An uncommon rhabdomyolysis: a case report on a Mycoplasma pneumoniae pneumonia

Laurent Truffaut(1), Caroline Vincent(1), Yves Coyette(2), Pierre Hanotier(2) Published in the journal : December 2018 Category : Infectiologie

We have herein reported on the case of a 97-year-old patient suffering from hypoxemic pneumonia caused by Mycoplasma pneumoniae, complicated by severe rhabdomyolysis. The diagnosis was based on the clinical picture associated with an equivocal serology, after excluding other obvious rhabdomyolysis-based etiologies. The clinical and biological progression proved to be rapidly favorable following targeted antibiotic therapy. After clarifying the unusual rhabdomyolysis etiology within a Geriatric Unit, we have further insisted on both the search and treatment of atypical bacteria when the clinical and radiological presentations point towards these conditions.

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Incidental finding of a nasopharyngeal mass in an anterior pituitary insufficiency setting

Lara Delcour (1), Marie-Anne Labaisse (2), Carine Hinkeltz (3) Published in the journal : December 2018 Category : Endocrinology, Otorhinolaryngology

The differential diagnosis of nasopharyngeal masses is vast and mainly comprises three categories of lesions: benign masses corresponding to benign tumors and inflammatory lesions, malignant tumors, and congenital lesions. The age of the patient, clinical context, symptoms associated with the mass, as well as iconographic data are essential to orientate professionals towards the various possible etiologies. In a context of hypothalamic-pituitary axis malformation, and with reference to the embryological origins of the pituitary gland, the hypothesis of extracranial ectopic pituitary tissue is, although rare, an etiology that must be evoked when confronted to a nasopharyngeal mass. However, biopsy with an anatomopathological examination proved to be the only technique able to confirm the lesion’s histological origin.

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Anomalous right coronary artery from the pulmonary artery

Morgane Slaedts(1), MD, Alain Poncelet(2), PhD, Stéphane Moniotte(1), PhD Published in the journal : December 2018 Category : Cardiovasculaire

The anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital heart disease, with an incidence of 0.002%. Often asymptomatic upon childhood, the diagnosis is easily missed, with the anomaly often diagnosed incidentally. Nevertheless, ARCAPA may lead to myocardial ischemia or sudden cardiac death, even in early childhood.

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“Autoresuscitation” after cardiac arrest: the Lazarus phenomenon

Michèle J. Yerna (1), Cristian R. Tarta (1), Juline A. Verjans (2), Renaud A. Verjans (2), Amir S. Aouachria (3) Published in the journal : December 2018 Category : Cardiovasculaire

The Lazarus phenomenon is characterized by spontaneous recovery of circulation after cessation of cardiopulmonary resuscitation. The pathophysiological mechanism is still unknown. We have reported the case of a 61-year-old man who collapsed owing to cardiac arrest after anaphylactic shock in relation to hymenoptera bites. Advanced life support was initiated within 10 minutes, and an alternation of shockable and non-shockable rhythms was observed over 60 minutes. Following intravenous administration of 14mg epinephrine and six external electric shocks, treatment was stopped. Monitoring system was maintained, and 5 minutes later, a spontaneous return of electrical activity with palpable pulse was noted. Despite an aggressive treatment, the patient died 12 hours later from refractory shock.

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Atrioesophageal fistula after radiofrequency ablation: a rare and often fatal complication

Emilie Evrard (1), Dan Gusu (2), Pierre Hausman (3), Denis Glorieux (4) Published in the journal : December 2018 Category : Cardiovasculaire

The atrioesophageal fistula (AEF) is a rare complication of the atrial fibrillation (AF) ablation procedure. This complication is mostly fatal, with a mortality rate exceeding 80% (1), while its incidence does not exceed 0.3% (1). It is the second cause of death after tamponade following this procedure (2). The AEF results from the proximity between the esophagus and left atrium (3), as well as fromthermal esophageal mucosal lesions (4). We have here reported the case of a 65-year-old man who developed neurologic and septic symptoms 31 days after a second AF ablation. Upon admission, a cerebral scanner revealed a small ischemic lesion in the right temporal lobe. Initially hospitalized in a stroke unit, the patient was then transferred to an ICU because of his rapid neurologic deterioration. Upon the intubation maneuver, massive hemorrhaging from an upper digestive site occurred, with patient reanimation required. Confronted with an unknown diagnosis, a gastric endoscopy was performed, revealing two sluices on the anterior esophagus surface, opposite the left atrium. Thoracic CT scan corroborated the AEF diagnosis with an air bubble observed in the mediastinum, between esophagus and left atrium. Nevertheless, the patient died owing to massive cerebral air embolism.

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Management of chronic hepatitis C in children

Pauline Van Gyseghem, Etienne Sokal (1) Published in the journal : December 2018 Category : Pediatrics

With about 11 million children suffering from chronic hepatitis C infection worldwide, hepatitis C remains a major concern in pediatrics. In children, the main source of transmission is vertical, from the mother to the child around birth. Overall, 80% of infected children will develop a chronic infection, with about 1-2% evolving into hepatic cirrhosis. Pediatric treatments aim to eradicate the virus in order to reduce the transmission risk and prevent tissue damage in the long-term. Classical treatments based on pegylated interferon and ribavirin allow sustained virologic response to be achieved in about 45 to 95% of cases (1). In adults, new direct-acting antiviral (DAA) regimens have been approved in recent years and are now being used in the first-line setting. The first successful study that tested their efficacy in a pediatric population reported a sustained virological response in 97 to 100% of cases (2). If this rate is confirmed in other ongoing studies, disease eradication in the pediatric population should be feasible, enabling us to eradicate the virus reservoir, a latent source of new contaminations and chronic liver diseases.

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Alcohol at work, what can the occupational physician do?

Françoise Verstraete Published in the journal : December 2018 Category : Médecine du travail

In Belgium, drug and alcohol consumption at the workplace is regulated by a Collective Labor Agreement called CCT 100. In theory, all employers are required to assume a preventive policy concerning this issue. Yet, in the field, employers sometimes call on occupational physician as a matter of urgency, distraught by one of their employee’s excessive alcohol consumption. During the medical consultation, the occupational physician should attempt to provide preventive information and guidance to the employee or, in case of highrisk activity, to assess the employee’s ability to perform the specific duties. The role of the occupational physician is strictly regulated by labor legislation, although he is invited to collaborate with all medical stakeholders, while observing professional secrecy. This article presents a few practical cases that precisely outline the role of the occupational physician as regards to alcohol consumption at work.

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History of the youngest medical specialty : (Part 3 of 4 parts)

Yves Pirson Published in the journal : November 2018 Category : Ama Contacts

Between the half of the 19th and the half of the 20th centuries, Richard Bright’s successors have a profound problem classifying diseases leading to uremia. The advent of immunology around the onset of the 20th century sheds new light on this issue, with the identification of immune-complex and antibody mediated disorders.

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Liver transplantation for hepatocellular carcinoma: role of immunosuppression and rejection treatment in cancer recurrence - results of a multicenter study

Maxime Foguenne, Samuele Iesari, Jan Lerut Published in the journal : November 2018 Category : Mémoires de Recherche Clinique

Liver transplantation (LT) was initially dedicated to the treatment of cirrhosis. Nowadays, it is playing an increasingly important role in the treatment of hepatocellular carcinoma (HCC). Surgery, in the form of partial or total (i.e., transplantation) liver resection, represents the only curative treatment of HCC. It is important to keep in mind that a patient affected by HCC has in fact two diseases: the cancer itself and the underlying cirrhosis. LT thus represents a very interesting approach that treats both of them, but is really challenging.

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Glucocorticoid withdrawal in an incident cohort of lupus nephritis patients

Séverine Wautier, Farah Tamirou, Séverine Nieuwland-Husson, Frédéric Houssiau Published in the journal : November 2018 Category : Mémoires de Recherche Clinique

Nephritis is one the most frequent and severe manifestation of systemic lupus erythematosus. Treatment of lupus nephritis (LN) is based on the use of glucocorticoids (GC) and other immunosuppressants on the one hand, and on optimal renal protection on the other hand. The objective is to induce renal remission while avoiding cumulative damages. In this respect, chronic GC use is associated with many severe adverse events leading to increased morbidity. A prompt stop and withdrawal of GC is therefore of paramount importance.

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