Optic neuritis revealing Kikuchi-Fujimoto disease

Kikuchi-Fujimoto disease is a rare systemic disease with uncommon neurological involvement. We report the case of a 30-year-old Asian woman who presented a rapidly progressive loss of vision. Magnetic resonance imaging (MRI) of the optic nerve revealed an inflammation of the left optic nerve with chiasmatic involvement, without any encephalic or medullar lesion. Thoracic computed tomography scan showed bilateral axillary lymphadenopathy. Analysis of a biopsy of the axillary lymph node showed typical histological findings of Kikuchi-Fujimoto disease. There was no clinical or biological sign of associated systemic lupus erythematosus. The patient spontaneously recovered normal visual acuity in 4 weeks, with resolution of MRI abnormalities. No optic neuritis relapse or neurological event occurred in a 3-year follow-up. To our knowledge this is the first case of optic neuritis associated with Kikuchi-Fujimoto disease.

Fingolimod to treat severe multiple sclerosis after natalizumab-associated progressive multifocal leukoencephalopathy: a valid option?

We report two cases of multiple sclerosis (MS) patients with natalizumab-associated progressive multifocal leukoencephalopathy. Severe MS relapses occurred between four and five months after natalizumab discontinuation. After failure of immunomodulatory treatment, both patients were treated with fingolimod. The outcome was positive on clinical and MRI disease activity, without worsening of the progressive multifocal leukoencephalopathy. These observations suggest that using fingolimod for severe multiple sclerosis after natalizumab-associated progressive multifocal leukoencephalopathy may be an option, under close clinical and radiological monitoring.

High performance multi-spectral interrogation for surface plasmon resonance imaging sensors

Surface plasmon resonance (SPR) sensing has proven to be a valuable tool in the field of surface interactions characterization, especially for biomedical applications where label-free techniques are of particular interest. In order to approach the theoretical resolution limit, most SPR-based systems have turned to either angular or spectral interrogation modes, which both offer very accurate real-time measurements, but at the expense of the 2-dimensional imaging capability, therefore decreasing the data throughput. In this article, we show numerically and experimentally how to combine the multi-spectral interrogation technique with 2D-imaging, while finding an optimum in terms of resolution, accuracy, acquisition speed and reduction in data dispersion with respect to the classical reflectivity interrogation mode. This multi-spectral interrogation methodology is based on a robust five parameter fitting of the spectral reflectivity curve which enables monitoring of the reflectivity spectral shift with a resolution of the order of ten picometers, and using only five wavelength measurements per point. In fine, such multi-spectral based plasmonic imaging system allows biomolecular interaction monitoring in a linear regime independently of variations of buffer optical index, which is illustrated on a DNA-DNA model case.

[Treatment of multiple sclerosis: new approaches to treat case by case]

Multiple sclerosis is a complex disease of the central nervous system involving inflammation, demyelinisation, remyelinisation and axonal degeneration. Based on a real case report, we will review different treatments in multiple sclerosis. Improvement in targeting the inflammatory component of the disease allows an early treatment to prevent relapses and long term disability, but sometimes with serious adverse events. Therapeutic decision must be taken individually based on an accurate evaluation of the risk-benefit balance.

Encephalitis and CSF increased level of interferon-α in Kikuchi-Fujimoto disease

Neurological manifestations have been reported in Kikuchi-Fujimoto disease (KFD). Characteristics of brain lesions are not defined. In addition, no biological indexes are known to help clinicians along the diagnosis process. The authors describe encephalitis associated with KFD. Brain MRI, positron emission tomography (PET) scan and a large biological assessment including interferon α (INF-α) level measurement in cerebrospinal fluid (CSF) were performed. A 39-year-old man with chronic headaches developed diplopia, slow ideation and behavioural disturbances. MRI showed brain lesions particularly in the pontine region and internal temporal lobes with enhancement of the perivacular space and the walls of the lateral ventricle. The IFN-α level was increased in the CSF without viral infection. Cervical and mediastinal adenitis were evident as a hypermetabolic focus on a PET scan, and biopsy confirmed the diagnosis of KFD. The encephalitis spontaneously remitted. The authors characterised brain lesions especially related to KFD in association with increased of IFN-α level in the CSF.

Peut-on proposer une prise en charge de la fibrose rétropéritonéale idiopathique validée par les données de la littérature ?

BACKGROUND

Nowadays it is quite easy to diagnose idiopathic retroperitoneal fibrosis (IRF), particularly with the help of medical imaging. However there is no guideline about the treatment.

PURPOSE

Looking for data about an evidence-based management.

METHODS

Screening of the database Medline. Titles and abstracts of articles published between 01/01/1985 and 31/12/2004 have been read to identify clinical trials and series about more than ten patients.

RESULTS

No record of any therapeutic trials has been found. Eight series in total, which included 177 patients, were identified. Two of the patients have been treated by an ureteral desobstruction only (endoscopy or nephrostomy), 45 by surgery (ureterolysis), 65 by corticotherapy and 64 both by surgery and steroids. For 38 patients, immunosuppressive drugs were combined with corticotherapy (azathioprine, cyclophosphamide or D-penicillamine). According to the authors, doses and duration of corticotherapy varied. Median follow-up lasted 56 months. The outcome is satisfactory in 73% for surgery alone, 86% for medical treatment alone and 73% for both. The association between steroids therapy and immunosuppressive drugs is efficient in 97% of the cases. No clear data about side effects was mentioned.

DISCUSSION

Treatment of the IRF is still empirical, based on surgery and corticotherapy. There is no guideline about the treatment strategy. Although tamoxifen has been proposed, efficacy evidence is lacking. Prospective multicenter studies will help us to progress in the management of the IRF.