Coexistence of Behçet's disease with ankylosing spondylitis and familial Mediterranean fever: a rare occurrence

Behçet's disease (BD) and familial Mediterranean fever (FMF), which are two separate diseases sharing some clinical features, may also coexist in the same patient. Further investigations are needed to understand whether this coexistence is due to either chance or geographical distribution patterns of these diseases or to common etiopathogenetic characteristics. Spondylarthritis as part of the clinical picture in these two diseases has been questioned and probably it is not a prominent characteristic of any of them. We report a 35-year-old Tunisian man who had an association of BD, FMF and Human Leukocyte Antigen (HLA) B27 positive ankylosing spondylitis. Although that spondylarthritis is an infrequent joint involvement of FMF and BD, it must be looked for in case of association of these diseases.

Peripheral neuropathies associated with primary Sjögren syndrome: immunologic profiles of nonataxic sensory neuropathy and sensorimotor neuropathy

We conducted this study to characterize the relationship between primary Sjögren syndrome (pSS)-associated peripheral neuropathy (PN) and markers of B-cell monoclonal proliferation and chronic activation. The cohort included 120 consecutive patients presenting with definite pSS according to the American-European Consensus Group criteria. Serum markers of chronic B-cell activation included autoantibodies and hypergammaglobulinemia. Markers of monoclonal B-cell proliferation included mixed cryoglobulin, monoclonal gammopathy, abnormal κ/λ free light chain (FLC) ratio, and B-cell non-Hodgkin lymphoma (B-NHL). Definite PN was present in 30 patients (25%) including 7 patients (23%) with sensorimotor neuropathy, 3 patients (10%) with ataxic sensory neuropathy, and 20 patients (67%) with nonataxic sensory neuropathy. Patients with a sensorimotor neuropathy differed from those without PN by higher rates of monoclonal B-cell proliferation markers, that is, mixed cryoglobulin (57% vs. 11%; p = 0.008), monoclonal gammopathy (71% vs. 17%; p = 0.004), higher FLC ratio (2.7 ± 1.5 vs. 1.7 ± 1.8; p = 0.024), and B-NHL (57% vs. 3%; p < 0.001). Patients with nonataxic sensory neuropathy were characterized by a higher age (57.5 ± 10.7 vs. 48.7 ± 14.3 years; p = 0.007), more frequent central nervous system (CNS) involvement (15% vs. 2%; p = 0.04) and a lower prevalence of chronic B-cell activation serum markers, that is, antinuclear antibodies (ANA) (60% vs. 90%; p = 0.003), anti-SSA (Ro) (40% vs. 72%; p = 0.009), anti-SSB (La) (15% vs. 41%; p = 0.039), rheumatoid factor (37% vs. 67%; p = 0.02), and hypergammaglobulinemia (35% vs. 64%; p = 0.023). In multivariate analysis, sensorimotor neuropathy was associated with the presence of B-NHL (odds ratio [OR], 39.0; p < 0.001), whereas nonataxic sensory neuropathy was associated with the presence of CNS involvement (OR, 17.0; p = 0.025) and ANA (OR, 0.07; p < 0.001). In conclusion, we found that up to 25% of pSS patients presented with PN, predominantly sensory neuropathy. Distinctive immunologic profiles were found according to the type of SS-associated neuropathy: nonataxic sensory neuropathy was marked by a low prevalence of B-cell activation markers, and sensorimotor neuropathy was marked by a high prevalence of B-cell monoclonal proliferation markers.

[Laryngotracheobronchial foreign body in children: predictive factors of respiratory sequelae]

BACKGROUND

Inhalation of laryngotracheobronchial foreign body in children is a serious accident that may compromise the prognosis of the child and the respiratory function in the long term.

AIM

identify the predictive factors of respiratory sequelae of laryngotracheobronchial foreign body inhalation.

METHODS

This retrospective study was conducted in the children hospital of Tunis during a period of nine years (2000 - 2008). In all statistical tests, the significance level was set at 0.05.

RESULTS

60 children were included in the study. The average age was 24.9 +/- 3.4 months. 2 / 3 of the children were boys. The foreign body was plant in 80% of cases. The penetration syndrome was reported in 83.7% of cases. The average time of stay of foreign body was 14 days. The chest radiograph was abnormal in 77.4% of cases. Endoscopic extraction was performed in 59 cases and a pneumectomy was conducted in one child. 30 children were followed for an average of 23 months. 18 children had not respiratory sequelae (clinical, radiological and scintigraphic). 10 children had respiratory sequelae (clinical and radiological and/or scintigraphic) at the last follow-up and four patients developed bronchial dilatation. Respiratory sequelae were correlated with the stay period of the foreign body exceeding 84H. Neither age, nor sex, nor the nature of foreign body or its location, nor the presence of radiological opacity at the initial radiograph, were predictive factors of respiratory sequelae.

CONCLUSION

The inhalation of foreign body is a serious accident affecting essentially male infants. Clinical, radiological and scintigraphic follow up is mandatory.

Membranous glomerulopathy associated with idiopathic hypereosinophilic syndrome

Renal involvement is rarely reported and little is known about the renal morphologic changes in the idiopathic hypereosinophilic syndromes. We reported a case of a 52-year-old man with idiopathic hypereosinophilic syndrome associated with membranous glomerulopathy. The eosinophilia and the proteinuria greatly improved with corticosteroid treatment. We review the literature regarding the nephropathy of this hematologic disorder.

Clinical and diagnostic value of ribosomal P autoantibodies in systemic lupus erythematosus

OBJECTIVE

To analyse prospectively the diagnostic sensitivity and specificity as well as the clinical relevance of ribosomal P (anti-P) autoantibodies in a large cohort of SLE patients.

METHODS

The anti-P autoantibodies were evaluated in the serum of 200 Tunisian SLE patients at disease onset and 130 various control subjects by a sensitive immunodot assay. A complete laboratory evaluation and clinical examination were performed in each SLE patient. During the follow-up, the patients were regularly monitored for clinical parameters. Global SLE activity was measured by the ECLAM.

RESULTS

The sensitivity and specificity of anti-P testing for SLE were 23.5 and 98.4%, respectively. The anti-P-positive samples 14/47 (29.8%), 27/47 (57.4%) and 5/47 (10.6%) were negative for anti-dsDNA, anti-Sm or both antibodies, respectively. The anti-P-positive patients showed more active disease activity and a much higher prevalence of arthritis. An association between IgG aCLs and anti-P antibodies was also found. However, anti-P antibodies were not associated with neuropsychiatric manifestations or lupus nephritis.

CONCLUSION

This study does not seem to confirm the described association of anti-P antibodies with neuropsychiatric manifestations of SLE. However, it supports the anti-P antibody association with arthritis and disease activity as well as the presence of aCL. Based on our study and other related studies, we propose that, akin to anti-Sm and anti-dsDNA, anti-P antibodies detected by one agreed method may be considered for inclusion as a criterion for the classification of SLE.

[Pleural effusion revealing Horton's disease]

Pulmonary involvement is rare in Horton's disease. Only few cases have been reported presenting as interstitial infiltration, pulmonary artery vasculitis, pulmonary nodules and granulome formation. Pleural effusion was rarely reported. A 65-year-old male patient presented with a right pleural effusion. Horton's disease was evoked in the presence of cephalgias, an ocular involvement and general signs. Temporal artery biopsy showed giant cell arteritis. After negative etiologic work up, pleural effusion was attributed to Horton's disease. Outcome was favourable with systemic corticosteroid therapy. Pleural involvment in Horton's disease is rare and characterized the absence of specific biological and histological findings. However, pleural effusion may be a presenting manifestation of Horton's disease.

Clinical and immunological manifestations of systemic lupus erythematosus: study on 146 south Tunisian patients

The objective of this study was to determine the main clinical and laboratory features as well as the morbidity and mortality of systemic lupus erythematosus (SLE) in a population of patients predominantly from the south of Tunisia. A retrospective review of a well documented population of 146 patients with SLE was undertaken. All patients fulfilled four or more criteria defined by the American College of Rheumatology. The mean age at presentation was 29.2 years (range 6-55) and the mean duration of follow-up was 62 months (range 0.25-374). Musculoskeletal (84.2%) and mucocutaneous (75.3%) were the most frequent clinical manifestations. Antinuclear antibodies were detected in 97.3%, anti-DNA antibodies in 69.2% and anti-Sm in 39.2% of the patients. Anti-cardiolipin antibodies and lupus anticoagulant were ob-served respectively in 71.6% and 37.8% of the patients. The five-year survival rate in our series was 92%. Renal involvement and thrombocytopenia were associated with poor prognosis (p< 0.05). The clinical and immunological characteristics of our SLE patients are largely comparable to most major studies. Main differences included prominent major organ damage and high pre-valence of anti-Sm and anti-cardiolipin antibodies.

[Mortality and prognostic factors in 146 patients with systemic lupus erythematosus in southern Tunisia]

OBJECTIVES

The objective of this study was to analyze the survival rate, causes of death, and prognostic factors in patients with systemic lupus erythematosus (SLE), mainly from southern Tunisia.

METHODS

This retrospective study examined the records of 146 Tunisian patients with SLE, all meeting at least 4 of the American College of Rheumatology criteria for this diagnosis.

RESULTS

The mean age at presentation of these patients (126 women and 20 men) was 29.2 years (range: 6-55), and the mean duration of follow up 62 months (range: 3 days-374 months). Eleven patients (7.5%) died during follow-up. The 5- and 10-year survival rates in this cohort were both 92.1%. The most frequent causes of death were infections and disease activity, each accounting for 4 deaths. Logistic regression showed that nephrotic syndrome was an independent prognostic factor for death (p=0.032, OR=5.64).

CONCLUSIONS

Our results confirmed the improvement in recent years of survival rates among SLE patients. Infections and disease activity remain the most common causes of death. Nephrotic syndrome is independent risk factor for mortality.