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Introduction: Cryptococcosis is a serious invasive fungal infection mostly described in patients with cell-mediated immunosuppression. Cryptococcus neoformans osteomyelitis is a rare infection that occurs mainly during disseminated forms., Observation: A 72-year-old diabetic patient, treated with fludarabine-cyclophosphamide-rituximab (since 10 months) for lymphocytic leukemia presented with osteolysis of the fourth left hand metacarpien the histological examination of which revealed C. neoformans. This bone involvement was associated with costal osteolytis and pulmonary cryptococcosis but central nervous system (CNS) was spared. Fluconazole was administered intravenously for 15 days, then switched to oral route for 6 months with favorable clinical course. This case describes an unusual clinical presentation of disseminated cryptococcosis without CNS involvement with multiple osseous metastases. A review of cryptococcal osteomyelitis cases reported in adult from 2000 to 2011 is also discussed., Conclusion: Cryptococcosis is a rare infection that should be discussed in seriously immunocompromized patients presenting with osteomyelitis even in the absence of CNS involvement., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: A cluster of indigenous typhoid fever cases in the greater Lille area, in January 2009, triggered investigations to identify the contamination source and to optimize care for infected individuals., Methods: A case was defined as a person, living in the greater Lille area of, having presented with symptoms of typhoid fever, from January to March 2009., Results: Sixteen cases of typhoid fever were identified between January 23 and March 22, 2009. Patients, none of whom had travelled, had all participated in a common meal on January 10, 2009. A woman, who helped prepare the meal and who had previously stayed in an endemic zone, was detected as the asymptomatic carrier of Salmonella Typhi., Conclusion: In France, although typhoid fever remains essentially an imported disease, there is a risk of indigenous epidemic and its diagnosis can be suggested for individuals who have not travelled. The features of this cluster illustrate the importance of respecting basic rules of hygiene in catering., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

A case of Salmonella paratyphi A infection was diagnosed late in a patient treated for febrile pneumonia after his returning from India. This case was remarkable in two aspects: first, it illustrated the reemergence of S.paratyphi A infections in people having traveled to India, with increasing fluoroquinolone resistance, and second the difficulty of diagnosing this disease, since the patient was initially treated for pneumonia and flu-like syndrome. Salmonella typhi or paratyphi infections should be evoked in case of persistent fever in patients having traveled to endemic areas, even if digestive signs are absent. Furthermore, choosing an empiric antibiotic treatment with fluoroquinolones could lead to treatment failure if the patient traveled in a country where fluoroquinolone resistance is high, as in Asia and especially in India.

The authors report an unusual case of prosthetic vascular graft infection due to Salmonellatyphimurium. The initial treatment combined antibiotherapy and surgical replacement of the arteriovenous graft. The infection relapsed within 6 weeks and was successfully treated with antibiotics only. Five cases of vascular graft infection due to Salmonella have been reported so far, but only one occurred in a previously healthy man and was not related to local infection, but to bacteremic seeding. Specific features of vascular graft infection and importance of prevention are discussed.

Septic arthritis is potentially a life-threatening disease and frequently afflicts the most fragile patients. It is crucial to rule-out this diagnosis in a patient presenting with monoarticular arthritis, and the gold-standard is aspiration of the joint. A primary site of infection such as endocarditis or spondylodiscitis must be excluded by appropriate examination and investigative studies. The usual infecting organisms causing septic arthritis are Staphylococcus and Streptococcus species, and in young adults Gonococcus must be considered. Antibiotics should be started promptly after obtaining joint fluid for bacteriologic studies. Efficient drainage and lavage of the joint should be performed without delay because articular cartilage can be damaged quickly. Arthroscopy is a well-accepted technique in treating septic arthritis, particularly when the knee is involved.

Introduction: Meningoencephalitis attributed to Chlamydiae pneumoniae has rarely been reported in the literature., Observation: We describe the case of a 21-year-old-man admitted for a meningeal syndrome and fever associated with respiratory symptoms and a temporal syndrome. Even though the clinical presentation and certain serological results suggested Chlamydiae infection, some of the biological data raised the possibility of Epstein Barr Virus infection. Intravenous fluoroquinolone therapy led to a successful outcome., Conclusion: Meningoencephalitis associated with non neurological symptoms, especially respiratory symptoms, is suggestive of Chlamydia pneumoniae infection. A broad spectrum antibiotic should be prescribed.

Introduction: Screening strategies among pregnant women have decreased the incidence of group B Streptococcus, which causes severe neonatal infections. The incidence of these infections has increased among diabetic patients, however., Objectives: To specify the characteristics of diabetic foot infections in which surgical samples have isolated one or several germs including group B Streptococcus, study its risk factors and determine its course., Materials and Methods: We retrospectively evaluated the records of all patients admitted to the University Hospital of Geneva from January 1999 through October 2004, with diagnoses of severe foot infection (+/- osteomyelitis) documented during surgery., Results: Twenty-five severe diabetic foot infections were identified, 21 with osteomyelitis. The most common risk factors were age older than 60 years (n=10), chronic renal failure (n=7), severe arteriopathy (n=6), and immune depression (n=2). Most lesions were classified as grade 3 or 4 of Wagner's classification. 80% of the surgical samples were polymicrobial. Blood cultures were positive in 4 patients, one in septic shock. Half the patients (n=13) underwent amputation, despite initially appropriate antibiotic treatment. No patients died but 3 relapsed., Conclusion: Group B streptococcal foot infections often occur in fragile patients with immune depression or severe arterial disease. Despite intensive antibiotic therapy and adequate debridement, amputation is often required in diabetic patients because of severe damage to the tissue and poor vascularization.

A DELETERIOUS ROLE OF STREPTOCOCCUS AGALACTIAE?: Introduction Screening strategies among pregnant women have decreased the incidence of group B Streptococcus, which causes severe neonatal infections. The incidence of these infections has increased among diabetic patients, however. OBJECTIVES: To specify the characteristics of diabetic foot infections in which surgical samples have isolated one or several germs including group B Streptococcus, study its risk factors and determine its course. Materials and methods We retrospectively evaluated the records of all patients admitted to the University Hospital of Geneva from January 1999 through October 2004, with diagnoses of severe foot infection (+/- osteomyelitis) documented during surgery. RESULTS: Twenty-five severe diabetic foot infections were identified, 21 with osteomyelitis. The most common risk factors were age older than 60 years (n=10), chronic renal failure (n=7), severe arteriopathy (n=6), and immune depression (n=2). Most lesions were classified as grade 3 or 4 of Wagner's classification. 80% of the surgical samples were polymicrobial. Blood cultures were positive in 4 patients, one in septic shock. Half the patients (n=13) underwent amputation, despite initially appropriate antibiotic treatment. No patients died but 3 relapsed. CONCLUSION: Group B streptococcal foot infections often occur in fragile patients with immune depression or severe arterial disease. Despite intensive antibiotic therapy and adequate debridement, amputation is often required in diabetic patients because of severe damage to the tissue and poor vascularization.

Respiratory infections are frequently encountered in the community; these infections are usually associated with only minor consequences. Many different agents, such as influenza and parainfluenza virus, respiratory syncitial virus, rhinovirus, coronavirus, adenovirus and herpes virus can be found in immuno-competent patients. Among these pathogens, cytomegalovirus (CMV) has been found to be responsible for nosocomial pneumonia in ICU. The main problem for viral infections, is the diagnosis, isolation of the pathogen is often difficult and not always reliable and the symptoms not specific. However, influenza is characterised by fever, myalgia, headache and pharyngitis, this infection may be very mild, even asymptomatic, moderate or very severe. Finally, the most recent viral pathogen involved in respiratory disease is a newly discovered coronavirus, the SARS-CoV which was responsible for the worldwide outbreak of Severe Acute Respiratory Syndrome. Viral pneumonia is a common pathology which is probably underdiagnosed in immuno-competent patients; many reports show that even if the diagnosis is difficult to obtain, it is not useless as long as we have, for most of the pathogens, an effective treatment. The gold standard was histology, new techniques like PCR can probably make a difference and should be included in the guidelines to improve diagnostic efficiency., (Copyright © 2004 Société de réanimation de langue française. Published by Elsevier Masson SAS All rights reserved.)

Purpose: Antisynthetase syndrome (AS) is frequently revealed by interstitial lung disease and arthritis. There are mechanic's hand, Raynaud's phenomenon and anti aminoacyl t-RNA synthetase antibodies. The anti JO-1 antibody is the most frequently identified. We report five cases of antisynthetase syndrome with particular clinical features and good response to corticosteroids., Methods: There are three women and two men with a median age of 59 years at presentation (range: 44-77). Three patients progressively developed AS: the symptoms are dyspnea (three). Raynaud's phenomenon (one), purpura (one) and hyperkeratosis, scaling and fissuring on the lateral sides of the fingers (two). Patients always had skin signs: hyperkeratosis and scaling (five), purpura (one), Raynaud's phenomenon with normal capillaroscopy (two). Lung disease is present in the five cases with interstitial lesions in CT scans (five), trouble of CO diffusion (three/three) and lymphocytic alveolitis (two/two). Moderate muscular disorders are present in five cases (moderate elevated muscular enzyme: five, positive muscle histology: two). Anti-JO-1 antibodies are present in five cases. AS is associated with connective tissue diseases: rheumatoid polyarthritis in one case and Gougerot-Sjögren in three cases. No malignant tumour is associated. Patients have received oral corticosteroid treatment (five/five) with high doses of intravenous perfusions (three/five) with, initially, a good response. For only one patient, immunosuppressive treatment was necessary because of the articular relapse. The interstitial lung disease had a good response to corticosteroids therapy alone in four cases. Because of the relapse during the tapering off of corticosteroids, corticosteroids were increased in one case and immunosuppressive therapy was required in one case., Conclusion: The prognosis of AS depends of the interstitial lung disease. High doses of corticosteroids are required. In our study, the response to corticosteroids is good. Immunosuppressive agents must be added in severe and progressive form of interstitial lung disease in AS.

Introduction: To better individualize drug hypersensitivity reaction, Bocquet et al. have recently called this adverse drug reaction DRESS (Drug Rash with Eosinophilia and Systemic Symptoms)., Exegesis: We report two cases of DRESS and highlight the main characteristics of this syndrome. Two patients presented severe febrile skin eruption following drug intake (carbamazepine or sulfazalazine), with hypereosinophilia and hepatitis. All symptoms resolved after drug withdrawal and corticosteroid therapy. DRESS syndrome is an idiosyncratic reaction characterised by febrile eruption, occurring 2 to 6 weeks after the beginning of the treatment, accompanied by systemic symptoms and biological abnormalities (hypereosinophilia, hepatitis). Some complications can occur. This syndrome can be fatal. Numerous drugs can be responsible for this reaction to medication. The physiopathology has not yet been elucidated, and the treatment is not codified, but the triggering agent must immediately be stopped. Corticotherapy is sometimes used., Conclusion: It is important to recognize this entity recently named DRESS syndrome because it can mimic other pathologies, is potentially serious, and because withdrawal of the incriminating drug is imperative.

Background: There are many causes of macroglossia, including fatty infiltration. Unlike unique or multiple lipomas of the tongue, non-encapsulated adipocyte masses develop in the tongue in symmetrical benign lipomatosis. Only six cases have been reported in the literature., Case Report: A 69-year-old man with a history of chronic alcoholism developed a soft tumefied formation on the lateral margins of the tongue. A yellow-colored content was perceived through the thin mucosa. The formation was bilateral and had developed for more than 10 years. The patient also presented Launois-Bensaude lipomatosis localized on the neck, the nuchal region and the shoulders., Discussion: This is, to our knowledge, the first reported case of symmetrical benign lipomatosis associated with Launois-Bensaude lipomatosis. An analogy between these two conditions has been suggested, but the six earlier cases of lipomatosis of the tongue reported in the literature developed in patients without cutaneous lipomatosis.

Background: Tramadol chlorhydrate (Topalgic) is a powerful analgesic recently introduced in France where its use has spread rapidly. We report a case where this drug induced a maculopapulous toxic skin reaction with secondary erythrodermia., Case Report: A 47-year-old man was treated for lower back pain with tramadol chlorhydrate (50 mg b.i.d.). Otherwise, he was in good general health and was taking no other medications. Shortly after beginning the treatment, he developed a highly pruriginous maculopapulous eruption involving the entire skin surface, hyperthermia and general degradation. There was no skin exfoliation, mucosal involvement nor nodal enlargement. Tramadol was withdrawn and the patient was given corticosteroid therapy. Secondary erythrodermia developed after termination of the corticosteroids. The lesions regressed after tramadol withdrawal., Discussion: Tramadol-induced skin reactions are uncommon and usually benign. In our case, the delay from onset of tramadol and the development of the maculopapulous eruption was very short (four days). The patient was taking no other medication. We hypothesize that the patient had been sensitized by cross-reaction with another compound and recall the fundamental aspects of tramadol and opiate drugs.