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Background Hughes–Stovin syndrome (HSS) is a rare vasculitis characterized by the association of thrombophlebitis with pulmonary artery aneurysms (PAAs). Because it is rarely reported, there are currently no established diagnostic criteria or standardized treatment guidelines for HSS. While conventional immunosuppressants are generally effective as first-line treatment, relapsing and refractory cases urge the need to investigate alternative therapies, such as TNF-alpha inhibitors. However, with only five cases published in the literature, knowledge of their efficacy in HSS is very limited. Case summary A 28-year-old man, with no past medical history, presented with haemoptysis, chest pain, and dyspnoea on exertion. Physical examination found bilateral leg swelling, with no associated lesions. CT angiography showed multiple bilateral PAA, proximal pulmonary artery thrombosis (PAT), and deep venous thrombosis (DVT) in the superior mesenteric vein and spleno-mesaraic confluence. Echocardiography was performed, identifying right intracardiac thrombosis (ICT). Initial management included high-dose corticosteroids and monthly cyclophosphamide cycles, followed by maintenance treatment with oral azathioprine. Eighteen months later, the patient presented with haemoptysis revealing a relapse of ICT and two new PAA. Infliximab was initiated, allowing complete and sustained remission after one year of follow-up. Discussion We report the challenging case of an HSS patient presenting with multiple PAA, proximal PAT, right ICT, and extended abdominal DVT. The positive response of our patient to infliximab, following a relapse under conventional immunosuppressants, supports the efficacy of TNF-alpha inhibitors as second-line treatment in relapsing/refractory HSS. [ABSTRACT FROM AUTHOR]

The new corona virus disease (COVID-19) pandemic originated from Wuhan, China, at the end of 2019 [1] and has now rapidly spread over the world. This pandemic is the defining global health crisis of our time and the greatest threat we have faced during this century. As a highly contagious virus, the infections rapidly spread globally; with the most affected regions being the USA, South-East Asia, Europe and Eastern Mediterranean. The African continent is less affected but a gradual increase in cases has been noted since two months ago in several African countries including Morocco. According to the World Health Organizations' (WHO) data, in globally, in 19th September 2020, there have been 30,369,778 confirmed cases of COVID-19, including 948,795 deaths [2]. To date, in the absence of any specific treatment, our knowledge of the disease is better known but is subject to rapid change. This has led to the prompt development of clinical patient risk stratification tools to aid in determining the need for testing, isolation, monitoring, ventilator support and disposition.

Abstract Introduction Subacute combined degeneration of the spinal cord is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and is a neurological complication of vitamin B12 deficiency. Subacute combined degeneration without anemia or macrocytosis is rare. Case presentation We present a case of cobalamin deficiency in a 29-year-old Moroccan woman who presented with subacute combined degeneration without evidence of anemia or macrocytosis. Magnetic resonance imaging of the spinal cord demonstrated abnormal hyperintense signal changes on T2-weighted imaging of the posterior and lateral columns from the medulla oblongata to the thoracic spine. A diagnosis of subacute combined degeneration of the spinal cord was considered and confirmed by low serum cobalamin. The patient was treated with vitamin B12 supplements and showed improvement in her clinical symptoms. Conclusion Physicians should diagnose subacute combined degeneration in patients early by having a high index of suspicion and using diagnostic tools such as magnetic resonance imaging.

L'ostéochondromatose synoviale est une métaplasie chondroïde synoviale qui se détache de la synoviale pour évoluer jusqu'à la calcification et l'ossification. Cette tumeur bénigne peut prendre des volumes considérables et est ainsi susceptible d'avoir un retentissement fonctionnel sur l'articulation atteinte, nécessitant une prise en charge chirurgicale. La litérature rapporte trois cas d'ostéochondromatose synoviale, primitive ou secondaire, au cours d'un lupus systémique. Nous en donnons ici une nouvelle observation. [ABSTRACT FROM AUTHOR]

La calcinose sous-cutanée est une complication rare mais redoutable des connectivites, notamment du lupus érythémateux systémique, en particulier au cas de lésions cutanées chroniques. Elle résulte d'un dépôt de cristaux de calcium dans le tissu cutané, le plus souvent en région périarticulaire. Son mécanisme physiopathologique est encore mal élucidé. Elle peut entraver la qualité de vie des patients par ses complications, notamment articulaires. Son traitement n'est pas bien codifié. Plusieurs molécules ont été utilisées, avec des effets aléatoires. La chirurgie est proposée pour des calcinoses larges et distinctes. [ABSTRACT FROM AUTHOR]

Le pyoderma gangrenosum (PG) est une dermatose neutrophilique qui se présente cliniquement par des ulcérations cutanées aseptiques. L'association d'un PG au lupus érythémateux systémique est rarement décrite dans la littérature. Elle est souvent l'apanage du sujet jeune. Les phénomènes physiopathologiques du PG (activation des polynucléaires neutrophiles, infiltration et diapédèse) ainsi que la sécrétion de certaines cytokines pro-inflammatoires pourraient jouer un rôle dans la pathogénie du lupus érythémateux systémique. Le caractère paranéoplasique de ces deux pathologies associées, surtout chez le sujet âgé, mérite une investigation approfondie et une surveillance étroite, du fait de son caractère péjoratif. Le traitement de base du PG reste local. La corticothérapie est souvent indiquée. Le choix thérapeutique, dans notre cas, était fait au vu de la gravité, de la dissémination des ulcérations cutanées ainsi que de l'association avec d'autres atteintes organiques du lupus. Les immunosuppresseurs et les anti-TNF présentent une deuxième alternative thérapeutique. Nous rapportons une observation illustrant cette association rare de PG et de lupus systémique chez un sujet âgé. [ABSTRACT FROM AUTHOR]

Intravascular large B-cell lymphoma (IVLBCL) remains a diagnostic challenge, because of non-specific findings on clinical, laboratory, and imaging studies. We present a case in which 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography was particularly useful to suspect the diagnosis, to detect unexpected locations, to guide contributive biopsy, and to assess the response to treatment. In case of initial negative results, FDG-PET should be repeated in the course of clinical evolution. In the presence of neurological or hormonal symptoms without brain magnetic resonance imaging abnormality, FDG-PET brain slices could depict additional pituitary and/or brain hypermetabolisms. We discuss the potential interests of FDG-PET in IVLBCL by a literature review. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Neurologic signs and symptoms may represent the initial presentation of AIDS in 10-30% of patients. Movement disorders may be the result of direct central nervous system infection by human immunodeficiency virus (HIV) or the result of opportunistic infections. We report the case of a 59 years old woman who had hemichorea-hemiballismus subsequently found to be secondary to a cerebral toxoplasmosis infection revealing HIV infection. Movement disorders, headache and nausea were resolved after two weeks of antitoxoplasmic treatment. Brain MRI control showed a marked resolution of cerebral lesion. Occurrence of hemichorea-ballismus in patient without familial history of movement disorders suggests a diagnosis of AIDS and in particular the diagnosis of secondary cerebral toxoplasmosis. Early recognition is important since it is a treatable entity. [ABSTRACT FROM AUTHOR]

Behçet disease is a multi-systemic complex vasculitis with unknown etiology characterized by different clinical involvements, including mucocutaneous, ocular, vascular, articular, neurological, and gastrointestinal manifestations. Growing evidence supports that different phenotypes, characterized by clusters of co-existing involvements, can be distinguished. Namely, the vascular phenotype identifies a specific group of patients who suffer from recurrent inflammatory thrombosis and arterial involvement. Vascular disease develops in up to 40% with a definite male preponderance and is usually an early manifestation. Venous involvement is significantly more common than arterial disease, and lower extremity deep vein thrombosis is its most frequent manifestation. Arterial disease involves mostly pulmonary arteries and aorta and manifests mainly in the form of aneurysms. Glucocorticoids and immunosuppressants are the recommended first-line treatments in vasculo-Behçet. Furthermore, controlled trials are still needed to assess the role of adding anticoagulation to the treatment regimen, with an accent on new oral anticoagulants. Treatment with anti-TNF alpha agents seems promising, but the management strategies are not clear yet.

Ankylosing spondylitis is a chronic inflammatory rheumatism; it is part of the group of spondyloarthrites. General signs such as fever and weight loss are of little importance. Adult Still's disease is a rare systemic condition, a diagnosis of exclusion commonly characterized by high hectic fever, rash, arthritis and various systemic manifestations. Few cases of ankylosing spondylitis associated with adult Still's disease have been described in the literature. We here report the case of a 31-year old patient followed up for ankylosing spondylitis presenting with fever which had lasted for a long time and clinico-biological signs compatible with adult Still's disease. A possible pathophysiologic link between the two diseases may be suggested, even if their simultaneous occurrence has been rarely reported in the literature.