Clinical Characteristics and Follow-Up Data in a Series of Twenty Infective Endocarditis Complicated of Rheumatic Manifestations

The infective endocarditis is a septicemia complicated of many systemic manifestations. Rheumatic manifestations can be revelatory, leading sometimes to a lateness diagnosis. The aim of this study is to determine the epidemiological, clinical, bacteriological profile and the follow up in patients affected of an infective endocarditis complicated of rheumatic manifestations. It’s a retrospective study concerning the period from January 1990 to December 2015. The analysis had implicated epidemiological, clinical, biological data, in association to immunological, bacteriological and radiological examinations. All the patients fulfilled the revised Duke’s criteria for the infective endocarditis. Articular and osseous radiographs, blood culture, transthoracic and/or transoesophageal echocardiography were performed in all patients. Twenty patients had rheumatic manifestations. The mean age was 37 years. There were arthralgia in 15 cases, myalgia in 5 cases and arthritis in 8 cases: 6 cases of mono-arthritis and 2 cases of oligo-arthritis. All patients had an inflammatory biological syndrome. The blood culture was positive in all the cases. Echocardiography revealed vegetations in all the patients: mitral in 10 cases, aortic in 4 cases, mitral and aortic in 4 cases, aortic and tricuspid in 1 case, tricuspid in 1 case. The radiological examination found 2 cases of spondylodiscitis and a case of saco-iliitis. The articular outcome was favorable in 17 cases. Three patients had died. The infective endocarditis should be considered in case of febrile arthritis. An early diagnosis and adapted treatment are guarantors of better prognosis.

Epidemiological, Clinical and Follow-Up Data in a Series of Thirteen Renal Insufficiencies Complicating Sarcoidosis

The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It’s a retrospective study implicating 13 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and the interest of considering sarcoidosis diagnosis in case of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 13 women with an average age of 41 years. Biological investigations showed an abnormal normocalcemia in 8 cases, a hypercalcemia in 5 cases, a hypercalciuria in 11 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 540 umol/L. The renal echography was normal in all patients. The kidney biopsy performed in all patients showed tubulo-interstitial nephritis. The extra-renal signs were: pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymphadenopathy in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 3 cases and a polyarthritis in 6 cases. Six patients benefited from hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis should be made rapidly in order to avoid end stage renal failure.

Adult Onset Still’s Disease: Articular Manifestations in Twenty Cases

The adult onset Still’s disease is a rare inflammatory pathology of unknown pathogeny. The clinical features are variable. The diagnosis is difficult since exclusion of infectious, systemic and tumoral pathologies should be done. The articular complications are frequent and can be revelatory of this pathology. The articular prognosis depends on the diagnosis delay and the treatment efficiency. Our study aims to analyze different aspects of articular manifestations complicating adult onset Still’s disease to define epidemiological, clinical and evolving characteristics of these complications. It was a cross-sectional study concerning 20 cases of adult onset Still’s disease diagnosed from 1990 to 2015 in the internal medicine A department of Charles Nicolle Hospital in Tunis, meeting Yamaguchi criteria. We identified clinical, radiological, evolving and therapeutic profile of the articular manifestations occurred in these patients. There were 13 women and 7 men. The average age was 25 years. The arthralgias were reported in all cases;while, the arthritis interested fifteen patients. A hand deformation was found in four patients. A wrist ankylosis was noted in one case and a flexion elbow in one patient. The standard articular radiographs were normal in twelve cases. The treatment associated essentially non-steroidal anti-inflammatory and/or corticosteroids and/or methotrexate. Concerning the evolving profile, the monocyclic form was present in 25% of the cases, the intermittent form in 45% and the chronic articular form in 30% of our patients. The adult onset Still’s disease is rare and heterogeneous. The articular disturbances are frequent and have various outcomes.