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Isolated Tracheobronchial Amyloidosis

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International Journal of Clinical Medicine 2015年第9期6卷 643-645页

作者： Madiha Mahfoudhi Imen Gorsane sami turki Taieb Ben Abdallah Department of Internal Medicine A Charles Nicolle Hospital Tunis Tunisia

The tracheobronchial amyloidosis is a rarely localized form. It may manifest as a cancer. Only histological results allow diagnosis confirmation. A 68-year-old man was admitted for exploration of a low abundance hemoptysis. The chest radiograph was normal. CT scan objectified thickening of the walls of the trachea and bronchi which are the seat of calcifications. Bronchoscopy found a burgeoning infiltrative lesion training the right side face of the trachea and the anterior edge of the hull. Histological results confirmed tracheobronchial amyloidosis. Typing of this amyloidosis concluded to AL form. The study of amyloid extension lesion was negative. Immunoelectrophoresis of proteins in the blood and urine was normal. The patient was sent to receive external beam radiation to prepare for endoscopic surgical removal. Post-operative suites were marked by a complete resolution of clinical signs particularly hemoptysis with a follow-up of two years.

关键词： Amyloidosis Trachea Biopsy

Systemic Sarcoidosis Revealed by a Nasal Lesion: A Case Report

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International Journal of Clinical Medicine 2015年第4期6卷 257-261页

作者： Madiha Mahfoudhi Khaled Khammassi sami turki Mamia Ben Salah Department of Internal Medicine A Charles Nicolle Hospital Tunis Tunisia Department of Oto-Rhino-Laryngology Charles Nicolle Hospital Tunis Tunisia

A 62-year-old man presented with bilateral nasal obstruction and recurrent epistaxis episodes. Physical examination revealed normal body temperature and free cervical lymph nodes areas. Nasal endoscopy found a congestive nasal mucosa associated to bilateral inferior turbinate hypertrophy with a granular aspect of the right inferior turbinate. The biological examination showed lymphopenia, inflammatory syndrome, high serum level of angiotensin-converting enzyme and β2 microglobulin. Tuberculin skin test and Quantiferon gold were negative. The nasal and accessory salivary gland biopsies revealed granulomatous giant cell lesions non-caseating evoking systemic sarcoidosis. Ziehl-Neelsen staining and Lowenstein culture were negative. The diagnosis was systemic sarcoidosis revealed by nasal localization. The systemic extension research was negative. The treatment was based on corticosteroids (1 mg/kg/day) and gradual degression doses associated to a local nasal corticosteroid. The outcome was favorable with improvement of nasal obstruction and disappearance of initial lesions. The follow-up was 2 years.

关键词： Sarcoidosis Nose Granuloma Corticosteroids

Kikuchi-Fujimoto Disease Mimicking Tuberculosis

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International Journal of Clinical Medicine 2015年第10期6卷 725-728页

作者： Madiha Mahfoudhi Imen Gorsane sami turki Taieb Ben Abdallah Department of Internal Medicine A Charles Nicolle Hospital Tunis Tunisia

A 32-year-old woman presented with a fever and cervical lymphadenopathies. The research for Mycobacterium tuberculosis was negative. Tuberculin skin test was positive. Laboratory investigations showed an elevated erythrocyte sedimentation rate and a normal white blood cell count. Bacteriological and viral investigations were negative. Quantiferon-Tb Gold test was indeterminate. Thraco-abdominal and pelvic computed tomography, FDG-PET and gallium scintigraphy revealed no abnormalities. Histological study of cervical lymph node biopsy found signs in favor of histiocytic necrotizing lymphadenitis. There were no epithelioid cell granulomas. A test tuberculosis treatment was refused by the patient. The evolution was marked by spontaneous clinical and biological resolution in fifty days. The negative Lowenstein-Jensen culture eliminated formally the tuberculosis. KFD was thus the most likely diagnosis.

关键词： Kikuchi-Fujimoto Disease Mycobacterium tuberculosis Lymphadenitis Histology

Adult Onset Still’s Disease

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International Journal of Clinical Medicine 2015年第10期6卷 716-724页

作者： Madiha Mahfoudhi Imen Gorsane Rafik Shimi sami turki Taieb Ben Abdallah Department of Internal Medicine A Charles Nicolle Hospital Tunis Tunisia

The adult onset Still’s disease is a rare affection characterised by occurrence of fever, arthralgia or arthritis and evanescent cutaneous eruption. Multiple other systemic lesions make the diagnosis more difficult. Several diagnostic criteria were formulated to confirm this disease. The physiopathology of the adult onset Still’s disease is not well elucidated. However, several studies based on new facts in physiopathology, improved the therapy of refractory forms for which the biotherapy was an interesting alternative. The TNF alpha receptor antagonists are efficient on systemic and articular manifestations of this disease and allow a corticosteroid’s saving. Tocilizumab (interleukin 6 receptor antagonist), and Anakinra (interleukin 1 receptor antagonist) are also new promising treatments for resistant forms.

关键词： Adult Onset Still’s Disease Cytokine TNF Alpha Receptor Antagonist Interleukin 6 Receptor Antagonist Interleukin 1 Receptor Antagonist

Relapsing Polychondritis Associated with Myelodysplastic Syndrome

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Open Journal of Clinical Diagnostics 2015年第1期5卷 10-13页

作者： Mahfoudhi Madiha Mamlouk Habiba Lahiani Rym turki sami Kheder Adel Department of Internal Medicine A Charles Nicolle Hospital Tunis Tunisia

A 62-year-old man had arthritis and an infiltrated purpuric eruption of the legs. He presented then a cyanosis and aches of the left ear’s pinna with a voice disturbance and an inflammatory aspect of the nose. He had an anemia and a thrombopenia. The infectious and auto-immune research was negative. The laryngo-tracheal scan revealed calcifications of the larynx, the trachea and the initial portion of bronchi. Moreover, the biopsy from ear’s pinna cartilage confirmed the diagnosis of chondritis and peri-chondritis. He was thus considered to have the association with relapsing polychondritis and a myelodysplastic syndrome. The patient was treated with corticosteroids and iterative transfusions. The articular and skinny patient’s symptoms completely resolved. The anemia and the thrombopenia were partially improved. The relapsing polychondritis can be considered as paraneoplastic complication in the context of a myelodysplastic syndrome or as a fortuitous association. The mechanism of such an association remains unknown.

关键词： Relapsing Polychodritis Biopsy Myelodysplastic Syndrome Prognosis

Recurrent Hemoptysis in a Young Man

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Open Journal of Internal Medicine 2015年第3期5卷 29-32页

作者： Madiha Mahfoudhi Imen Gorsane Mounira El Euch sami turki Taieb Ben Abdallah Internal Medicine Department Charles Nicolle Hospital Tunis Tunisia

Hughes-Stovin syndrome is a scarce entity associating pulmonary artery aneurysms and deep venous thrombosis. It was considered to be a form of Behcet’s syndrome at its initial feature. We present a case of a 27-year-old man having a Hughes-Stovin syndrome. The patient had a history of left ilio-femoral thrombosis and suffered from recurrent oral ulcers. He presented with recurrent hemoptysis. A giant pulmonary aneurysm was confirmed by chest CT scan. A right femoral thrombosis was shown on the inferior legs doppler ultrasonography. The patient was treated by steroids and cyclophosphamide and proposed to an embolization to prevent recurrence of symptoms.

关键词： Hemoptysis Pulmonary Aneurysm Hughes-Stovin Syndrome

Primary Laryngeal Tuberculosis

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International Journal of Clinical Medicine 2015年第4期6卷 249-251页

作者： Madiha Mahfoudhi Khaled Khammassi Amel Gaieb Battikh Mamia Ben Salah sami turki Department of Internal Medicine A. Charles Nicolle Hospital Tunis Tunisia Department of Oto-Rhino-Laryngology Charles Nicolle Hospital Tunis Tunisia

Primary laryngeal tuberculosis is rare. It can manifest as a malignancy delaying the diagnosis and the therapeutic management. We report the case of a 34-year-old immunocompetent man whose plaints were fever, sweat and dysphonia. There were no adenopathy, nor hepatosplenomegaly. Several blood cultures were negative. Laboratory studies showed an inflammatory syndrome. In addition, the bacteriological examinations of sputum and urine in search of Mycobacterium tuberculosis were negative. Laryngoscopy confirmed the presence of a thickness of the right vocal cord and an ulcer in the hemilarynx. The histological examination revealed tuberculoid granulomas suggestive of tuberculosis. The culture from vocal cord tissue for Mycobacterium tuberculosis was positive. No other focus of tuberculosis was found on X-ray and computed tomography. Treatment by a combination of isoniazid, rifampicin, pyrazinamide induced a total resolution of symptoms.

关键词： Larynx Tuberculosis Dysphonia

Systemic Sarcoidosis Associated to IgA Nephropathy

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Case Reports in Clinical Medicine 2015年第8期4卷 284-288页

作者： Madiha Mahfoudhi Imen Gorsane Mounira El Euch Rym Goucha sami turki Taieb Ben Abdallah Internal Medicine A Department Charles Nicolle Hospital Tunis Tunisia

The sarcoidosis was rarely associated to IgA nephropathy. We report a 38-year-old man presented decreased visual acuity and xerostomia. He had two axillary lymphadenopathies and pitting edema of legs in physical examination. The ophthalmological examination revealed a right posterior uveitis. Biological investigations showed a mild renal insufficiency and elevated serum level of angiotensin-converting enzyme, β2 microglobulin and IgA. He had a proteinuria and a microscopic hematuria. The kidney echography was without abnormalities. Histological study of the renal biopsy found results in favor to IgA nephropathy. Biopsies performed in accessory salivary gland and lymph nodes revealed non-necrotising epitheloid and gigantocellular granulomatous inflammation suggesting a sarcoidosis. The diagnosis of a sarcoidosis associated to IgA nephropathy was posed. The treatment was based on oral prednisolone with gradual tapering doses. He regained normal vision. The renal function had not worsened. No relapse of sarcoidosis was noted during our follow up.

关键词： Sarcoidosis Granuloma Proteinuria IgA Nephropathy

Hypokalemic Paresis Revealing a Primary Sjogren’s Syndrome

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Open Journal of Internal Medicine 2015年第3期5卷 33-36页

作者： Madiha Mahfoudhi Hedia Bellali Imen Gorsane Mounira El Euch sami turki Taieb Ben Abdallah Internal Medicine Department Charles Nicolle HospitalTunisTunisia Epidemiology and Statistics Department Mami HospitalArianaTunisia

Hypokalemic acidosis can complicate a primary Sjögren’s syndrome. The clinical feature is rarely revealed by manifestations due to hypokalemia. We report the case of a 46-year-old woman, admitted to explore a paresthesia and paresis of inferior limbs. The diagnosis of Sjögren’s syndrome was retained since there was the association of xerophthalmia, sialadenitis at the labial biopsy and positive immunological results (anti-SSA and anti-SSB). The absence of another auto-immune or systemic illness allowed us to consider that the Sjögren’s syndrome was primary. The biological explorations revealed a hyperchloremic and hypokalemic acidosis. The treatment was based on corticosteroid and potassium supplementation. The follow-up was marked by a clinical and biological amelioration.

关键词： Sjogren’s Syndrome Hypokalemia Interstitial Nephritis Tubulopathy