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Serious Myasthenia at the Department of Internal Medicine of Point G University Teaching Hospital: A Clinical Case

Neuroscience & Medicine 2019年第3期10卷 207-212页

作者： Assétou Kaya Soukho Djenebou Traoré Adramé Keita Djibril Sy Guida Landouré Seybou Hassane Diallo Youssouf Fofana Kaly Keita Mamadou Mallé Ibrahima Amadou Dembélé Drissa Sangaré Mamadou Cissoko Barry Boubacar Sangaré Mamadou Dembélé Abdel Kader Traoré Hamar alassane Traoré Department of Internal Medicine Point G University Teaching Hospital Bamako Mali Department of Neurology Point G University Teaching Hospital Bamako Mali Department of Neurology GABRIEL TOURE University Teaching Hospital Bamako Mali Department of Internal Medicine Mother-Child Hospital “Luxembourg” Bamako Mali

Introduction: Myasthenia is a rare and disabling autoimmune disease. Few studies were devoted to this pathology. We report a clinical case of myasthenia in the Department of Internal Medicine at the Point G University Teaching Hospital. Observation: This is a 41-year-old patient of Malian origin, a trader with a history of hemorrhoidectomy in 2011 and familial hypertension, was admitted on August 19, 2014, for muscle weakness, dysphonia, and dysphagia. The disease started 1 year before admission at the department with progressive muscle weakness of the upper limbs aggravated by repetitive movements and spreading to the head “drooping head” and inferior limbs, associated with general fatigue, dysphonia and selective dysphagia for solid foods. The diagnosis of myasthenia was maintained based on the clinical signs such as ptosis, bilateral diplopia, and weakness with lower limbs muscle strength rated at 3/5, and confirmed with confirmatory exams;a positive anti-acetylcholine receptor antibody (RIA), the post-synaptic neuromuscular conduction block at ENMG and the positive neostigmine pharmacological test. The patient received Neostigmine (prostagmine) 0.5 mg one ampoule in IM/day and Prednisone at a dosage of 1 mg/kg/day. The evolution was marked by a moderate improvement of the symptomatology afterward the patient was evacuated to Tunisia on family request where he received a course of immunoglobulin 2 g/kg in 2 days. The evolution in Tunisia was favorable. The patient returned in Mali and death occurred after 2 months in a context of respiratory distress. Conclusion: Myasthenia is a rare but serious disease requiring careful management and monitoring to reduce respiratory complications.

关键词： Myasthenia Immunoglobulin Internal Medicine Point G Hospital

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Factors Associated with Death among Tuberculosis Patients in Dakar

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Advances in Infectious Diseases 2021年第2期11卷 122-139页

作者： Moustapha Diop Papa Samba Ba Jean Augustin Diegane Tine Ndèye Maguette Fall Tracie Youbong Mouhamadou Ndiaye Ndèye Mouminatou Mbaye Mouhamed Bouye Nestor Diatta alassane Sarr Sokhna Walo Ndiaye Ibrahima Cisse Louise Fortes Degenonvo Abdourahmane Niang Adama Faye Moussa Seydi Department of Infectious and Tropical Diseases Dakar Principal Hospital Dakar Senegal Health and Development Institute Cheikh Anta Diop University of Dakar Dakar Senegal Department of Infectious and Tropical Diseases FANN Teaching Hospital Dakar Senegal Department of Pulmonology Dakar Principal Hospital Dakar Senegal Faculty of Medicine and Odontology Cheikh Anta Diop University of Dakar Dakar Senegal Private Institute for Training and Research in Medicine Dakar Senegal

Introduction-Objective: Tuberculosis (TB) is the leading cause of death from a single infectious agent worldwide. The predictors of mortality due to TB are rarely evaluated in Senegal. The aim of our study was to identify factors associated with related TB death in two treatment centers in Dakar, Senegal. Method: We conducted a prospective descriptive-analytical study dealing with TB patients followed in the Department of Infectious and Tropical Diseases at FANN Teaching Hospital and Dakar Principal Hospital and in the Department of Pulmonology at Dakar Principal Hospital from March 1st, 2019 to February 29th, 2020. Univariate and multivariate logistic regressions were performed to identify the associated factors of death. Results: Two hundred eighty-two patients in the Department of Infectious and Tropical Diseases at FANN teaching hospital (57%), in the Department of Infectious and Tropical Diseases at Dakar Principal Hospital (31%), and in the Department of Pulmonology at Dakar Principal Hospital (12%) were included in the study. The mean age was 39 ± 16 years and the male to female ratio was 2.2. Isolated pulmonary TB, isolated extrapulmonary TB, and both pulmonary and extrapulmonary TB were present in 33.3%, 30.5% and 36.2% of cases, respectively. Twenty-two patients died, corresponding to a mortality rate of 7.8%. Factors independently associated with death were age ≥ 60 years (26.2 [3.6 - 191.2]) compared to 16 - 40 years’ age group, HIV infection (7.2 [1.4 - 36.9]), neurological localization of TB (13.19 [3.2 - 54.3]), and hemoglobin level Conclusion: Tuberculosis remains a fatal disease despite therapeutic advances. Better knowledge of associated factors of death from TB may help to reduce its mortality.

关键词： Tuberculosis Death Associated Factors Dakar

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Prognostic Factors for Cirrhosis Hospital in Abidjan (Cote d’Ivoire)

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Open Journal of Gastroenterology 2015年第7期5卷 103-109页

作者： Mamert Fulgence Yao Bathaix Akelesso Bagny Kouamé alassane Mahassadi Anassé Jean-Baptiste Okon Ya Henriette Kissi-Anzouan Stanislas Doffou Aboubacar Demba Bangoura Hatrydt Dimitri Kouamé Kadiatou Diallo Antonin N’Dam Aoudi Ousman De Koffi Alain Attia Aya Thérèse N’dri Yoman Department of Hepatology and Gastroenterology of the Centre Hospitalier Universitaire de Yopougon (CHU-Y) Abidjan Cote d’Ivoire

Cirrhosis is the cause of a high rate of death in hospitals. The aim of this research was to estimate the incidence of mortality and identify the risk factors associated with cirrhosis patients in hospital in Cote d’Ivoire. Methodology: It is a retrospective study covering from January 1st, 2002 to December 31st, 2011 at Centre Hospitalier et Universitaire de Yopougon in Abidjan. We concerned the cirrhosis patients that have been followed at the hepatology and gastroenterology department. Survival was estimated by the Kaplan-Meier curve and comparison of survival curves by the log-rank test. The multi-varied analysis of the survivals has been achieved with the Cox proportional Hazard regression. A p value < 0.05 was taken as significant. Results: We recruited, 221 patients (135 men) of whom the medium age was 59 ± 15.12 years. Among those patients, 34.5% were classified as Child Pugh C and 52.94% Child Pugh B, 19.45% suffered from digestive hemorrhage, 26.5% suffered from renal deficiency, 47% suffered from hepatic encephalopathy and 10.7% from hyponatremia. The median overall survival of patients was 0.50 person-months. The variables that were significantly associated to a reduction of survival were hepatic encephalopathy (p = 0.0029), spontaneous ascitesfluid infection (p = 0.0208), hyponatremia (p = 0.0434) and stage Cof Child- Pugh score (p = 0.046). Conclusion: The incidence of mortality in cirrhotic patients hospitalized in Abidjan is high. Pejorative prognostic factors were essentially hepatic encephalopathy, spontaneous ascites fluid infection, hyponatremia and stage C of Child-Pugh score.

关键词： Cirrhosis Portal Hypertension Child-Pugh Encephalopathy Prognostic Cote d’Ivoire

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Epidemiological and Serological Profile of Hepatitis B Virus in an Urban Area in Mali

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Open Journal of Gastroenterology 2019年第8期9卷 158-163页

作者： Anselme Konaté H. Sow Wife Coulibaly K. Doumbia Wife Samaké Moussa Younoussou Dicko R. Dembélé Wife Dakouo A. Souckho Wife Kaya Makan Ciré Tounkara Hamadoun Guindo Abdoulaye Maiga Mamadou Dembélé Hamar alassane Traoré Moussa Tiémoko Diarra Moussa Youssoufa Maiga Hepato-Gastroenterology Department CHU Gabriel Touré Bamako Mali Department of Internal Medicine of the Point G Hospital Bamako Mali

The objective of our study was to evaluate hepatitis B virus (HBV) infection in an urban population. This longitudinal study was conducted in Bamako District and Kati Commune. After a preparatory phase, the persons who accepted the protocol were assessed for HBsAg. HBsAg carriers had blood collection for HBeAg assay, viral load assessment, genotyping, DNA mutation testing, and severity of hepatic fibrosis and necrosis. At the end of this study, 1475 persons were included, of which 195 had HBsAg positive confirmed, that is to say 13.97%. The mean age of HBsAg positive patients was 35.11 ± 11.12 years with a sex ratio of 2.68. HBeAg was found in 8.9% of the patients tested for this antigen. The viral load was undetectable in 10.52% of patients and greater than 2000 IU/mL in 32.24% of cases. Fibrosis ≥ F2 and necrosis ≥ A2 were found in respectively 19.72% and 6.80% of cases. Genotype E was found in 91.6 patients and an R249S mutation observed in 39.04% of cases. Conclusion: HBV infection has a serious impact on socio-economic development in Mali because it affects mainly the young male population, hence the need to organize preventive measures effectively.

关键词： Hepatitis B Virus Epidemiology Serology Bamako Kati

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Tubercular Uveitis in the Event of HIV Infection about a Case

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Journal of Tuberculosis Research 2019年第4期7卷 253-258页

作者： Abdramane Traoré Hamsatou Cisse Nagou Tolo Djenebou Traoré Condé Lassana Assétou Soukho Kaya Abasse Sanogo Bréhima B. Berthé Ibrahima Amadou Dembélé Mahamadou Saliou Djibril Sy Nanco Doumbia Sekou Mamadou Cissé Boubacar Zana Cisse Mamadou Dembélé Abdel Kader Traoré Hamar alassane Traoré Department of Medicine Sidy Bocar Sall Kati Hospital Koulikoro Mali Department of Internal Medicine at CHU Point G Bamako Mali Department of Internal Medicine of CHU Gabriel Touré Bamako Mali Internal Medicine Service of the Mali Hospital Bamako Mali

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. This disease is the second leading cause of infectious mortality in the world after infection with the human immunodeficiency virus. We report a case of multifocal tuberculosis with neuromuscular and ocular localization in an HIV-1 immunosuppressed patient in clinical and virological failure following therapeutic discontinuation due to non-compliance. This is a 43-year-old immunocompromised HIV1 patient with a history of cerebral toxoplasmosis in 2016 who consulted for right hemiplegia. These symptoms would go back to about 3 days marked by a deficit of progressive installation of the right hemicorps preceded by diffuse headaches, of moderate intensity without triggering factor radiating to the eyes associated with an intermittent fever with periods of spontaneous remissions, night sweats and chills, non-selective anorexia, non-increasing physical asthenia and unquantified weight loss. Management was 8-month antituberculous treatment, combining the first two months isoniazid (INH), rifampicin (RMP), pyrazinamide (PZN) and ethambutol (EMB), then the next 6 months (INH) and rifampicin (RMP). The reintroduction of the same antiretroviral protocol and a reinforcement of the therapeutic education made it possible to observe a decrease of the viral load. Treatment of ocular involvement was instituted with Timosol 1 drop in the eyes morning and evening and Diclocid 1 mg/ml: 1 drop in the eyes in the morning.

关键词： Tucerculose/Uveitis

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Panorama of Autoimmune and Autoinflammatory Diseases in Internal Medicine at the University Hospital Center (UHC) of the Point G

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Open Journal of Internal Medicine 2021年第2期11卷 91-108页

作者： Soukho Assétou Kaya Keïta Kaly Sy Djibril Traoré Djénébou Dembélé Ibrahim Amadou Mallé Mamadou Cissoko Mamadou Sangaré Barry Boubacar Oumar Keïta Adramé Keïta Mamadou Nyanké Romuald Diarra Bacary Cissé Idrissa Ahmadou Diakité Mahamadou Dembélé Mamadou Traoré Abdel Kader Traoré Hamar alassane Department of Internal Medicine at the University Hospital Center of the Point G Bamako Mali Faculty of Medicine and Odontostomatology (FMOS) University of Sciences Techniques and Technologies of Bamako (USSTB) Bamako Mali Department of Rheumatology at the University Hospital Center of the Point G Bamako Mali University of Clinical Research Center (UCRC) at the University Hospital Center of the Point G Bamako Mali Faculty of Medicine Kankou Moussa University (UKM) Bamako Mali

Introduction: Panorama studies of autoimmune and auto-inflammatory diseases are still very little carried out in Africa and particularly in Mali. The objective of this descriptive study with retrospective collection was to describe the epidemiological and clinical profile of all autoimmune and auto-inflammatory diseases in the department of internal medicine at the University Hospital Center of the Point G. Methods: This was a descriptive study with a retrospective survey of the records of patients hospitalized for autoimmune and auto-inflammatory diseases in the department of internal medicine at the CHU of Point G for a study period of 15 years from January 1, 2005 to December 31, 2019. We included in the study all patients hospitalized for autoimmune and auto-inflammatory diseases. Results: During the study period (January 31, 2005 to December 31, 2019), 6383 patients were hospitalized in internal medicine at the University Hospital Center of the Point G, of which 317 patients presented with autoimmune and/or auto-inflammatory disease with an average annual hospital recruitment rate of 21 ± 7.87 cases per year. The female sex accounted for 64.98% with a sex ratio of 0.54. The mean age of patients was 35.27 ± 16.27 years and the extreme ages were 07 and 79 years. Out of the 317 medical records included according to our inclusion criteria, there were 07 cases of association between autoimmune disease and autoinflammatory disease, i.e. 14 cases of autoimmune and autoinflammatory diseases. A total of 331 autoimmune diseases and/or auto-inflammatory diseases were collected, i.e. a frequency of 5.19%, including 291 cases of autoimmune diseases (221 cases of organ-specific autoimmune diseases and 70 cases of systemic autoimmune diseases) and 40 cases of autoinflammatory diseases (no case of monogenic forms, 08 cases of “systemic” polygenic forms and 32 cases of “organ-specific” polygenic forms). Organ-sp

关键词： Autoimmune Disease Autoinflammatory Disease Internal Medicine Mali

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Cardiac Rehabilitation in the Elderly

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World Journal of Cardiovascular Diseases 2023年第12期13卷 854-869页

作者： Aw Fatou Wiam Akif Mame Madjiguene Ka Aimee Mbaye Sy Waly Niang Mboup Aliou Aalassane Ngaide Ccherif Mboup Simon Antoine Sarr Josep Salvadou Mingou Marguerite Tening Diouf Khadim Rassoul Diop Momar Dioum Malick Bodian Mohamed Leye Alain Désiré Affangla Mouhammadou Bamba Ndiaye alassane Mbaye Serigne Mor Beye Adama Kane Maboury Diao Abdoul Kane Department of Cardiology University Hospital Center Aristide Le Dantec Dakar Senegal Hopital Principal Dakar Senegal Hopital Dalal Jamm Dakar Senegal Hopital général Idrissa Pouye Dakar Senegal University Hospital Center Fann Dakar Senegal UFR de Thies Dakar Senegal UFR de Saint Louis Dakar Senegal Medical Department Cheikh Anta Diop University Dakar Senegal

Introduction: The purpose of cardiac rehabilitation is to improve the effects of aging and maintain a good quality of life for older individuals. This study aims to assess how cardiac rehabilitation affects the autonomy and quality of life of older adults. Patients and Method: This was a longitudinal, descriptive and comparative before-and-after cardiovascular rehabilitation study conducted over a two-year period from January 2019 to December 2021. This study was conducted at four cardiac rehabilitation units in Dakar: the Aristide Le Dantec Hospital (HALD), National Dalal Jamm Hospital, and the General Idrissa Pouye Hospital (HOGIP). We compared the degree of autonomy, dependence and quality of life of subjects aged over 65 before and after the cardiac rehabilitation program using the Katz index, the Lowton index and the SF12 quality-of-life questionnaire. Results: Over a two-year period, a total of 345 patients had benefited from a complete cardiovascular rehabilitation program in the four cardiovascular rehabilitation units in Dakar, and 86 patients, or 24.92% of the population, were at least 65 years old. The patients were predominantly male (sex ratio M/F = 4.73). The mean age was 70.35 ± 4.55 years for men and 69.27 ± 4.59 years for women. The main pathology motivating cardiac rehabilitation was ischemic heart disease, which was found in 73 patients (84.88%). Initial assessment revealed exertional dyspnea in 35 patients (40.69%), followed by residual exertional angina in 21 patients (4.41%). Mean functional capacity increased from 5.81 ± 2.38 Mets in pre-cardiac rehabilitation to 8.68 ± 2.28 Mets in post-cardiac rehabilitation (p < 0.001). The mean distance covered in the 6-minute walk test increased from 330.42 ± 170.50 m in pre-cardiac rehabilitation to 524 ± 98.54 m in post-cardiac rehabilitation (p = 0.119). The Lowton dependency index in pre-cardiac rehabilitation was 44.18% versus 36.04% in post-cardiac rehabilitation (p = 0.0156). The mental quality of

关键词： Cardiac Rehabilitation Elderly Dakar

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Lipid Profile among the Diabetic and Non-Diabetic Obese Patients

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Open Journal of Internal Medicine 2018年第1期8卷 89-97页

作者： Djénèbou Traoré Aminata Hamar Traoré Djeneba Sylla Sow Massama Konaté Amadou Koné Hadiaratou Doumbia N’Diaye Modibo Mariko Ibrahim Amadou Dembélé Moctar Bah Bah Traoré Djibril Sy Ichaka Menta Hamidou Oumar Ba Nongoba Sawadogo Abdramane Traoré Assa Traoré Sidibé Assétou Soukho Kaya Abdel Kader Traoré Mamadou Dembélé Hamar alassane Traoré Service of Internal Medicine and Endocrinology of Hospital of Mali Bamako Mali Service of Internal Medicine of Point G University Hospital Center Bamako Mali Service of Cardiology of Gabriel Touré University Hospital Center Bamako Mali Service of Internal Medicine of CHR de Kaya Kaya Burkina Fasso Service of Internal Medicine of Kati University Hospital Center Bamako Mali

Objective: To study the lipid profile among the diabetic and non-diabetic obese patients. Methods: It was a descriptive and prospective study carried out over a period of 9 months from March to December 2010. It concerned all the patients who came for consultation in endocrinology at the internal medicine of Point G University Hospital Center and at the National Center for Diabetes Research. All the patients were included without any gender or age difference, voluntary and with a BMI ≥ 30 kg/m2. Results: Out of the 1543 patients received in consultation, we had identified 178 obese people that is to say 11, 53% of the cases. Among these cases 60 abided by our criteria with 30 diabetic patients and 30 non-diabetic ones. The average age was 45.83 ± 14.68 years old;73.3% were more than 40 years old. The sex ratio was 0.07. Two third (66.7%) of our patients limited their eating diet to the three main meals/day and 61.7% were sedentary. The notion of family obesity was found in 93.4% of the cases, of family diabetes in 58.3% of the cases, of past personal medical history of hypertension in 43.3% of the cases. It was about an android obesity in 91% and Gynoid in 9% of the cases. The BMI was 55% of the cases comprised between 30 - 34.9 kg/m2. The lipid profile noticed was: A hypertriglyceridemia: 33% of diabetic patients and 10% of non-diabetic patients, a high LDL cholesterol: 37% of diabetic patients and 30% of our diabetic patients, a HDL hypocholesterolemia: 40% of the diabetic patients and 20% of the non-diabetic patients, a total hypercholesterolemia: 37% of the diabetic patients and 23% of non-diabetic patients. A hyperglycemia was noticed in 13.3% of non-diabetic patients. Conclusion: The frequency of metabolic troubles was higher in obese diabetic patients compared to non-diabetic obese patients mainly the hypertriglyceridemia.

关键词： Diabetes Obesity Dyslipidemia

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Epidemiological, Clinical and Outcome Aspects of Care-Related Tetanus in Dakar, Senegal

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Advances in Infectious Diseases 2022年第2期12卷 230-240页

作者： Viviane Marie Pierre Cisse Ndèye Fatou Ngom Gueye Louise Fortes Imelda Mickelina Thoo Aminata Massaly Khardiata Diallo Mbaye Daye Ka Ndèye Aissatou Lakhe Assane Diouf Ndèye Maguette Fall Daouda Thioub Aboubakry Sidikh Badiane Latyr Junior Diouf alassane Sarr Sylvie Audrey Diop Cheikh Tidiane Ndour Masserigne Soumaré Moussa Seydi Infectious and Tropical Diseases Department Fann Teaching University Hospital Dakar Senegal Department of Community Health Alioune Diop University Bambey Senegal Department of Health Thies University Thies Senegal

Introduction: Tetanus portals of entry are numerous. Amongst these, the carerelated portals of entry are rarely reported. The aim of the study was to describe the epidemiological, clinical and outcome aspects and identify the factors associated with death from care-related tetanus. Patients and Methods: This is a retrospective study of descriptive and analytical purposes. Data were collected from the medical records of patients admitted to the Infectious and Tropical Diseases Department of the National University Hospital Center (CHNU) of Fann in Dakar for care-related tetanus during the period ranging from 1 January 2009 to 31 December 2016. Care-related tetanus was defined as any case of tetanus occurring after a surgical procedure, including circumcisions performed even outside a health facility. Results: In eight years, 50 cases of care-related tetanus were recorded. Care-related tetanus accounted for 6.7% of hospitalized tetanus cases. The mean age of patients was 21 ± 22 years, with a male predominance (sex ratio: 6.14). The procedure had been performed in most cases, either in a health facility in 22 patients (44%) or at home in 16 patients (32%), and occurred after circumcision. In 62% of cases the portal of entry was urological, followed by orthopedic surgery (14%) and visceral surgery (10%). The procedures performed were dominated by circumcision (31 cases), limb amputation (3 cases) and inguinal hernia repair (2 cases). Tetanus was immediately generalized on admission in all patients. Eighty-four percent (84%) of patients were admitted with Mollaret stage II. Cardiovascular (11 cases), infectious (10 cases) and respiratory (9 cases) complications were the most frequent. The hospital case fatality rate was 24%. Factors associated with death were female gender (p = 0.03), age between 15 - 60 years (p = 0.02), incubation time Conclusion: Care-related tetanus remains a concern in poor income countries, particularly in Senegal. The drop of these cases will req

关键词： Tetanus Care Surgery Dakar Senegal

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Hemoglobinopathy and Systemic Lupus: A Rare Association

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Open Journal of Internal Medicine 2019年第3期9卷 72-77页

作者： Assétou Kaya Soukho Ibrahima Amadou Dembele Djenebou Traore Nounga Romuald Nyanke Djibril Sy Abasse Sanogo Mamadou Cissoko Barry Boubacar Sangare Mamadou Malle Sékou Mamadou Cisse Abdramane Traore Mahamadou Saliou Nanko Doumbia Brehima Boly Berthe Kaly Keita Boubacar Zoumana Cisse Drissa Sangare Youssouf Fofana Kokou Tbah Tighankpa Adramé Keita Mamadou Keita Mamadou Dembele Abdel Kader Traore Hamar alassane Traore Department of Internal Medicine Point G University Teaching Hospital Bamako Mali

The authors report a case of systemic lupus associated with a composite heterozygosis SC with thalassemic component in a 19-year-old patient hospitalized for anemia and polyarthralgia who has a staturoponderal delay, macular erythematous lesions in butterfly wings on the face and ears, photosensitivity, puffy face, alopecia, pubic and axillary hair loss, scalp dermatophytosis, painful swelling of the interphalangeal joints, wrists and knees. The hemoglobin electrophoresis showed a compound heterozygote SC associated with β thalassemia. Antinuclear antibodies were positive with an anti-Sm positive antibody. Conclusion: The diagnosis of both diseases can be difficult when symptoms are concomitant and look alike.

关键词： Hemoglobinopathy Lupus University Teaching Hospital Point G

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