaire sans gluten. Ce cas illustre l'importance d'une recherche étiologique minutieuse face à une hépatopathie; elle peut parfois aboutir à une solution thérapeutique simple et efficace.

[Ulcerated duodenitis revealing Henoch-Schönlein purpura]. / LE CAS CLINIQUE DU MOIS. Duodénite ulcérée révélant un purpura rhumatoïde.

Inflammation and duodenal ulcers can meet many etiologies. We report the case of a young adult with an ulcerated duodenitis revealing Henoch-Schönlein purpura. The abdominal symptoms preceded the emergence of the classical cutaneous signs of the disease.

Lead substitution in synaptotagmin: a case study.

Quantum chemistry computations have been used to investigate the possibility of a Pb(2+)/Ca(2+) substitution in the three calcium sites of the synaptotagmin enzyme. Provided explicit cation solvation is taken into account, it is shown that the substitution is energetically feasible and induces a strong reorganization of the Ca(2+)-coordinating sites, which may preclude the enzyme for any efficient role when lead poisoning occurs.

[Clinical case of the month. Adult onset Still's disease: a rare cause of acute febrile hepatitis]. / Le cas clinique du mois. La maladie de still de l'adulte: une cause rare d'hépatite aiguë fébrile.

A 63-year-old woman was hospitalized for the third time in one year for asthenia, fever and chills, jaundice, cytolysis and cholestasis. An adult onset Still's disease was diagnosed. Hepatic manifestations, diagnostic criteria and efficient therapy of AOSD will be reviewed.

[Polyarteritis nodosa related to hepatitis b virus infection]. / Périartérite noueuse en relation avec une hépatite B.

A 66-year-old man was hospitalized for asthenia, weight loss, fever and chills. A polyarteritis nodosa associated with hepatitis B virus infection in a replicative phase was diagnosed. Etiology, physiopathology, and clinical characteristics of hepatitis B virus-related polyarteritis nodosa will be reviewed, as well as the effectiveness of therapy combining corticosteroïds, interferon alpha and plasma exchanges.

Hepatic ascaridiasis.

Adult Ascaris, which are usually found in the intestine, can enter the ampulla of Vater if the sphincter of Oddi is not efficient. This situation seems common in children; in adults it occurs after endoscopic or surgical sphincterotomy. The worms can then migrate up into the intrahepatic bile ducts and provoke biliary stasis which may become infected and complicated by abscesses. It is inside such abscesses that we may find fragments of adult Ascaris. In the 4 cases reported in the literature during the last 20 years, we note in particular that the clinical signs vary considerably, according to the age of the patient. In children, the parasitic infestation is often massive and the clinical features are extremely serious, namely shock and acute abdominal pain, which lead to a laparotomy being done. In adults, the clinical feature is that of a biliary infection. Here we describe a fifth case of hepatic ascaridiasis which differs from the others in that the diagnosis was established by ERCP and CT scan and that treatment was medical.