Cervical cysts in adults: caution!

Daniel Moens (1), Sébastien Van der Vorst (2) Published in the journal : September 2023 Category : Clinical Report

Any cervical cystic lesion detected after the age of 40 should lead to thorough investigations in the ear-nose-throat (ENT) sphere and in particular in the homolateral palatine tonsil and tongue base.

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Pyroglutamic acidemia in an elderly patient

Maxime Cuylits (1), Christophe Dumont (2), Blaise Anthonissen (3), Denis Glorieux (4), Ioana Almas (5) Published in the journal : September 2023 Category : Clinical Report

Pyroglutamic acidemia, initially described in the pediatric population due to inborn enzymatic deficiencies, is a relatively unknown cause of high anion gap metabolic acidosis (1). Acquired pyroglutamic acidemia is mostly diagnosed in malnourished women suffering from a chronic illness and with a history of chronic acetaminophen use (2). During the past decade, several cases of flucloxacillin- and paracetamol-induced pyroglutamic acidosis have been reported (3,4). We herein report a case of a patient diagnosed with pyroglutamic acidosis in the context of concomitant paracetamol and flucloxacillin treatment. This case report highlights the need to consider pyroglutamic acidosis in the differential diagnosis of high anion gap metabolic acidosis, given its reversibility under appropriate management.

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Myocarditis after COVID-19 vaccination

Antoine Lété (1), Stella Marchetta (2), Julien Djekic (3), Thierry Couvreur (3), Philippe Evrard (2), Bruno Raskinet (2), Olivier Gach (2) Published in the journal : April 2023 Category : Clinical Report

Myocarditis reactive to the COVID-19 vaccine has progressively been observed during the massive vaccination campaign among the population. It usually follows the second dose, occurs within 5 days of vaccine administration, and affects more often young men. The incidence is rare, clinical presentation usually benign, and the evolution is generally uncomplicated, without long term sequelae. Moreover, mortality is rate extremely low. Although the physio-pathological mechanisms implicated are not fully elucidated to date, several hypotheses have been put forward. Finally, the low risk of post-vaccination myocarditis must be weighed against the undeniable public health benefits of the vaccine compared to the risks of severe complications inherent to COVID-19 infection itself.

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Radiation-Induced Breast Angiosarcoma

Charlotte Charlier (1), Stanislas Laurent (2) Published in the journal : April 2023 Category : Clinical Report

Breast angiosarcoma is a rare primary or secondary endothelial tumour. Optimal management differs according to the etiology.

The authors illustrate the diagnostic and therapeutic complexity of this type of cancer, based on two clinical cases. A recent review article sheds light on the management of this pathology.

The two types of angiosarcomas have different macroscopic appearances. An anatomopathological analysis enables a real diagnosis of this tumour, as do the immunohistological markers such as c-Myc and FLT4, which allow to differentiate between a primary or secondary angiosarcoma. (1)

Imaging tests such as ultrasound, mammography and (magnetic resonance imaging) MRI are not specific but can detect distant metastases and make the differential diagnosis with breast cancer recurrence. (2)

The specificity of post-radiation angiosarcoma surgical treatment lies in the width of the procedure. It is imperative to resect the entire irradiated skin area. Primary angiosarcoma, on the other hand, should be resected with a margin of 1cm to 2cm for tumours which are ≤ 5cm in diameter. (3) Indeed, the irradiated bed is the breeding ground for subsequent recurrence.

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Case report of a pseudoaneurysm of the pedal artery: a rare ankle sprain complication

Yaseen Golamhossein, Pierre Milet Published in the journal : January 2023 Category : Clinical Report

Ankle sprains represent a frequent reason for general or emergency medicine consultations. The most common complications are ligament lesions, bone avulsions, and hemarthroses. The pseudoaneurysm of the pedal artery is an often overlooked and rare complication. The case presented in this article is that of a 32-year-old man treated for a sprained ankle 3 weeks before. He received conservative treatment because no fractures were detected during the X-ray examination. Two weeks later, he presented with a pulsatile mass in front of the anterior talofibular ligament, associated with a small wound.

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Spontaneous pneumothorax in a pregnant woman : difficulty of diagnosis and treatment

Natacha De Decker (1), Pol Vincent (1), Thierry Castelain (2), Paula Blaj (2), Pascale Grandjean (3), Sophie Gilles (3), Tudor Azoicai (1) Published in the journal : December 2022 Category : Clinical Report

Spontaneous pneumothorax is a frequent cause of admission to emergency departments. Its etiology and lethal potential if not diagnosed are well known. However, there are less common etiologies of this condition. The diagnosis can then be tricky, especially since the symptoms may be equivocal. This is the case of spontaneous pneumothorax in pregnant women with no risk factors, in whom the symptoms may mimic those observed during the last trimester of pregnancy.

In this context, we wish to report a case of spontaneous pneumothorax in a 32-week pregnant wo-man, without any known risk factor. We also propose a literature review on this subject.

Our analysis highlights that spontaneous pneumothorax in pregnant women is a rare condition whose diagnosis may be overlooked, given the clinical manifestations that may be confused with physiological phenomena of the last trimester of pregnancy.

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Fulminant hepatitis complicated by a reactive hemophagocytic syndrome in an immunocompetent patient: two rare manifestations of Herpes simplex virus 1 infection.

Sarah Brilot (1), Esther Calvo Lasso De La Vega (2), Christian Michaux (2), Leïla Belkhir (1), Lucie Pothen (1) Published in the journal : December 2022 Category : Clinical Report

Fulminant hepatitis is a rare and fatal complication of Herpes simplex virus 1 (HSV1) infection, which can affect both immunocompetent and immunodeficient adults. The diagnosis is often delayed due to the rapid evolution of the infection, hence the importance of initiating rapid treatment with aciclovir. We report the case of a 36-year-old patient with no medical history who consulted for sudden asthenia after two days of fever and myalgia. The initial laboratory workup revealed hepatic cytolysis and bicytopenia (thrombocytopenia and leukopenia). The evolution was rapidly unfavorable, with the development of acute hepatic failure and a reactive hemophagocytic syndrome. The etiological workup then revealed an HSV1 infection. Treatment with aciclovir resulted in clinical and biological improvement, and the patient fully recovered.

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Antiphospholipid syndrome, an unrecognized cause of multiple and varied thrombotic events

Camille Desender (1), Pascal Fajardo (2), Nicolas Eppe (3), Fleur André-Mathieu (4), Ludivine Hougardy (5) Published in the journal : October 2022 Category : Clinical Report

The antiphospholipid syndrome is an acquired autoimmune thrombotic disorder that has been known since 1906, with an incidence of 40 to 50/100,000 people. Its complex pathophysiology remains poorly understood at present, with all organs potentially affected. Symptoms are very variable and most commonly associated with multiple thrombotic or thromboembolic events. If such manifestations including obstetric events occur in young patients, we should consider the diagnosis of antiphospholipid syndrome. Owing to its morbidity and mortality, this syndrome constitutes a diagnostic and therapeutic emergency.

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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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