Adult IgA vascularitis : a case report and review of the literature

Ramanandafy Herveat 1, Ramily Samison Leophonte 2, Raharinoro Raïssa Haingotiana1, Ratovonjanahary Volatantely 2, Rakotoarisaona Fifaliana Mendrika 2, Sendrasoa Fandresena Arilala 2, Rahantamalala Marie Ida 1, Ramarozatovo Lala Soavina 2, Vololontiana Han Published in the journal : July 2022 Category : Clinical Report

Adult IgA vasculitis or Henoch-Schonlein rheumatoid purpura is a rare clinical entity, which is characterized by tissue deposits of immune complexes containing type A immunoglobulins. A 24-year-old man without any particular history, especially concerning past infections, displayed purpuric petechial and ecchymotic skin lesions, which were infiltrated and vascular in nature, as well as associated with polyarthralgia of the elbows and knees, in addition to spasmodic abdominal pain. The blood analysis revealed a discrete inflammatory syndrome with a C-reactive protein (CRP) level at 37 mg/L, the rest of the workup including hemostasis being unremarkable. The renal assessment showed significant proteinuria at 0.73g/24 hours without renal failure. Skin histology exhibited a lymphocytic vasculitis lesion and perivascular infiltrates consisting of mononuclear cells, without fibrinoid necrosis. The diagnosis of subacute IgA vasculitis was established based on the criteria of the American College of Rheumatology and EULAR/PRINTO/PRES (European League Against Rheumatism/Paediatric Rheumatology INternational Trials Organisation/Paediatric Rheumatology European Society). A cortico-resistance of the skin lesions was noted following 21 days of treatment, which eventually resolved at 1 month.

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Spontaneous coronary artery dissection (SCAD): a case report and literature review

Merveil Ndongala1, Christophe Laruelle2 Published in the journal : July 2022 Category : Clinical Report

Myocardial infarction results from obstruction of the coronary arteries, which is most often secondary to the progression of atherosclerotic disease with rupture of the atheromatous plaques formed. In some cases, myocardial infarction is not secondary to the progression of atherosclerotic disease, but it is rather due to coronary artery stenosis following dissection of the artery wall and this, in a population without significant cardiovascular risk factors.

This article illustrates, based on three cases managed in our institution, the presentation and current state of knowledge pertaining to an atypical cause of myocardial infarction, namely the spontaneous coronary artery dissection (SCAD).

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Antenatal diagnosis of Miller-Dieker syndrome, ultrasound screening and differential diagnosis

Marta Merola Martinez1, Anne Guillaume2, Jean-Paul Hermand3, Maia Delaine4, Didier Van Wymersch5 Published in the journal : April 2022 Category : Clinical Report

We herein describe the antenatal diagnosis of Miller-Dieker syndrome. Ultrasound is the primary means of screening for Miller-Dieker syndrome. However, early presentations of the disease vary widely. With this case report, we want to emphasize facial dysmorphism, and namely retrognathism, as an important feature that can raise suspicion of the diagnosis, especially when associated with ventriculomegaly and intrauterine growth restriction.

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Guillain-Barré and severe myositis induced by hepatitis E virus: case report and literature review

Ewelina Uscilowska (a), Marie De Vos (b), Catherine Thiran (c), Ilisei Dragos (d) Published in the journal : April 2022 Category : Clinical Report

Hepatitis E virus (HEV), which is spread all over the world, is nowadays among the most common causes of viral hepatitis, mainly affecting developing countries. Nevertheless, over the last 10 years, there has been a resurgence of viral hepatitis cases in developed countries. In most cases, HEV infection has been rather benign, but it can at times be complicated by extra-hepatic manifestations, neurological ones being the most common. Based on a clinical case report, we have describe the atypical evolution of HEV infection, which was complicated by Guillain Barré syndrome and myositis.

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COVID-19-induced urological pathologies, a review of the literature based on an observation of Peyronie's disease

Nathan Wirtzfeld*, Gwenola Mambour**, Bertrand Tombal***, Annabelle Stainier*, Roland Vaesen*, Frédéric Leduc* Published in the journal : April 2022 Category : Clinical Report

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by the SARS-CoV-2. This coronavirus proves able to invade endothelial cells, thereby causing systemic inflammation and a blood hypercoagulable state. This systematic review of the literature reports on the various urological disorders observed in the course of COVID-19, starting from a case of Peyronie's disease. Only one case of post-COVID-19 Peyronie's disease has been described in the literature so far. Peyronie's disease should be considered as a possible sequela of COVID-19, and healthcare professionals should inquire about a possible COVID-19 history in patients with Peyronie's disease.

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An intense sports effort not so harmless in pediatric patients?

Emmy Hoornaert¹, Jean-Luc Hennecker¹, Simon Vandergugten², Nathalie Blavier¹, Véronique Maes¹ Published in the journal : March 2022 Category : Clinical Report

Pyomyositis is an acute bacterial infection of skeletal muscles arising from transient bacteremia, commonly associated with Staphylococcus aureus. Owing to its higher frequency in tropical regions, the infection has earned itself the title of “tropical pyomyositis”. However, it must be mentioned that the disease is no longer restricted to tropical regions, and its frequency is increasing worldwide. Obturator pyomyositis mimics other common infections involving this area like septic arthritis. Indeed lack of awareness of pyomyositis commonly leads to delays in both diagnosis and adequate treatment. Magnetic resonance imaging (MRI) is the best tool for diagnosing pyomyositis. Treatment consists of bed rest, antibiotics, percutaneous drainage, as well as surgical intervention, depending on diagnostic delay and extension of the infection.

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Perforated jejunal diverticulum with abscess: a literature review

Miroslava Kuzmova, Mikhael Salame, Philippe Colonval (1) Published in the journal : October 2021 Category : Clinical Report

Acquired diverticula of the small intestine are formed via a mucosa and submucosa herniation through the muscular layer of the intestinal wall.

These diverticula remain asymptomatic in 60 to 70% of cases. Symptoms, when present, are non-specific, as they likely imitate other acute intra-abdominal conditions. The etiological diagnosis proves often difficult following initial assessment. In most cases, an exploratory laparoscopy is necessary in view of an accurate diagnosis.

This article consists of an exhaustive review of the literature in regard to this pathology.

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Antenatal management of disorders of sex development

Cécile Habran (1), Marie Laterre (2), Julie Fudvoye (3), Michelle Nisolle (4) Published in the journal : October 2021 Category : Clinical Report

Disorders of sex development (DSD) represent a diagnostic challenge. The complexity and variability of DSD and their psychosocial consequences require multidisciplinary care, including obstetricians, endocrino-pediatricians, clinical geneticists, pediatric urologists, neonatologists, psychologists, as well as child psychiatrists. The clinical case described herein is a genotypic-phenotypic discordance. Indeed, the non-invasive prenatal test argued in favor of a male chromosomal sex, whereas the fetal ultrasound was rather in favor of a female phenotype. The antenatal biological explorations will likely enable us to review both the mechanisms and genes involved in sex determination and sexual differentiation. Currently, a molecular diagnosis is found in only 30-50% of cases pertaining to 46, XY. In the event of an unusual external genitalia appearance, 75% of the reported cases are related to 46, XY, the most commonly encountered being hypospadias. The etiology retained in this foetal case is idiopathic DSD, with normal testicular function and severe intrauterine growth restriction (IUGR). Despite the improved etiological and genetic knowledge of sexual differentiation, the understanding of the underlying physiopathology is still incomplete, and some clinical situations remain unresolved.

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Understanding, recognizing, and preventing Necrotizing enterocolitis of the newborn

Stéphanie Jasienski (1), Bénédicte Van Grambezen (1) , Renaud Menten (2), Olivier Danhaive (1) Published in the journal : September 2021 Category : Clinical Report

Necrotizing enterocolitis remains the leading intestinal cause of morbidity and mortality in preterm infants. Given that this clinical condition can be unpredictable and fulminant, it is paramount to recognize this disease quickly and initiate appropriate treatment promptly so as to achieve better clinical outcomes. The condition’s management is multidisciplinary. Therefore, transferring the patient to a tertiary hospital with pediatric surgery must be considered in advanced cases. The condition’s physiopathology is still incompletely understood, with several factors considered to be involved, including the intestinal mucosa’s immaturity with innate immunity dysregulation, vascular immaturity, as well as microbiota imbalance that may be of iatrogenic origin. Complications may arise early or later in the disease course. Human milk and probiotics are the most established preventive measures.

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Surgical treatment of posttraumatic pseudo-aneurysm of right subclavian artery

Justine Malvaux (1), Asmae Belhaj (2), Philippe Eucher (3) Published in the journal : September 2021 Category : Clinical Report

Right proximal subclavian artery traumatism is rare, but it may be associated with pseudo-aneurysm formation. Currently, its treatment consists of an endovascular procedure using covered stenting. Indeed, open surgery can be quite challenging due to the subclavian artery’s anatomical; therefore, such an intervention is associated with a high morbidity and mortality rate. We report the case of a 71-year-old man presenting with a right proximal subclavian artery pseudo-aneurysm following a car injury having occurred 11 years prior. Several endovascular procedures were performed, but they all failed to exclude the aneurysm. This report sought to demonstrate that an open surgical approach is still possible following failure of less invasive interventions. A right aorto-carotido-subclavian bypass was carried out using an approach combining a median sternotomy and right cervicotomy. The patient’s postoperative course was uneventful. The first follow-up at 6 weeks post-intervention confirmed both the exclusion of the pseudo-aneurysm and vascular permeability. Yet, the 1-year-follow-up is mandatory to confirm this favorable outcome.

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