Conidiobolomycose ou entomophtoromycose rhinofaciale: à propos d’un cas au Togo

Background: Calcific tendinitis of the rotator cuff is a frequent cause of shoulder pain. Ultrasound-guided percutaneous lavage (UGPL) is an effective treatment, but factors associated with good clinical and radiological outcomes still need to be identified. Purpose: To study the clinical, procedural, and radiological characteristics associated with improved shoulder function and the disappearance of calcification on radiograph after UGPL. Study Design: Case-control study; Level of evidence, 3. Methods: This is a post hoc analysis of the CALCECHO trial, a double-blinded randomized controlled trial conducted on 132 patients. The trial assessed the effect of corticosteroid injections after UGPL, and patients were randomly assigned to receive either corticosteroid or saline solution in the subacromial bursa. We analyzed all patients included in the randomized controlled trial as 1 cohort. We collected the patients’ clinical, procedural, and radiological characteristics at baseline and during follow-up (3, 6, and 12 months). Univariable analysis, followed by multivariable stepwise regression through forward elimination, was performed to identify the factors associated with clinical success (Disabilities of the Arm, Shoulder and Hand [DASH] score <15) or the disappearance of calcification. Results: Good clinical outcomes at 3 months were associated with steroid injections after the procedure (odd ratio [OR], 3.143; 95% CI, 1.105-8.94). At 6 months, good clinical evolution was associated with a lower DASH score at 3 months (OR, 0.92; 95% CI, 0.890-0.956) and calcium extraction (OR, 10.7; 95% CI, 1.791-63.927). A lower DASH at 6 months was also associated with a long-term favorable outcome at 12 months (OR, 0.939; 95% CI, 0.912-0.966). Disappearance of calcification at 3 and 12 months occurred more frequently in patients in whom communication was created between the calcification and the subacromial bursa during the procedure (OR, 2.728 [95% CI, 1.194-6.234] at 3 months; OR, 9.835 [95% CI, 1.977-48.931] at 12 months). Importantly, an association between calcification resorption and good clinical outcome was found at each time point. Conclusion: Assessing patients at 3 months seems to be an essential part of their management strategy. Calcium extraction and creating a communication between the calcific deposits and subacromial bursa are procedural characteristics associated with good clinical and radiological evolution.

BackgroundCarotid dissection (CD) may, in certain cases, lead to significant stenosis, occlusion, or pseudoaneurysm formation, causing embolic stroke or hemodynamic failure, despite medical therapy.ObjectiveTo evaluate the results of endovascular treatment...

Utilidad pronóstica de la gammagrafía con leucocitos marcados 99mTc-HMPAO en la enfermedad inflamatoria intestinal

Deep cutaneous fungal infections, including subcutaneous mycoses and systemic fungal infection with cutaneous involvement, cause significant morbidity and mortality in light of increasing immunocompromised patients and global warming. Although a few studies reviewed deep fungal infections in temperate regions, a relevant study in tropical regions is lacking. We evaluated features of deep cutaneous fungal infections in southern Taiwan among the tropical regions. We retrospectively reviewed all histopathological specimens with deep cutaneous fungal infections in a single referral center from 2001 to 2014 and successfully identified 23 cases. Medical chart review revealed patient demographic data, clinical presentation, underlying disease, microbiological culture reports, and treatment outcomes. The average patient age was 52 years. Fourteen cases had primary subcutaneous mycoses, and nine had systemic mycoses. Fifteen patients were immunocompromised, including hematological malignancies. Acquired immune deficiency syndrome (AIDS) and long-term steroid use were most commonly associated with deep fungal infections. The positive culture growth rate was 63%. Fonsecaea sp. was most frequently identified by tissue culture. Aspergillosis, mucormycosis, and disseminated cryptococcosis were particularly fatal. Diabetes and long-term steroid use appear as major risk factors for advanced mycoses in this region. Rapid diagnosis with skin biopsy and tissue culture along with appropriate treatment of deep cutaneous fungal infection are necessary.

We present the case of a female patient diagnosed in 2004 with systemic lupus erythematosus, initially with joint and hematological damage complaint, for which she was treated with Methylprednisolone for 6 months. Subsequently, symptomatology and paraclinical screening raised the suspicion of renal impairment, a pulse therapy with Solumedrol and Cyclophosphamide was initiated, a total of 6 pulses. She is in the database of our Clinic since March 2008, when a renal biopsy was performed, revealing a class IV lupus nephritis, initiating treatment with Mycophenolate mofetil and Prednisone until 2010, when the dose of Prednisone is progressively reduced until cessation at the time of remission. Subsequently she presented two relapse episodes, recovered by pulse therapy with Methylprednisolone and Cyclophosphamide, followed by maintenance therapy with Mycophenolate mofetil and Prednisone with a good clinical evolution. In 2017 the patient has a pregnancy with favorable evolution (under treatment with Azathioprine), presenting normal values of cDNA, C3, C4 during the 9 months, but with a persistent nephrotic-range proteinuria; in these conditions gives birth physiologically at 37 weeks. During 2019 apparent remission is maintained (stationary nitrogen retention, anti-dsDNA antibodies within normal range), but with moderate anaemia and persistent, but diminished proteinuria (being under treatment with reduced dose Prednisolone and Mycophenolate mofetil); along the way proteinuria is accentuated again and it is decided to return to reduced dose Azathioprine treatment, with good clinical evolution. Conclusion. The presented case reinforces the idea of systematic monitoring of patients with SLE and the need for permanent adaptation of treatment especially when there is an increased risk of relapse. Pregnancy, paradoxically well tolerated, increases subsequently the risk of reactivation of lupus nephritis.

The gastrectomy is an uncommon procedure because the proton bomb inhibitors associated to the antibiotic outlines used to eradicate the Helicobacter pylori changed the focus of the peptic ulcer treatment. Later evaluation on those patients who underwent partial gastrectomy as a treatment for peptic ulcer, at that time when any drug to eradicate the Helicobacter pylori was not used. The clinical evaluation included the late postoperative symptoms and postgastrectomy syndromes like dumping, diarrhea, alkaline gastritis and nutritional aspects. The upper digestive endoscopy analysed the surgery reconstruction and the gastric stump, the duodenum and the jejunum mucosa aspects. The histopathological evaluation included looking for Helicobacter pylori by using two different methods: histology and urease test. Fifty-nine patients, 44 (74.6%) male, median age 55.5 years old (range from 31 to 77 years old), who underwent a clinical interview and an upper digestive endoscopy. Paraffin blocks from the surgical specimen were reviewed in order to find out if the patients did have or did not have Helicobacter pylori before surgery. The final results show that most of the patients had very good and good clinical evolution (Visick I e II) in 96%. The most common symptoms on late postoperative are mild dyspepsia with or without Helicobacter pylori, and diarrhea, anemia and dumping occurred in, respectively, 11 (18.6%), 2 (3.4%) and 2 (3.4%) cases. The Billroth I reconstruction had the best clinical results on statistical rate. The endoscopic finding showed normal results in the most number of cases, and reflux alkaline gastritis or erosive gastritis in a few cases. Ulcer recurrences were diagnosed in two patients (3.4%), and both had positive Helicobacter pylori. Most of the patients had Helicobacter pylori (86%) before surgery and also in the postoperative time (89.9%). The patients had a very good clinical evolution after the gastrectomy. The Billroth I reconstruction had the best clinical results. The Helicobacter pylori is still present on gastric stump in late postoperative time, and we believe that it does not bring any negative influence to surgical results.

Recent reports indicate different side-effects of the new medication for psoriasis. Adalimumab. Adalimumab is a biologic agent acting as tumor necrosis factor alpha inhibitor. It is wildly used in treating psoriasis, following a national guide treatment. We report a clinical case of subacute thyroiditis induced by adalimumab in a psoriatic patient. A 54-year-old Caucasian female addressed to our dermatology clinic in 2008 with a 3 years history of moderate to severe psoriasis. The patient had been experiencing non-disabling joint pain in both knees and wrists for several years. Her medical history was remarkable for pulmonary sarcoidosis (at the age of 32), arterial hypertension and angina pectoris. The patient was started on adalimumab 40 mg twice monthly with good clinical evolution, but she was diagnosed, a few months after starting the therapy, with subacute thyroiditis with severe evolution, with transitory hyperthyroidism (thyroid stimulating hormone 0.1 uIU/ml). The treatment with adalimumab was discontinued, the symptoms cleared in 3 weeks with non-steroidal anti-inflammatory drugs and a fully recovered thyroid status was obtained in 1 month. The patient continued the psoriatic medication (adalimumab) with no influence on thyroid status. We describe a case of subacute thyroiditis in a psoriatic patient treated with adalimumab, with a very good clinical evolution with non-steroidal anti-inflammatory medication. Liaison between dermatologists and in this case, endocrinologists and rheumatologists, will help to determine the prevalence of these reactions and to provide insights into the very complex mechanisms of both diseases.

Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis for which accurate epidemiological data are limited and therapy remains a challenge. The primary study’s aim was to examine all cases of PG observed in our department over a 6-year period in order to describe the relevant characteristics and outcome under therapy. Fourteen patients were included (5 women, 9 men). The average age of our patients was 40,15 years. The classical, ulcerative form was found in 10 cases (71.42%), the pustular form in 4 cases (27.57%) and PG was multifocal in 4 cases. The PG was located preferentially to the lower limbs. Histological examination was realized in all patients and objectified inflammatory infiltrate composed of polymorphonuclear neutrophils in all cases with vasculitis in 4 cases. Six patients (42.85%) had associated disease at diagnosis of PG, including inflammatory bowel disease in two cases (14.28%), a blood disease in 2 cases (14.28%), lymph node tuberculosis and inflammatory arthritis in 1 case (7%). The most frequent first-line treatments were oral corticosteroids (7 cases) and other treatments used were colchicine in 2 cases, topical corticosteroids in 3 cases with good clinical evolution. Our study confirms that PG is a rare disease, associated in almost half of cases with systemic disease already present at diagnosis; in our Moroccan background, it is most often inflammatory bowel disease, hematological or solid cancer and tuberculosis.

Tuberculosis of the salivary glands and particularly of the parotid gland is a localization that remains rare even in endemic countries. The association of intra parotid tuberculosis with a benign tumor has been found only in rare cases in literature. A 50-year-old woman with a history of normal pressure hydrocephalus treated surgically, non-smoker, presented with a right parotid swelling progressively increasing in size for 3 years. Clinical examination revealed a 4 cm long, firm, mobile, painless parotid swelling without inflammatory signs and without accessory lymphadenopathy. The oropharyngeal examination was without abnormalities. Ultrasound showed a mass of 31 × 27 mm suggesting a pleomorphic adenoma. MRI confirmed the suspicion of a pleomorphic adenoma of both lobes. The patient underwent a conservative total parotidectomy. The extemporaneous examination was in favor of a pleomorphic adenoma while the final pathology showed the coexistence of active tuberculosis lesions. The patient was put on long-term antituberculosis treatment with good clinical evolution. The clinical presentation of parotid tuberculosis is nonspecific mimicking any other tumor and the diagnosis can only be made by histological examination. Therapeutic management is based on long-term antituberculosis treatment.

The Bi-Digital O-Ring Test has been very useful in the identification of bacterial and viral infections, as well as other etiological agents, in difficult clinical cases. Case report of a patient with multiple hepatic abscesses (pylephlebitis induced hepatic abscess is the most difficult abscess to treat), in which the etiological agent was suggested through Bi-Digital O-Ring Test with excellent clinical evolution after modification of previously ineffective multi anti-microbial treatment is presented. 45 years old, female with a history of pain at right hypochondria for 15 days, with jaundice, oscillating fever and shivering. Computerized tomography showed liver with multiples nodules in the parenchyma with additional appendicitis. An appendectomy was performed with drainage of intra abdominal abscesses. Treatment with metronidazol, ceftazidim and amicacine was performed with no improvement while the general condition of the patient was deteriorating progressively in the following 3 weeks. Bi-Digital O-Ring Test was then performed to determine the etiological agent and the drug compatibility test among effective antimicrobial agents. Based on the Bi-Digital O-Ring Test, the main etiological agent was found to be Enterobacter aerogenes. Amongst the three antibiotics that were being used, only metronidazol was effective and the other 2 was cancelled its effect. Based on Bi-Digital O-Ring Test findings two new antibiotics (cefadroxil and imipenen), were added to metronidazol and additional cilantro tablets by Hayashibara, Japan was given, and Selective Drug Uptake Enhancement Method performed, with excellent clinical, laboratory testing and tomography improvement within 10 days. Bi-Digital O-Ring Test suggested the etiological agent, and effective and mutually compatible antibiotics for treating the abscesses which resulted in a good clinical evolution, characterized by relief of fever and reduction of the hepatic abscesses in a short period and followed complete disappearance of hepatic abscess.

Twenty seven patients with neurocysticercosis were treated with praziquantel in progressive doses reaching 50 mg/kg/day associated with dexamethasone for 21 days. The patients were followed during and after treatment and those followed up for one year repeated their immunological tests (indirect immunofluorescence and ELISA) at this time. Headache was the most frequent symptom during the treatment, occurring on 37% of patients. During the treatment 18.5% of patients had intracranial hypertension and one died. One year after treatment 72.2% of patients who finished treatment improved. The immunological tests became negative in 45.4% of patients sera and 42.8% of cerebrospinal fluids. There was no correlation between the clinical evolution and immunological tests. In this study it is not possible to affirm that both negative immunological tests and good clinical evolution were consequent to the efficacy of praziquantel treatment. Due to the great frequency and seriousness of this treatment complications, the patients with neurocysticercosis must be individually evaluated to know the risks and the benefits of the treatment with praziquantel.

This study was performed to assess whether the theta/beta ratio can be regarded as an indicator of pediatric patients’ evolution while receiving treatment for ADHD. This required a spectral analysis of the electrophysiological power output from several channels with reference at the vertex (Cz). The files and EEG signals of sixteen clinical cases, which included children and adolescents from 4 to 16 years of age, were analyzed. The analysis of the EEG signals was performed using the Fast Fourier Transform (FFT) to obtain the frequency bands. Patients were under pharmacological treatment for at least one year and had at least 2 EEG studies. The results indicate that a good correlation exists between the theta/beta ratio and the patient’s clinical evolution. 42% of the patients who had 3 or more EEG’s, showed good correlation (r > 0.9), which was coherent with their good clinical evolution. 33% showed linear tendency (0.63 < r < 0.73), with variable response and recovery tendency. 25% had bad correlation (r < 0.3), also with variable treatment response. These results relate to poor adherence to the pharmacological treatment.

We approach an integrated, multidisciplinary, innovative research-action model in children and adolescents with psychosis. Our main focus was: to investigate the biochemical cerebral compounds and metabolites (NAA-N-acetylaspartate, GABA-Gama-Aminobutyric Acid, Asp-Aspartate, CR-Creatine, Gln-Glutamine, GPC-Glicerophosphocholine, PC-Phosphocholine, PCr-Phosphocreatine, Tau-Taurine, N-MDA-N-Metyl-D-Aspartate, Serine, Glicine, Cho-Choline); the neuroimagistic and neurobiological markers and the metabolic abnormalities in correlation with the molecular pharmacogenetic testing in psychoses, treated with antipsychotic medication; the dynamic evaluation of the clinical evolution for the studied groups in correlation with specific biochemical, metabolic, neurobiological and neuroimagistic variables and markers. Our research was conducted in the period 2010-2016 on 85 patients, children and adolescents with psychosis (42 took treatment after pharmacogenetic testing, 43 without). Also, the patients were evaluated through magnetic resonance (MR) spectroscopy at baseline and after pharmacotherapy. The efficacy of the chosen therapy in correlation with the pharmacogenetic testing was evaluated through the mean change in the Positive and Negative Syndrome Scale (PANSS) total scores, in the Clinical Global Impression Severity (CGI-S/I), Clinical Global Assessment of Functioning (CGAS) and through the change registered for the relevant biochemical, metabolic, neurobiological markers and MR spectroscopy metabolites, from baseline till endpoint in different timepoints. Our results, showed statistically significant differences of the clinical scores between the studied groups. Our research was a proof, that the biochemical brain metabolites register in psychoses modified values in the MR Spectroscopy, the administration of antipsychotics can determine metabolic abnormalities (changed lipid profiles, high insulin and blood sugar levels, weight gain, obesity). But on the other side, if the antipsychotic treatment is chosen properly according to the pharmacogenetic profile of the patient, then the biochemical metabolites obtained through the MR Spectroscopy, register improvement of the values correlated with the good clinical evolution.

Subcutaneous and deep fungal infections in the hand are rare among children. These are usually found in immunocompromised adults or in persons engaged in soil handling activities, due to direct exposure, especially in the tropics. Delay in diagnosis is usual because pyogenic and other granulomatous infections are considered first. The authors present the case of a healthy, immunocompetent 2½-year-old child who presented with progressive swelling of the right hand mimicking a localized gigantism of the entire hand. Multiple operative drainage procedures done previously had failed to resolve the condition. A biopsy established the presence of fungal hyphae, thus confirming the diagnosis of deep fungal infection of the hand and guided proper therapeutic intervention. A strong index of suspicion needs to be maintained in cases not responding to conventional antibacterial therapy, and both microbiologic and histopathologic samples need to be obtained to establish the diagnosis.

Facial swelling is a common problem in the pediatric population with a variety of causes, ranging from congenital to acquired diseases. A fundamental understanding of typical clinical presentation helps in narrowing this broad differential. A 35-month-old, previously healthy, African American boy presented with 2 weeks of intermittent nightly leg pain and 1 week of unilateral, progressive nontender facial swelling. He had severe, achy right leg pain relieved by ibuprofen, which was diagnosed as a sprain at an outside emergency center 2 days before admission. The patient had developed mild, nontender right facial swelling 1 week before admission and had started amoxicillin for a suspected tooth abscess (Fig 1). He developed a fever of 38.7°C 2 days before admission. Because the patient failed to improve with outpatient management, he was admitted for further evaluation. FIGURE 1 Patient at initial presentation with predominantly right facial swelling. On admission, the patient appeared well nourished with mild fever of 38.1°C, pulse rate of 108 beats per minute, and blood pressure of 107/64 mm Hg. His physical examination showed enlarged tonsils with no exudates and 1-cm, firm, nonerythematous soft tissue swelling overlying the right maxilla with no evidence of dental caries or decay. No cervical, axillary, or inguinal lymph nodes were palpated. There were no other signs of constitutional symptoms such as weight loss, night sweats, diarrhea, nausea, or vomiting. What should be included in an initial differential diagnosis of a patient who presents with facial swelling, and when is imaging indicated? Cases of facial swelling can be divided into 4 groups: acute swelling with inflammation, nonprogressive swelling, slowly progressive swelling, and rapidly progressive swelling.1 The most common form of facial swelling is acute swelling with inflammation, which typically is caused by lymphadenitis, sinusitis, or a tooth infection. Children who have severe systemic symptoms, concern for …