Search

Blastomycosis is a rare case. We report a first Moroccan case. A 41-year-old male presented with a 6-month history of dyspnea, fever and significant chest pain associated with night sweats and weight loss. The physical examination disclosed a firm painful paravertebral mass. The chest radiograph demonstrated a left apical opacity. The thoracic scan showed parenchymal infiltration of the apico-dorsal segment of the left upper lobe with vertebral and costal lytic lesions. Surgical biopsy showed granulomatous inflammation with giant-cell intracytoplasmic inclusions. Fungal studies yielded Blastomyces dermatitidis which responded excellently to ketoconazole. Outcome has been excellent at 3.5 years months follow-up. The clinical and radiographic presentation of blastomycosis is non-specific and can be mistaken for a neoplasm. Delay in diagnosis is common.

Resume Introduction Les troubles psychotiques sont classiques au cours du lupus systemique (LES), faisant partie des criteres de l’American College of Rheumatology (ARA), mais ils sont rarement revelateurs et sont source de difficultes diagnostiques surtout s’ils sont isoles. Cas clinique Une femme, âgee de 20 ans, fut hospitalisee pour un trouble psychotique aigu evoluant depuis deux semaines avec alteration de l’etat general. L’examen clinique objectivait des reflexes osteotendineux vifs avec un signe de Babinski a droite. L’IRM encephalique mit en evidence une lesion nodulaire du centre semi-ovale gauche en hyposignal en T1, hypersignal en T2 et T2 flair. Il existait une lymphopenie, et les anticorps antinucleaires, anti-ADN natifs et antiphospholipides etaient positifs. L’evolution fut favorable sous corticotherapie orale, neuroleptique et antidepresseur. Conclusion Devant toute symptomatologie psychiatrique atypique de la femme jeune, il faut evoquer un lupus systemique.

Introduction Le syndrome d’APECED (autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy) est une maladie rare, de transmission autosomique recessive, liee aux mutations du gene AIRE. Son diagnostic repose classiquement sur l’association de deux des trois criteres majeurs suivants: candidose cutaneomuqueuse chronique, hypoparathyroidie et insuffisance surrenale d’origine autoimmune. D’autres manifestations endocriniennes et autoimmunes peuvent completer le tableau. En revanche, l’association de cette polyendocrinopathie a une lymphangiectasie intestinale a ete rapportee trois fois, posant un probleme d’ordre nosologique sur le caractere fortuit ou non de cette association.

Resume Introduction L’hydatidose est une anthropozoonose cosmopolite commune a l’homme et a de nombreux mammiferes due au developpement dans l’organisme de l’Echinococcus granulosis. Observation Nous rapportons l’observation d’une patiente âgee de 58 ans qui consultait pour une masse sous-cutanee du cuir chevelu sans signes inflammatoires locaux. Les differentes explorations ont conclu a une masse kystique sous-cutanee. Une kystectomie totale etait realisee. L’examen anatomopathologique a conclu a un kyste hydatique. Discussion La localisation sous-cutanee de la maladie hydatique est tres rare, meme en zone d’endemie. Le diagnostic est evoque par l’imagerie echographique et confirme histologiquement.

Resume Introduction Les manifestations neurologiques du syndrome de Gougerot-Sjogren (SGS) touchent essentiellement le systeme nerveux peripherique. Nous rapportons un cas d’atteinte neurologique centrale rare. Observation Une femme, âgee de 54 ans, presenta des cephalees et un deficit des quatre membres, avec a l’examen, un syndrome tetrapyramidal ainsi qu’une parotidomegalie bilaterale sans alteration de l’etat general. L’IRM montra une formation heterogene, protuberantielle avec presence de multiples lesions de la substance blanche periventriculaire. Le bilan etiologique retrouva des anticorps anti-SSA et anti-SSB, un stade III a la BGSA et un test de Schirmer positif. Le diagnostic de syndrome de Gougerot-Sjogren primitif fut retenu. Conclusion Cette observation illustre l’interet de rechercher un syndrome de Gougerot-Sjogren devant une presentation clinicoradiologique centrale quand l’etiologie n’est pas patente.

The authors report a 38-year-old young Moroccan woman with retroperitoneal fibrosis (RPF) associated with Takayasu's disease. The RPF was diagnosed in the presence of an acute renal failure requiring placement of double J catheters while an abdominal CT scan was suggestive of RPF. The diagnosis of Takayasu's disease was suspected three years later when the patient presented with right upper extremity dysesthesia. Aortic angiography showed evidence of typical inflammatory arteritis involvement with bilateral regular and concentric stenosis of axillary arteries and a left, smoothly narrowed primitive carotid artery, and left renal artery partial occlusion. The patient was treated with prednisone (0.5mg/kg per day) with a marked improvement. The association between RPF and Takayasu's disease is very rare, and only five cases have been reported in the literature. These two diseases share similarities in some of the etiologic factors and anatomic localizations.

Hydatid disease is a broad-based anthropozoonosis common to humans and several mammal species. The disease results from the development of Echinococcus granulosis in the body.We report a new case involving a 58-year old woman hospitalized for a subcutaneous mass in the scalp with no local inflammatory signs. Radiological examination was consistent with a subcutaneous cyst. Complete surgical resection of the mass was performed. Histopathological examination demonstrated hydatid cyst.Subcutaneous localization of hydatid cyst is uncommon even in endemic zone. Diagnosis is suggested by ultrasonography and confirmed by histology.

Blastomycosis is a rare case. We report a first Moroccan case. A 41-year-old male presented with a 6-month history of dyspnea, fever and significant chest pain associated with night sweats and weight loss. The physical examination disclosed a firm painful paravertebral mass. The chest radiograph demonstrated a left apical opacity. The thoracic scan showed parenchymal infiltration of the apico-dorsal segment of the left upper lobe with vertebral and costal lytic lesions. Surgical biopsy showed granulomatous inflammation with giant-cell intracytoplasmic inclusions. Fungal studies yielded Blastomyces dermatitidis which responded excellently to ketoconazole. Outcome has been excellent at 3.5 years months follow-up. The clinical and radiographic presentation of blastomycosis is non-specific and can be mistaken for a neoplasm. Delay in diagnosis is common.

Neurological manifestations in Sjögren's syndrome are variable. The peripheral nervous system is generally involved. We report a rare case of an unusual central neurological manifestation.A 54-year-old woman was admitted with headache and tetraparesia. The physical examination revealed a tetrapyramidal syndrome and a bilateral parotidomegaly. The patient's general condition was nevertheless quite good. Brain MRI showed an heterogeneous pontine lesion with multiple nodular formations in the periventricular white matter. Blood tests revealed anti-SSA and anti-SSB antibodies. A labial salivary gland biopsy was grade IV in Chisholm scoring system and Schirmer's test was positive.A latent Sjögren's syndrome can lead to a wide variety of focal brain MRI abnormalities and should be evoked when the etiology is not clear.

The authors report a 38-year-old young Moroccan woman with retroperitoneal fibrosis (RPF) associated with Takayasu's disease. The RPF was diagnosed in the presence of an acute renal failure requiring placement of double J catheters while an abdominal CT scan was suggestive of RPF. The diagnosis of Takayasu's disease was suspected three years later when the patient presented with right upper extremity dysesthesia. Aortic angiography showed evidence of typical inflammatory arteritis involvement with bilateral regular and concentric stenosis of axillary arteries and a left, smoothly narrowed primitive carotid artery, and left renal artery partial occlusion. The patient was treated with prednisone (0.5mg/kg per day) with a marked improvement. The association between RPF and Takayasu's disease is very rare, and only five cases have been reported in the literature. These two diseases share similarities in some of the etiologic factors and anatomic localizations.

Psychotic disorders are classical in systemic lupus and are listed among American College of Rheumatology (ARA) criteria. They are rarely inaugural and can compromise diagnosis, especially if they are isolated.A 20-old-year woman was hospitalized for an acute psychotic disorder of two weeks duration with a degradation of the general status. Physical examination revealed intense osteo-tendon reflexes with a right Babinski sign. Brain MRI visualized a nodular low signal T1, T2 and high signal T2 flair in the left centrum semi-ovale. Blood counts showed lymphopenia. Antinuclear antibody and anti-DNA native antibody were positive. The clinical course favorable after treatment using oral corticosteroids, an neuroleptic and an antidepressant.Systemic lupus is a potential diagnosis for any atypical psychiatric symptoms in young women.