Tuberculose péritonéale : aspects épidémiologique, clinique et thérapeutique. À propos de 55 cas

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  • 66e Congrs de la Socit nationale francaise de mdecine interne12au 14dcembre 2012, Nice / La Revue de mdecine interne 33S (2012) A90A198 A129

    Conclusion. En zone endmique, devant tout tableau dhpatite,dascite avec vre prolonge, le diagnostic de LV doit tre forte-ment suspect.

    CA083Cas rarecompliquanticorpV. FassbendM. Debarle-a Service deb Immunoloc Inserm UMFranced Dermatoloe Anatomie eDraguignan

    Introductiondisease assohyperplastiin its multicof insulin hin the preseresistance).insulin resisPatients andwith Castlemrelapsing seResults.A 7for interminal lympharelevant pawere consiscarried-outlymphadento thepast sThepatienttions. Physiand left axinltrated lno malignaSerologicalor hepatitisimmunologneoplastic,At PET-Scansome hypestatus worshaemophagted with sksarcoma wrepeated ancular populPCR. The disarcoma antreatment bmycotic andthe treatmewas especiacemias andInsulin receB insulin refromchemoglycemia haDiscussion.diagnosis o

    reness in an HIV negative patient with lymphadenopathies andcytopenia. It has also taken a very experienced anatomopatho-logist implication to rapidly investigate for HHV8 presence onsampling tissues. The difculty to reach such a diagnosis highlights

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    exe Bgnosts etit dde ede maladie de Castleman (HHV8positif) dhypoglycmies secondaires des

    s anti-rcepteurs linsulineera, V. Queyrel a, N. Tieuliea, L. Galicierb,Caronc, F. Mantouxd, O. Viree, J.-G. Fuzibeta

    mdecine interne, hpital de lArchet-1, Nice, Francegie clinique, hpital Saint-Louis, Paris, FranceRS 938, hpital Saint-Antoine, facult de mdecine, Paris,

    gie, hpital de lArchet, Nice, Francet cytologie pathologique, polyclinique Notre-Dame,

    , France

    . Castlemans disease is a rare lymphoproliferativeciated with HHV8 infection, which can be revealed byc lymph nodes and by diverse systemic manifestationsentric form. Severe hypoglycemia with elevated levelsas been reported with several autoimmune disordersnce of anti-insulin receptors antibodies (type B insulinHowever, Castlemans disease presenting with type Btance has never been reported in the literature so far.methods. We report the case of a patient, diagnosedan disease, who presentedwith severe hypoglycemia,

    vere infections and hematological complications.2-year-old man was admitted in a community hospitalttent fever, severe asthenia, splenomegaly and ingui-denopathy. Apart from sarcoidosis at the age of 20, nost medical history was noted. The biological ndingstentwith tricytopenia anddisturbed LDH (805U/L). Thelymph node biopsy revealed a non-specic reactionalopathy. Corticosteroid therapywas startedwith respectarcoidosis history and secondarydiabetes has occurred.was transferred toourunit becauseofworsening condi-cal exam has found a signicant hepatosplenomegalyillary lymphadenopathies. CT Scan showed diffuselyymphadenopathies. The osteomedullar biopsy foundnt cells but lymphocytic inltration of about 1520%.exams searching for infectious origins such as HIVwere negative. Laboratory exams aiming to nd an

    ical cause were also negative. Based upon these data,infectious or autoimmune origins could be ruled out., diffuse osteomedullar xations were evidenced withrmetabolic sub-diaphragmatic lymph nodes. Generalened with fever, severe hypoglycemia and uctuantocytic syndrome. One month later, the patient presen-in eruptions and the skin biopsy has found a Kaposiith presence of HHV8. The axillary biopsy was thend has demonstrated enhanced lymphocytic perifolli-ation with HHV8 presence that was also conrmed byagnosis of Castlemans disease associated with Kaposid macrophagic activating syndrome was reached. Ay rituximab and etoposide was undertaken. Severalbacterial complications occurred during the course of

    nt and along the diagnostic period. The clinical picturelly remarkable for many severe episodes of hypogly-elevated serum insulin levels. The search for an antiptor antibodywas strongly positive and conrmed typesistance. At 9-month from the diagnosis and 3-monththerapy initiation, thepatient is still alive and thehypo-s persistently disappeared.This observation is interesting for many reasons. The

    f Castleman disease has required a high index of awa-

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    Introdutationscomplun diaPatientplaignadattituance of multidisciplinary approach to solve complexblems. Management of this patient was hindered by

    ematologic and infectious complications that are notreported with Castleman disease. The type B insulinepicted in this case was only described in autoimmunend to the best of our knowledge was found associatedtime with Castleman disease. Moreover, this observa-es further insights about the efcacy of Rituximab ine settings.Castleman disease may be associated with autoim-

    ders like type B insulin resistance.

    ose pritonale : aspectslogique, clinique et thrapeutique. e 55cas. Jaziri , A. Ben Slama Trabelsi , A. Souguir , S. Ajmirologie, hpital Sahloul, Sousse, Tunisie

    . Dterminer les aspects pidmiologiques, cliniquestiques de la tuberculose pritonale dans le centre tuni-

    thodes. Il sagit dune tude descriptive rtrospectivepatients atteints de tuberculose pritonale hospitali-02 et 2010.Nos patients taient repartis en 33 femmes et. La moyenne dge tait de 42ans (extrmes de 18rigine rurale tait note chez 48patients. Seulementts avaientdesantcdentspersonnelsde tuberculose. Lensultation le plus frquent tait la douleur abdominaleans 70% des cas. Quarante-neuf malades avaient unedative avec un taux moyen de protide de 61g/L. Lintration tait positive chez sept malades et la recherche decrachats tait positive dans un cas.tients ont subit une exploration de la cavit pritonaleue dans 36 cas et par laparotomie dans 18 cas.natomopathologique des biopsies pritonales avaitetenir lediagnostic de tuberculosepritonaledans tous

    ients ont t mis sous traitement antituberculeux pen-oyenne de dix mois avec une bonne tolrance et bonnetraitement avec une dure de suivie allant de six mois

    La tuberculose pritonale pose toujours un problmeblique. Son diagnostic nest pas aussi ais et il nces-majorit des cas le recours lexploration chirurgicaleque ou plus frquemment clioscopique.

    evant ce tremblement et pourtant. . .. Billot , A. Vauthier , O. Berets , M. Alettiterne, HIA Percy, Clamart, France

    . La neuroborrliose (NB) correspond des manifes-rologiques dune infection systmique spirochtes duorrelia burgdorferi. Les formes cliniques varies en fontic parfois non vident.mthodes. Un homme de 75ans, sans antcdent, seepuis quatre jours de cphales et dun tremblementt daction des deux mains rendant presque impossible


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