Unusual cause of back pain in a previously healthy teenager

Lara Lunelli, Camelia Rossi, Nathalie Demeulenaere, Marc Léon, Xavier Collard Published in the journal : July 2021 Category : Clinical Report

Infectious spondylodiscitis is a rare disease in children, generally of hematogenic origin. In the reported case, the clinical presentation was non-specific, whereas the usual symptom consisting of severe low back pain was present.

The responsible agent, which is not always found, is usually detected using blood cultures. The most commonly implicated germs are Staphylococcus aureus, Streptococcus α-hemolytic, Streptococcus pneumoniae bacteria, and gram-negative bacilli

Evidence of Streptococcus pyogenes is anecdotical.

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Anti-SAE ½ antibody-associated dermatomyositis on adalimumab treatment: a case report

Léa Frisson, Cédric Mahiat, Pauline Richez, Liliane Marot, Henri Colin, Philippe D’Abadie, Julie Lelotte, Jean Cyr Yombi, Halil Yildiz Published in the journal : July 2021 Category : Clinical Report

Dermatomyositis (DM) is an autoimmune inflammatory disorder affecting the skin and muscles, whose etiology is often unknown. While DM induced by biological agents like anti-tumor necrosis factor-alpha agents is uncommon, this disorder is mainly seen in patients with autoimmune disorders or underlying neoplasms. We report the case of a 57-year-old female patient who developed DM with anti-small ubiquitin-like modifier-1 activating enzyme (anti-SAE 1/2) antibodies following an adalimumab treatment on account of refractory hidradenitis suppurativa. Our patient presented typical cutaneous findings consisting of heliotrope rash, Gottron papule, arthralgia, joint swelling, proximal muscle weakness, and dysphagia. Laboratory studies showed mild inflammatory syndrome, polyclonal hypergammaglobulinemia, hypoalbuminemia, high LDH levels, yet normal CK, AST, and ALT levels. Myositis-specific antibody assay was found to be positive for anti-SAE 1/2 antibodies. The electromyogram (EMG) and muscle biopsy revealed inflammatory myopathy. Systemic corticosteroid therapy was initiated. As a result, the patient’s joint pain and muscle strength both improved following 7 days of treatment. A clinical recurrence of the pathology occurred during the gradual regression of corticosteroid therapy, requiring the initiation of azathioprine with both good clinical and biological responses.

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Cold urticaria

Nathalie Bilem, Marie-Noelle Vogeleer, Julien Mergen, Samuel Balbeur Published in the journal : July 2021 Category : Clinical Report

Cold urticaria is a physical urticaria induced by contact with cold environments like water or air, but also by contact with cold objects, food, or beverages. The severity of the reaction can vary widely, ranging from a simple urticaria up to an anaphylaxis with cardiovascular collapse. The cardiovascular and respiratory systems are mostly involved in severe anaphylaxis cases. Severe anaphylaxis occurs most often following aquatic activities in cold water. The diagnosis is based on the clinical history together with an ice cube challenge test. The treatment is based on antihistamines, as well as on using an epinephrine auto-injector in anaphylaxis cases. Awareness on how to avoid risk factors is also crucial, particularly including a warning against immersion in water colder than 25°C and against the ingestion of very cold food. Differential diagnosis includes the different forms of chronic physical urticaria.

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Ketamine in emergency situations: a molecule with a bright future!

Vanessa Bellemans, Caroline Declerfayt, Jean-Marie Jacques Published in the journal : July 2021 Category : Emergency

Ketamine is an old drug that was first used in the 1960s in anesthesia, displaying quite special properties. This agent is simultaneously hypnotic, amnesic, bronchodilator, antidepressant, and analgesic, while offering a safe profile of use. It preserves airway protection reflexes and respiratory drive, provides hemodynamic stability, and exerts enhanced sympathetic activity. These properties render it ideal for managing critically ill patients. In the emergency room, ketamine plays already a role in intubation support, sedation, and analgesia. Recently, its indications have been extended to the domains of psychiatry and neurology.

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Antinuclear autoantibodies: Let’s simplify these complex issues!

Farah Tamirou, Frédéric A. Houssiau Published in the journal : July 2021 Category : Rheumatology

While antinuclear autoantibodies (ANA) are commonly searched for, their interpretation is not always easy, especially when requested in front of an atypical clinical picture. Quite often, ANA detection is in fact a chance discovery. This article aimed to review the place of ANA dosage in the clinic, as well as ANA’s meaning depending on the patient's context.

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To understanding the experience made by a caregiver for an elderly subject requiring care in order to better appreciate the function of the general practitioner in this field

Lionel Roux, Delphine Nury, Ségolène de Rouffignac Published in the journal : May 2021 Category : Médecine Générale

Informal caregivers of dependent elderly persons are currently increasing in number in Belgium. Because of the physical or mental burden induced by their role, they are vulnerable. Nine informal caregivers with varied profiles were questioned using semi-structured individual interviews, which were aimed to better understand their experiences and clarify the place that the general practitioner could assume in this environment. Analysis of the testimonies clearly reveals a physical and psychological interdependence between both the caregiver and elderly person, which may at the origin of numerous disagreements within the dyad, along with the lack of a centralized referral system of professional helpers. The general practitioner, who is in the first-line of care, could play a key role in the early identification of the caregiver’s suffering, provided he relies on a proactive approach. The general practitioner could also centralize the available help, while always informing both the caregiver and elderly person.

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The ‘NPS’- new psychoactive substances - Clinical presentations and managment recommendations

Alexandra Serpe, Mathieu Bonnet, Germain Laubier, Magdalini Polikipis, Marie Belleflamme Published in the journal : May 2021 Category : Emergency

Over the past twenty years, the European drug market has turned out to become more complex because of the emergence of new psychoactive substances (N.P.S). The N.P.S designation refers to new synthetic drugs that are designed to mimic the effects of the so-called standard drugs, such as heroin, cannabis, cocaine, as well as others. Though being similar, the clinical features of N.P.S are inherently more complex to deal with because of their ability to act on different receptor types.

The treatment remains symptomatic owing to the lack of antidotes or quick identification tests. The identification, evaluation, and evolution of the patient at risk of instability primarily guide the treatment.

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Uretero-arterial fistulas: update and therapeutic advances - Literature review based on two clinical cases

Michel Bailly, Vincent Scavée, Christian Van Ruyssevelt, Olivier Rahier, Jean-Luc Jorion, Emmanuel Dardenne Published in the journal : May 2021 Category : Urology

Uretero-arterial fistulas (UAFs) are the consequence of a chronic inflammatory process that leads to the weakening of ureteral and arterial walls at the crossing level. In recent years, the number of cases described in the literature has continuously increased. Most UAFs are accounted for by the exposure to several typical risk factors. Clinical suspicion is the key for a rapid diagnosis and appropriate treatment. Management of UAFs has evolved over time, being currently based on an endovascular approach. Despite an improvement in diagnostic and therapeutic techniques, morbidity and mortality remain high.

This work, which is based on two clinical cases with different presentation and management, illustrates the heterogeneity of this pathology, which is often barely understood. In addition, the article proposes a review of the current recommendations on the subject.

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Sister Mary-Joseph nodule: the tip of the iceberg

Laura Wislet, Henri Thonon Published in the journal : May 2021 Category : Image

An umbilical lesion must be taken seriously by the practitioner, since it represents a neoplasm in two-thirds of cases, while being either a primary cancer or metastatic disease. Sister Marie-Joseph's nodule is a rare umbilical metastatic lesion, occurring in 1 to 3% of abdominopelvic adenocarcinomas. Its discovery should lead to performing an abdominopelvic scanner and skin biopsy. Therapeutic options include surgery or chemotherapy, but most often, management consists of palliative care. As for its oncological history, this nodule is characterized by its late appearance, and it has been associated with a poor prognosis.

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Multiple nonspecific symptoms in a patient treated by pembrolizumab

Victoria Van Hove, Sebahat Ocak, Etienne Delgrange Published in the journal : May 2021 Category : Internal Medicine

Immune checkpoint inhibitors, such as the receptor programmed cell death protein 1 (PD-1) or PD-1 ligand 1 (PD-L1), which are new therapeutic weapons against cancer, which are increasingly used nowadays.

This case report concerns a 72-year-old man treated by pembrolizumab (Keytruda®), a PD-1 inhibitor, in first-line systemic treatment of an Stage IVA lung adenocarcinoma. Three weeks before his eighth cure, the patient’s general condition deteriorated, including loss of appetite, fatigue, nausea, and a slight weigh loss. He also reported headaches. As an adrenal insufficiency was suspected, a substitution treatment consisting of hydrocortisone was initiated. The originality of this case lies in the relevance of also considering non-specific symptoms in cancer patients under immunotherapy, the emergency of the diagnosis, and the recommended medical management.

The aim of this article is direct your attention to this rare but potentially fatal adverse event of immunotherapy, with its new treatments that you will encounter increasingly often in your practice, and to revise some cases already published in the literature , in addition to another personal case.

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