Flu-like symptoms with cough may be the manifestation of many differential diagnoses. This article sought to demonstrate the relevance of a complete clinical examination, along with the need to look for underlying etiologies when faced to an unusual evolution of a flu-like syndrome
The adult-onset Still’s disease is a rare cause of fever of unknown origin. The clinical presentation and biological signs are rather polymorphous and non-specific. We herein emphasize the usefulness of measuring serum ferritin and glycosylated ferritin (GF) levels. The diagnosis of adult-onset Still’s disease is based on the Yamaguchi criteria, with three major criteria (high fever for more than 1 week, neutrophilic leucocytosis, and diffuse arthralgia) and three minor criteria (liver enzyme elevation of neither toxic nor drug-related origin, lymphadenopathy identified on PET imaging, and negativity of rheumatoid factors and antinuclear antibodies) to be present. The disease’s pathophysiology is still uncertain, and treatment essentially relies on systemic glucocorticoids. In this paper, we have discussed the usefulness of biotherapies, comprising primarily the monoclonal antibodies directed against the IL-6 receptor.
Omar El-Mourad (1), Fabien Roodhans (1,2), Valérie Huyge (3), Bruno Guetcho( 4)Published in the journal : April 2019Category : Observations cliniques
Horton's disease, also termed giant cell arteritis, mainly affects large-caliber vessels within the territories of the external carotid branches. Of note is that this condition can also involve the eye, central nervous system, digestive tract, respiratory system, as well as the arterial system of the lower limbs, and the heart. The diagnosis is confirmed based on the biopsy of the temporal artery, which is not positive in all cases. PET imaging takes an increasingly relevant place in the diagnostic tree, revealing metabolic hyperfixation of large and medium vessels. Treatment is mainly based on systemic glucocorticoids. Of note is the progressively increasing place of biotherapies in the condition’s management, primarily comprising specific antagonists of the IL-6 receptor.
Geoffrey Jacqmin (1), Jean-Philippe Stalens (2), Jean-Luc Dutrieux (3), Philippe Malvaux (4)Published in the journal : April 2019Category : Observations cliniques
Acute appendicitis is very rare in the neonatal period. The diagnosis may be delayed due to the lack of specific clinical symptoms, and because of its rarity in the patient population considered, leading to increased peritonitis and mortality rates. Despite neonatal appendicitis possibly manifesting as an isolated event, in many cases, it proves to be a complication of an underlying disease. While surgical treatment remains the gold standard in this pathological setting, conservative management may be considered in selected patients.
Mouhamadou Habib Diagne, Evariste Keyanina Nyumbandogo (1), Pol Vincent (2), Xavier Muschart (3)Published in the journal : April 2019Category : Observations cliniques
We herein present a case of methanol poisoning, promptly treated in an emergency setting. In this report, we have discussed its physiopathology, clinical presentation, and diagnostic methods, in addition to the therapeutic options currently available to manage methanol intoxication.
The occurrence of atrio-ventricular conduction disorders calls for further investigations. Differential diagnoses comprise infections, infiltrative diseases, and neoplasiae. Primary cardiac lymphoma is a rare condition, often associated with delayed diagnosis. Nevertheless, complete tumor response and, therefore, disappearance of the conduction disorder may be achieved through an appropriate treatment.
This article sought to present a rare iatrogenic complication occurring after a relatively common drug injection in medical practice. We have reported a "Nicolau syndrome" following a glucocorticoid injection. This term refers to a syndrome manifested by painful livedoid dermatitis, potentially associated with serious complications. This article aims to emphasize the relevance of preventing this syndrome, by providing technical recommendations for injections, along with the correct indications of glucocorticoid use. This paper ends by emphasizing the need of promptly diagnosing this syndrome, as accurately as possible, in order to limit its complications.
More than for other amputations, the upper limb prosthesis requires setting up a project. Established between the multi-disciplinary team and patient, this project must clearly match the patient's esthetic and functional wishes.
Following lower limb amputation, though it presents other difficulties, the primary aim is to enable the patient to regain the walking capacity. Given that the function of the upper limb is more complex, it is our responsibility to pay additional attention in order to prevent the patient from dropping the prosthesis.
More than for other amputations, the upper limb prosthesis requires setting up a project. Established between the multi-disciplinary team and patient, this project must clearly match the patient's esthetic and functional wishes. Following lower limb amputation, though it presents other difficulties, the primary aim is to enable the patient to regain the walking capacity. Given that the function of the upper limb is more complex, it is our responsibility to pay additional attention in order to prevent the patient from dropping the prosthesis.
Caroline Daems, Juliette Vanderroost, Philippe A. LysyPublished in the journal : April 2019Category : Diabétologie
Type 1 diabetes (T1D) is a medical condition characterized by insulin secretion deficiency, inducing chronic hyperglycemia, and subsequent autoimmune destruction of insulin-producing pancreatic β cells. This destruction is primarily mediated by CD4+ helper T cells and CD8+ cytotoxic T lymphocytes that induce β cell death, also termed apoptosis. Recently, several research teams have challenged the purely autoimmune origin of the disease. Indeed, insulitis is not systematically found in all pancreatic samples analyzed, whereas immune therapies aimed to suppress autoimmunity and restore the immune tolerance have not always achieved the expected success. Inflammation, undeniably, plays a key role in the trigger and development of T1D, and in particular the pro-inflammatory cytokines IL-1β, IFN-γ, and TNF-α. By activating inflammatory cascades and endoplasmic reticulum stress in β cells, these cytokines ultimately lead to cellular apoptosis. The condition’s true cause, whether autoimmunity or inflammation, is, however, still unknown. In this review, we have summarized the different pathophysiological aspects of T1D, whether autoimmune or inflammatory.