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Pyomyositis is a pyogenic infection of skeletal striated muscle, usually found in tropical areas, often in immunocompromised patients. We report a new observation of a nontropical Enterobacter pyomyositis occurring in an immunocompetent female in Tunisia. A 53-year-old patient presented with acute fever and intense myalgia in the right thigh. On clinical examination she had an altered general condition, a fever at 40°C and an important swelling of the lateral side of the right thigh. In biology, she had an inflammatory syndrome. Blood culture had identified Enterobacter. Muscle magnetic resonance imaging showed diffuse inflammatory involvement of the vastus lateralis muscle of the right quadriceps associated with edematous infiltration of subcutaneous fatty tissues. Diagnosis of pyomyositis was retained. Antibiotic therapy initially probabilistic and then adapted to the antibiogram was initiated with a favorable outcome. Although rare outside the tropics, the potential severity of pyomyositis encourages its better knowledge.

Rheumatoid pneumoconiosis, also known as Caplan's syndrome is defined as the association between silicosis and rheumatoid arthritis (RA). It is a rare and usually diagnosed in an advanced stage of RA course. It affects generally patients with long exposure to silica. In this article, we report a case of Caplan's syndrome. Keywords: Caplan syndrome, Rheumatoid arthritis, Silicosis, Chest CT scan, Rituximab

The management of high-energy pilon fractures is still controversial. Open reduction and internal fixation are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. The aim of this retrospective study was to analyze the clinical and radiographic outcome of the ILIZAROV technique in patients with high-energy pilon fractures. Thirty cases of distal tibia epiphysis fractures (pilon fractures) were managed from 1999 to 2012. The study group included 5 cases of open fractures. The mean age was 47 years. According to Rüedi and Algower classification; 11 fractures were type II, and 19 type III. All fractures were a consequence of high-energy trauma. Fractures of the lower fibula were present in 28 of the patients. An external Fixator was applied for open fractures. Closed injuries were operated on 3 to 13 days after injury, with an average of 8 days. The mean follow-up was 48 months. All fractures united. The external fixator was removed after a mean of 22 weeks (10 - 28 weeks). Two patients with a type III fracture had a delayed union and were treated with corticotomy and dynamisation of the ILIZAROV fixator. Only one secondary displacement of a type III fracture was noted after two months and was treated by adjuction of 2 olive wires. There were no cases of osteomyelitis or deep infections. Pin-tract infections occurred in ten patients. We had not any case of nervous injury due to introduction of the pins. Using radiological criteria for assessement of reduction of the articular fragments, there was excellent and good restoration of articular structure in 24 cases. The average American Orthopeadic Foot and Ankle Society ankle-hind foot score was excellent in 16, good in 6, fair in 6 and poor in 2. Soft tissue healing occurred without need for plastic surgery in all cases. The movements of the ankle ranged from 0 to 20, of dorsiflexion and 5 to 40 of plantar flexion. Twenty patients had gone back to their preinjury profession. The ILIZAROV technique is a safe and a very effective treatment for severe pilon fractures with minimum complications and good healing results.

Marginal zone lymphoma (MZL) describes a heterogeneous group of B-cell lymphomas derived from marginal zone cells found in the spleen's white pulp and surrounding germinal centers. To date, only one case of spinal primary MZL has been reported. We report a second case. A 67-year-old man without special medical history was referred to our clinic because of progressive paralysis first noticed 2 months before hospitalization. On examination, his paralysis concerned the lower limbs. No reflex deficits were identified. No further neurological deficits were found. Spinal MRI in sagittal sequence in weighting T2 (A) and sagittal sequence (B); coronal (C) and axial (D) T1-weighted after gadolinium injection showed dorsal compression by an extensive posterior epidural tissue process from T6 to T8 in continuity with left pleural neoplastic thickening through the inter-vertebral homolateral foramens. A laminectomy with resection of the intra-ductal lesion was performed, the examination of which found a MZL. In an extension study, thoraco-abdomino-pelvic CT showed medial and celiac lymphadenopathy, a tissue sleeve of the left costo-vertebral gutter extended to a height of 9 cm. An osteo-medullary biopsy revealed a marrow of normal wealth without sign of malignancy. The lymphoma was classified in bone IV stage. The patient was treated according to the 2013 National Adult Non-Hodgkin's Lymphoma protocol. He received 8 RCHOP cures. The evolution was marked by the improvement of neurological signs with no lesion of evolutive suspicious nature at the thoracic and abdominopelvic stages at the end-of-treatment scan.

Cellulitis is a frequent soft tissue and skin infection. The lower limbs are affected in 70 to 80% of cases. Cellulitis in aged persons is not yet well described in literature. A retrospective descriptive study conducted in the Internal Medicine Department of Sahloul hospital in Sousse in Tunisia. It included patients whose age was up to 65 years old admitted into hospital for cellulitis of the legs, the arms or the face. One hundred fifty eight patients with a mean age of 73 years old (range: 65 to 94 years old) were included. Female to male sex ratio was 0.68. Among them, we noted diabetes mellitus in 81 cases (50.6%). The infection was located in the lower limbs in 155 cases (98%), in the face in two cases (1.3%) and in the upper limb in one case (0.7%). Twenty one patients (13.3%) presented with severe cellulitis and one presented with necrotizing fasciitis. All patients received intra venous antibiotic therapy. Surgical treatment was indicated in 14 cases. Cefazolin was prescribed in 77 cases (48%). Favorable evolution was noted in 144 patients (91.1%). Forty four patients (27.8%) received prophylactic antibiotics. Prevention of skin and soft tissue infection is a crucial step to preserve health in aged persons.

Le sarcome granulocytique ou chlorome est une tumeur maligne extra-médullaire rare, composée de cellules myéloïdes immatures. La localisation rachidienne épidurale est exceptionnelle. Nous rapportons le cas d'un patient de 21 ans présentant une paraplégie complète avec un syndrome hémorragique (hématurie et ecchymoses diffuses). L'IRM rachidienne en séquence sagittale T2 (A) et axiale T1 après injection du gadolinium centrée sur D4 (B) a montré un processus expansif épidural postérieur étendu de D4 à D7 de signal hétérogène T2 rehaussé intensément après injection qui comble largement le canal médullaire et exerce un effet de masse sur la moelle dorsale en regard sans signe d'atteinte osseuse. L'hémogramme a montré une pancytopénie. Le frottis sanguin a objectivé 55% de blastes. Le myélogramme a révélé une leucémie aiguë myéloblastique (LAM). La cytologie du liquide céphalo-rachidien n'a pas montré de cellules malignes. Le patient a subi une laminectomie de D4 à D7 et une résection complète de la masse tumorale dont l'examen anatomopathologique a conclu à un sarcome granulocytique du rachis. Le patient a reçu une cure de chimiothérapie systémique selon le protocole des LAM de l'adulte. L'évolution était marquée par l'obtention d'une rémission hématologique et médullaire avec persistance d'un fauchage séquellaire avec un recul de 7 ans.

Madame M.S âgée de 55 ans, a consulté pour tuméfaction douloureuse de la cuisse droite évoluant depuis six mois faisant suite à une chute de sa propre hauteur. L'examen clinique a montré une cuisse droite tendue sans signes inflammatoires locaux avec une circonférence augmentée de 5 cm par rapport au coté gauche. Le bilan inflammatoire et les enzymes musculaires étaient corrects et les AAN étaient négatifs. La radiographie du fémur droit n'a pas montré d'anomalies en dehors de l'épaississement des parties molles. L'écho-doppler des membres inférieurs était normal. L'IRM de la cuisse droite a montré une discrète atrophie musculaire portant sur le muscle quadriceps essentiellement au niveau du 1/3 moyen et inférieur en T1 (A) avec une plage d'hyper signal STIR hétérogène des vastes médial et latéral qui prend le contraste (B). L'histologie de la biopsie musculaire a confirmé le diagnostic de myosite focale. La patiente a été mise sous antalgiques avec une corticothérapie à faible dose avec amélioration des myalgies et de la différence de circonférence des 2 cuisses de 2 cm à 3 mois de suivi.

La dactylite sarcoïdosique est rare. Nous rapportons l'observation d'une patiente de 65 ans ayant consulté pour une tuméfaction indolore du 4ème doigt de la main gauche évoluant depuis 6 ans. La radiographie de la main (A) a montré une ostéolyse de la 1ère phalange du 4ème doigt avec rupture corticale sans réaction périostée. La radiographie du thorax (B) a révélé des adénopathies hilaires bilatérales avec un infiltrat interstitiel. Le bilan tuberculeux était négatif. La biopsie osseuse a montré à l'étude anatomopathologique des granulomes épithélioïdes et giganto-cellulaires sans nécrose caséeuse. Le diagnostic de dactylite sarcoïdosique était retenu. Les principaux diagnostics différentiels regroupent les étiologies infectieuses surtout la dactylite tuberculeuse, le chondrome, la dysplasie fibreuse de l'os et le kyste osseux essentiel, la goutte et l'hyperparathyroïdie primitive.

L'otéopoécilie est une ostéopathie condensante bénigne et rare. Son association à un rhumatisme inflammatoire est très rare. Nous en rapportons un cas. Patiente âgée de 25 ans, atteinte dun psoriasis cutané, a consulté pour douleur inguinale inflammatoire. L'examen a montré une limitation des hanches, une inégalité de longueur des membres inférieurs et une douleur à la mobilisation de la sacro-iliaque droite. La biologie a montré un syndrome inflammatoire et un bilan immunologique négatif. La radiographie du bassin a révélé une ostéopoécilie associée à une coxite destructrice. La TDM du bassin a montré en plus de la coxite et de l'ostéopoécilie une sacro-illite bilatérale. Le diagnostic d'un rhumatisme psoriasique associé à une ostéopoécilie a été retenu. La patiente a été mise sous méthotrexate et AINS. L'ostéopoécilie est souvent de découverte fortuite. Son diagnostic radiologique est impératif afin d'éviter des explorations et des traitements inutiles.

Septic arthritis of the pubis symphysis is rare and difficult to diagnose. The objective of our study was to describe the biological, clinical, radiological and therapeutic aspects of this disease. This is a retrospective study of 4 cases of septic arthritis of the pubic symphysis collected in the Department of Rheumatology and Orthopaedics in Sousse in Tunisia over a period of 16 years (2000-2016). Our population consists of 3 women and one men. The mean age was 47 years (18-83). Clinical signs of appeal were inflammatory groin pain, pubic pain and fever. Symptoms appeared after forceps delivery in 2 cases, after surgery on the pelvis in one case and in a context of sepsis in one case. Radiographs showed pubic disjunction with irregular shoreline in all cases. CT performed in all patients and MRI in 2 patients showed erosions of the banks of the pubic symphysis with infiltration of the soft parts in all cases. The causative organisms were isolated in 3 cases by biopsy of soft tissue abscess under CT in 2 cases and vaginal swab in one case. Identified germs were staphylococcus aureus Méti-S (n=1), proteus mirabilis (n=1) and varied flora (n=1). The treatment consisted of appropriate antibiotics in all cases and surgical drainage of soft tissue abscess resistant to medical treatment in 2 cases. The outcome was favorable in all cases. Diagnosis of septic arthritis of the pubic symphysis is based on clinic supported by microbiologic culture results, image methods, and proteins augment during acute phase.

A 40-year-old patient was hospitalized for inflammatory pain in the superior-external surface of the right thigh evolving since 8 months, with no change in the general condition or fever. The pressure towards the right large trochanter was painful without local inflammatory signs. Biology did not show any inflammatory syndrome. The X-ray of the pelvis revealed an osteolytic lesion of the right great trochanter with thickening of the soft parts (Panel A). Bone scintigraphy showed hyperfixation of the right great trochanter (Panel B). The scanner of the basin revealed an osteolytic lesion of the right great trochanter containing multiple sequesters with cortical irregularity (Panel C). A great-trochanter bone biopsy under scannographic control was made (Panel D). The histological study showed an epithelioid and giganto-cellular granuloma with the presence of BK in the culture of the puncture fluid. The diagnosis of trochanteric tuberculosis was then made. Tuberculin intradermal reaction (IDR) was negative. The search for other tuberculous sites was negative. The patient was treated with anti-tuberculosis drugs during 12 months with good progression. Tuberculosis is a rare cause of trochanteritis. The peculiarity of our observation lies also in the absence of other tuberculous localizations.

Les tumeurs à cellules géantes des gaines synoviales (TCGGS) des tendons représentent la forme localisée de la synovite villonodulaire hémopigmentée. Elles s'observent le plus souvent au niveau des mains. Notre but était d'étudier les caractéristiques épidémio-cliniques et thérapeutiques des TCGGS, évaluer les résultats du traitement chirurgical et dégager les facteurs de récidives. Il s'agit d'une étude rétrospective de 50 cas de TCGGS de la main colligés entre 1992 et 2016 au service d'orthopédie de l'hôpital Sahloul de Sousse en Tunisie. Les caractéristiques cliniques et épidémiologiques des TCGGS ont été précisées. L'âge moyen des patients était de 33 ans (9-69 ans) avec un sexe-ratio de 0,6. Les motifs de consultation étaient l'apparition constante d'une tuméfaction (100%), la gêne à la mobilisation des articulations inter-phalangiennes (6%) et la douleur digitale (18%). Toutes les tumeurs étaient localisées au niveau de la région digitale, surtout au niveau de l'index (42%). La localisation était palmaire dans 66% des cas. Tous les malades ont été opérés, l'aspect macroscopique montrait une tumeur encapsulée, polylobée et jaune brunâtre qui se prolongeait dans la gaine des tendons fléchisseurs (4 cas) et sous le tendon extenseur (2 cas). Nous avons noté un seul cas de récidive, soit 2% qui ont été repris chirurgicalement. Les résultats fonctionnels étaient bons dans tous les cas. Le diagnostic de TCGGS doit être évoqué devant une tuméfaction digitale. Leur prise en charge fait appel à la chirurgie qui reste difficile et doit être correctement exécutée pour éviter les récidives.

The algodystrophy is a regional pain syndrome, characterized by complex neurovascular abnormalities. Pregnancy appears through mechanical factors promote dystrophy of the lower limbs. We report the case of a 31 year old woman, primipara, who presented in the third quarter of pregnancy (35 weeks gestation) mechanical right groin pain with functional impairment. She has consulted in postpartum (4 days after birth). The review noted a limp, functional impairment with a visual analogue scale (VAS) pain 70%. Standard radiographs postpartum showed speckled locoregional demineralization of the right hip. MRI confirmed the diagnosis of right hip algodystrophy (A and B). The patient took analgesic treatment with a discharge and rest for 3 months. She has not received bisphosphonates because she breastfeeding. Disease duration was 24 weeks. The evolution was marked by the persistence of residual pain (VAS 20%) without sequelae. Algodystrophy during pregnancy is rare and is often misunderstood. The analysis of our results compared to literature, allows to identify the main characteristics of this variety of reflex sympathetic dystrophy: gradual onset in the second or third trimester, location in the hip alone or associated with other locations. MRI is currently the modality of choice for the early and differential diagnosis. The course is generally favorable. The safety of bisphosphonates during pregnancy and lactation remains to be demonstrated.

A 69-year-old man, native of metlaoui in Tunisia, presented to the Department of Rheumatology at our institution with 10 years of non-inflammatory rachialgia with polyarthralgia. On examination, the patient had no fever or joint swelling, his teeth had brown strains and rough, there was diffuse tenderness at the cervical and lumbar spine and neurological examination was normal. Standard radiographs revealed diffuse bone condensation involving all vertebrae of the cervical, dorsal (A) and lumbar (B) spine, the skull (C), the pelvis (D) and the limbs. The origin of the patient, the brownish color of the teeth and the radiological appearance led to suspicion of fluoride poisoning, which was confirmed by the very high blood fluoride and urine dosage. Skeletal fluorosis is a rare toxic osteopathy characterized by massive bone fixation of fluoride. Its origin is dominated in the countries of North Africa by hydro-telluric poisoning. Its severity lies in the development of skeletal deformities and neurological complications. Management of fluorosis generally focuses on symptom treatment.

A 23-year-old female patient with a family history of pulmonary tuberculosis and tuberculous spondylodiscitis was hospitalized for swelling of the left anterior-external surface of the left thigh, (A) with altered general status. Biology has shown a biological inflammatory syndrome. The ultrasound showed a collection opposite the great trochanter fusing towards the lodge of the gluteus muscle and forward towards the terminal part of the common chief ischio-psoas. MRI of the hips revealed an intra-muscular collection of the antero-lateral side of the thigh root, taking contrast in the periphery, involving the quadriceps muscle and tensor of facia lata, (B and C). The biopsy of the collection under ultrasound guidance brought back 30 cc of casein. The diagnosis of tuberculosis of the quadriceps muscle and tensor of the facia lata was based on the positivity of the tuberculin skin test, (D), the positivity of the PCR for Mycobacterium tuberculosis in the puncture fluid and histology showing multiple epithelioid granulomas centered by caseous necrosis. There were no other tuberculous sites. The patient was treated with antituberculosis drugs for 12 months with good progress. Muscular tuberculosis (MT) is a rare localization of the disease (0.01 to 2%). Its occurrence without associated bone involvement is exceptional. MT often simulates a muscular tumor. MRI contributes to the improvement of the sensitivity of the diagnosis of MT because it allows to specify the extent of the muscular lesions and to orient the site of the muscular biopsy. The diagnosis is essentially based on histology.

We here report the case of a 68-year old female patient presenting with inflammatory poorly systematized bilateral lumbosciatica, without vesico-sphincteric disorders or associated general symptoms evolving for 4 months. Physical exam showed gait with little steps with trunk anteflexion, disappearance of lumbar lordosis, lumbar spine stiffness, positive bilateral Lasègue's test and hyperactive osteotendinous reflexes in lower limbs without motor and sensory deficit or saddle block anesthesia. Laboratory tests did not show any inflammatory syndrome. Lumbar spine X-rays were normal. Given the abnormal clinical picture, spinal MRI was performed which showed oval intracanalar mass behind L4 vertebral body, measuring 3 cm height with discrete hypersignal on T1 (A) and with hypersignal on T2 (B), enhanced after gadolinium administration and containing superior polar cystic component. The patient underwent tumor resection in orthopaedics. Histological examination of the surgical specimen revealed myxopapillary ependymomas.

A 14-year-old patient presented with chronic shoulder pain evolving since three years. The pain persisted despite the various medicated and physical treatments followed. The clinical examination noted a normal shoulder examination with pain facing the right scapula without local inflammatory signs. There were no abnormalities in the biological examinations, in particular absence of biological inflammatory syndrome, rheumatoid factor negative and normal calcemia. Radiographs of the shoulder and scapula were normal. Bone scintigraphy showed hyperfixation of the radiotracer regarding the right scapular spine evoking an osteoid osteoma (A). CT scan of the right scapula showed a very limited osteolytic lesion without osteocondensation edges with a non-enhanced hypodense matrix after injection of contrast agent (B). MRI showed lesion of the right scapular spine in hypersignal T1 and T2 without cortical rupture or periosteal reaction suggestive of a benign lesion such as osteoid osteoma (C, D). The patient had a biopsy with surgical resection of the lesion. The diagnosis of osteoid osteoma was confirmed histologically. The peculiarity of this observation lies in the rarity of this localization and the deceptive clinical picture suggesting a shoulder pathology in first intention. In cases of diagnostic doubt and in the presence of normal radiographs, the most specific examination is thin-section CT scans, the sensitivity of which can be improved by association with an MRI.

53-year-old man presented with monoarthritis of the knee without fever evolving since 6 months associated with an inflammatory biological syndrome. The articular puncture brought back a sterile inflammatory fluid. The radiographs of the frontal knee (A) and profile knee (B) and CT of the knee (C, D) showed destruction of the internal femoral condyle with osteolysis of the medial border of the internal tibial plateau associated with multiple bone constructions with the presence of intra-articular fragments, intra-articular effusion and thickening of the synovium. The diagnosis of tabetic arthropathy in its hypertrophic form was retained following a 20-year history of syphilitic inoculation chancre, posterior radiculocordonal syndrome, imaging data and positive syphilitic serology (TPHA-VDRL) in the blood and cerebrospinal fluid. The patient was treated with penicillin G (24 million/day) for 15 days. Tabetic arthropathy is a type of neuropathic arthropathy that has become rare and unfamiliarity with the clinical presentation of this disease may lead to considerable delay in diagnosis. This disease means progressive painless joint destruction that is related to neurosensory deficits caused by syphilis. His diagnosis is difficult as its clinical presentation is not specific and differential diagnosis is wide ranging. Hence, his diagnosis requires clinical suspicion and an appropriate serological test.

Un patient âgé de 40 ans, était hospitalisé pour exploration d'une douleur inflammatoire intéressant la face supéro-externe de la cuisse droite évoluant depuis 8 mois, sans altération de l'état général ni fièvre. La pression en regard du grand trochanter droit était douloureuse sans signes inflammatoires locaux. La biologie n'a pas montré de syndrome inflammatoire. La radiographie du bassin a révélé une lésion ostéolytique du grand trochanter droit avec épaississement des parties molles en regard (A). La scintigraphie osseuse a montré une hyperfixation du grand trochanter droit (B). Le scanner du basin a révélé une lésion ostéolytique du grand trochanter droit contenant de multiples séquestres, avec irrégularité corticale et collection multicloisonnée en regard de la lésion (C). Une ponction-biopsie osseuse du grand trochanter, sous contrôle scannographique (D), a mis en évidence un granulome épithélioïde et giganto-cellulaire à l'histologie, avec présence de BK à la culture du liquide de ponction. Le diagnostic de tuberculose trochantérienne était alors porté. L'intradermoréaction à la tuberculine (IDR) était négative. La recherche d'autres localisations tuberculeuses s'est révélée négative. Le patient a été mis sous antituberculeux pendant 12 mois avec bonne évolution. La tuberculose constitue actuellement une cause rare sinon exceptionnelle de douleur trochantérienne. La particularité de notre observation réside aussi dans l'absence d'autres localisations tuberculeuses.

A 45-year-old man presented with low back pain evolving since 8 years associated sometimes with a radicular radiation. The clinical examination found a patient in good general condition, a loss of the lumbar lordosis, an exaggeration of the dorsal kyphosis with stiffness of the lumbar spine. The cutaneous-mucosal examination showed a brownish appearance of the ears, conjunctiva, and lower eyelids. In biology there was neither inflammatory syndrome nor perturbation of the phosphocalcic balance. The standard radiographs of the lumbar spine (A) and dorsal spine (B) revealed multiple disc calcifications associated with large staggered disc clumps and discal empty images. Due to mucocutaneous signs, normality of biology and the radiological aspect, the diagnosis of ochronosis was suspected and confirmed by the test of blackening of the urine to the ambient air, the results of the cutaneous biopsy showed pigmented deposits yellow ocher and brownish in the dermis and the dosage of alkaptonuria. Symptomatic treatment resulted in moderate improvement. The family survey did not reveal any similar cases. Ochronosis or alkaptonuria is a rare autosomal recessive disorder of tyrosine metabolism. Deficiency of homogentisate 1,2 dioxygenase results in accumulation of oxidized homogentisic acid in the connective tissues of the skin, eyes and ears, musculoskeletal system, and cardiac valves, and in urolithiasis. Ochronosis is of late onset, responsible for the rachis of extended disc calcifications with maximum spinal fusion. It is the cause of degenerative arthropathy. Early diagnosis and screening of this disease are then of great interest, especially for genetic counseling.

Il s'agit d'un patient âgé de 53 ans, qui a consulté pour une monoarthrite du genou droit évoluant depuis 6 mois sans fièvre, associé à un syndrome inflammatoire biologique. La ponction articulaire a ramené un liquide inflammatoire stérile. Les radiographies du genou de face ( A) et de profil (B) et la TDM du genou (C et D) ont montré une destruction du condyle fémoral interne avec une ostéolyse du rebord médial du plateau tibial interne associé à de multiples constructions osseuses avec présence de fragments intra-articulaires, d'un épanchement intra-articulaire et d'un épaississement de la synoviale. Le diagnostic d'arthropathie tabétique dans sa forme hypertrophique a été retenu devant un antécédent de chancre d'inoculation syphilitique datant de 20 ans, un syndrome radiculocordonal postérieur, les données de l'imagerie et une sérologie syphilitique (TPHA-VDRL) positive dans le sang et le LCR. Le patient a été traité par pénicilline G (24 millions/j) pendant 15 jours. Plus fréquent chez l'homme que chez la femme, le tabès, devenu exceptionnel, se découvre tardivement vers 50 ou 60 ans. L'arthropathie tabétique est une affection neurogène destructrice secondaire à l'infection par le tréponème. Elle concerne 4 à 10% des tabétiques. Le genou est l'articulation la plus souvent atteinte. Les formes de début souvent méconnues miment une gonarthrose banale. L'aspect habituel réalise une forme hypertrophique. Le traitement de l'arthropathie tabétique est essentiellement médical basé sur la pénicilline G.

Il s'agit d'une patiente âgée de 53 ans, suivie pour une polyarthrite rhumatoïde (PR) érosive très sévère avec luxation atloido-axoidienne sous anti TNF Elle a consulté pour des crises douloureuses à type de brûlure au niveau des mains, déclenchées par la chaleur et soulagées par le froid, évoluant depuis 2 semaines, concomitantes à une poussée de sa PR. L'examen dermatologique durant la crise, a révélé un érythème douloureux palmaire bilatéral, intéressant surtout les pulpes digitales et les éminences thénar et hypothénar avec rougeur et chaleur locale. Le diagnostic d'érythromélalgie (EM) a été retenu. Dans le cadre de l'enquête étiologique, nous avons éliminé les principales causes d'EM secondaire: prise médicamenteuse, un lupus, un syndrome myéloprolifératif, une néoplasie, un diabète, une prise de toxique, une virose ou une hyperthyroïdie à l'origine de cet acrosyndrome. La PR était à l'origine de l'EM secondaire dans notre cas, ce qui est exceptionnel au cours ce rhumatisme. Le pronostic dépend de la sévérité de la PR et de sa réponse au traitement. La patiente a eu un switch vers le tocilizumab.

A 35-year-old man of Tunisian origin complained of inflammatory arthralgia and he had noticed a progressive enlargement of his hands and feet as well as facial furrowing. On examination, he had thickening of the skin of the head and distal extremities and deep folds and furrows of the skin of the forehead (A), digital clubbing of fingers (B) and toes (C), spadelike enlargement of the hands and feet, hyperhidrosis of the hands and feet and seborrhea. Inflammation tests were disturbed. Radiographs showed periostosis of the long bones (D) and sacro-iliac osteosclerosis. After excluding secondary causes, primary hypertrophic osteoarthropathy also called pachydermoperiostosis (PDP) was established. This disease is characterised by thickening of the skin of the head and distal extremities, deep folds and furrows of the skin of the forehead, cheeks, and scalp, seborrhea; hyperhidrosis; periostosis of the long bones and digital clubbing. The treatment consisted in our case of analgesics and NSAIDs.

Une cervicalgie fébrile est souvent secondaire à une méningite ou à une spondylodiscite, exceptionnellement à une arthropathie microcristalline. Nous en rapportons un cas. Un homme de 81 ans sans antécédents particuliers est hospitalisé pour cervicalgie fébrile. Les diagnostics initialement évoqués étaient ceux de méningite et de spondylodiscite. L'examen a montré une raideur globale du rachis cervical. L'IRM rachidienne a montré une anomalie de signal de l'articulation atloïdo-axoïdienne se réhaussant après injection de gadolinium avec une hypertrophie synoviale associée à un aspect irrégulier et hétérogène de la dent de l'axis. Les coupes tomodensitométriques atlo-axoïdiennes montraient des calcifications péri-odontoïdales confirmant le diagnostic de syndrome de dent couronnée (SDC). L'évolution était favorable sous AINS. Le SDC mérite d'être mieux connu ; il peut mimer de nombreux diagnostics et être responsable de fièvre au long cours.

La sclérodermie systémique liée à l'exposition à la silice cristalline peut apparaître chez les personnes utilisant la soudure à l'arc. Une forme diffuse de sclérodermie a été diagnostiquée chez un plombier-soudeur de 57 ans, qui présentait des polyarthralgies inflammatoires, un phénomène de Raynaud, une sclérodactylie, une sclérose cutanée diffuse, des télangiectasies, une atteinte ésophagienne, une hypertension artérielle pulmonaire et une fibrose pulmonaire associées à la présence d'anticorps anti-nucléosomes. Au cours de son activité professionnelle, le patient était fréquemment exposé à des concentrations atmosphériques élevées de silice cristalline lors de la soudure à l'arc. Le diagnostic d'un syndrome d'Erasmus avec une association d'une sclérodermie systémique à une silicose pulmonaire était retenu. Une déclaration en maladie professionnelle au titre du tableau n'17 en Tunisie a été réalisée.

Les sacroiliites infectieuses sont rares mais peuvent se compliquer de séquelles fonctionnelles invalidantes. Décrire les caractéristiques cliniques et bactériologiques des sacroiliites infectieuses chez les patients suivis à Sousse, Centre Tunisien. Etude rétrospective, descriptive, des cas de sacroiliites infectieuses chez les patients hospitalisés à Sousse entre 2000 et 2015. Le diagnostic a été retenu devant des signes cliniques, d'imagerie, et microbiologiques évocateurs. Vingt-cinq patients, 10 hommes et 15 femmes, d'âge moyen 41 ans (19-78) ont été inclus. Les sacroiliites étaient dues à des bactéries pyogènes dans 14 cas (56%), brucelliennes dans 6 cas (24%), et tuberculeuses dans 5 cas (20%). La durée moyenne d'évolution était de 61, 45 et 402 jours respectivement. Les signes cliniques les plus fréquents étaient les douleurs fessières (92%) et la fièvre (88%). La radiographie standard était anormale dans 75% des cas. La TDM et l'IRM sacro-iliaques dans tous les cas. Le diagnostic a été confirmé bactériologiquement dans 24 cas (96%). La durée moyenne d'antibiothérapie était de 83 jours dans les sacroiliites à pyogènes, et de 102 jours dans les SI brucelliennes. L'évolution était favorable chez 12 patients (48%), 9 patients (36%) ont gardé une douleur sacro-iliaque séquellaire, et 4 patients (16%) sont décédés. Dans notre étude, la durée d'évolution de la sacroiliite infectieuse ne permettait pas de prédire la bactérie responsable, d'où la nécessité d'obtenir une documentation bactériologique afin de prescrire une antibiothérapie appropriée.

Introduction. Isolated fracture of the trochlea is an uncommon condition requiring a particular mechanism of injury. Its association with a distal radial fracture is rare. We aimed through this case report to identify the injury mechanism and to assess surgical outcomes. Case Presentation. We report a 26-year-old female who was admitted to our department for elbow trauma following an accidental fall on her outstretched right hand with her elbow extended and supinated. On examination, the right elbow was swollen with tenderness over the anteromedial aspect of the distal humerus. The elbow range was restricted. Standard radiographs showed an intra-articular half-moon-shaped fragment lying proximal and anterior to the distal humerus. There was a comminuted articular fracture of the distal radius with an anterior displacement. A computed tomography revealed an isolated shear fracture of the trochlea without any associated lesion of the elbow. The patient was surgically managed. Anatomical reduction was achieved and the fracture was fixed with 2 Kirschner wires. The distal radial fracture was treated by open reduction and plate fixation. The postoperative course was uneventful with a good recovery. Conclusion. Knowledge of such entity would be useful to indicate the suitable surgical management and eventually to obtain good functional outcomes.

Infection of the lumbosacral junction by tuberculosis is quite rare and occurs in only 1 to 2% of all cases of spinal tuberculosis; moreover, isolated sacrococcygeal or coccygeal tuberculosis is much rarer. Failure to identify and treat these areas of involvement at an early stage may lead to serious complications such as vertebral collapse, spinal compression, and spinal deformity. In the present paper, we report an uncommon case of spinal tuberculosis with sacrococcygeal location revealed by a chronic low back pain that was successfully managed. Computed tomography scan and magnetic resonance imaging of the pelvis revealed a lytic lesion affecting both of sacrum and coccyx causing osseous destruction and suggesting a malignant process. A surgical biopsy was performed to establish the tissue diagnosis. Histopathological report confirmed the diagnosis of skeletal tuberculosis. The patient was treated with antibacillary chemotherapy for a period of 9 months. The follow-up period was of 36 months. There was a full recovery and the patient was asymptomatic.