[Neurobrucellosis: clinical features and therapeutic responses in 15 patients]

We report a retrospective analysis of 15 cases of neurobrucellosis. Initial clinical manifestations consisted of meningoencephalitis in 5 patients, acute and subacute meningitis in 4, intracranial hypertension in 2, polyradiculoneuritis with albumin-cell dissociation in 2 (one with cerebral and subarachnoid hemorrhage), and transverse myelitis and lumbar epidural abcess with root involvement in 1 each. Cranial nerve involvement was noted in 5 patients. Fever was absent in 3. Transient clinical manifestations mimicking transient ischemic attacks were noted in 3 patients. Unusual central nervous system demyelinating lesions were observed on the MRI in 1 of the patients with meningoencephalitis. Cerebrospinal fluid Wright titers and culture were rarely helpful. Most patients responded favorably with minor neurological sequelae. The most commonly used antibiotics were rifampin, doxycycline, and trimethoprim-sulphamethoxazole, in various combinations for at least 3 months. The differential diagnosis of neurobrucellosis is wide. However, in endemic areas, the disease should be ruled out in all patients who develop unexplained neurological symptoms.

[Distal glue embolization in a patient with gastrointestinal hemorrhage]

This is a case report, concerning the endovascular use of N-butyl-2-cyanoacrylate, for treatment of a digestive hemorrhage from a distal branch of the superior mesenteric artery, leading to a successful outcome. This material, usually used in brain angiomas, constitutes an alternative for digestive embolization, which is quick, precise and definitive, without additional risk in experienced hands.

[Vertebral actinomycosis: case report and review of the literature]

In this article, the case of a 32-year-old man with a paravertebral actinomycosis is discussed. Initially, the diagnosis was not obvious but it was confirmed later with the repetitive radiologic procedures, the elimination of other etiologies (purulent, mycobacterial or mycotic infections and neoplasia) and the biopsy. Treatment with penicillin initially and then with tetracycline for a long term led to a very good outcome at a 3-year follow-up with a radiologic remission. Following the discussion of the case, a review of the literature concerning the paravertebral actinomycosis, its diagnostic clues and treatment is undertaken.

[Human brucellosis. Retrospective studies of 63 cases in Lebanon]

OBJECTIVES

We performed an epidemiological survey to ascertain the clinical features of brucellosis in Lebanon.

PATIENTS AND METHODS

Between 1994 and 1998, 63 patients were seen at the Hôtel-Dieu de France Hospital in Beirut Lebanon. Diagnostic criteria were brucellar agglutinins at a titer > or = 1/160 with symptoms suggestive of brucellosis in the absence of another diagnosis. We also conducted a survey in 1138 cases registered by the Ministry of Health during the same period.

RESULTS

Among the 1137 cases, 40% of the patients were over 60 and only 16% were under 14. The overall male to female ratio was 1.01 and 69% of the patients were seen in spring and summer. Among the 63 patients, 10 were pediatric cases. The disease was acute in 41 (65%), subacute in 21 (33%) and chronic in 1. The main presenting symptoms were fever, sweating, easy fatigability and joint pain. Osteoarticular involvement was the most prevalent complication (25%), predominantly spondylitis. Among the blood tests, relative lymphocytosis was significantly more frequent in children than adults (80% versus 13%, p < 0.001).

CONCLUSION

Brucellosis is still an endemic disease in Lebanon and should be considered notably in patients presenting with prolonged fever, and articular and neurological manifestations.

[Agents and consequences of nosocomial infections in a Lebanese university hospital. Retrospective study over a two-year period]

OBJECTIVES

Study the common sites of nosocomial infection, pathogens and antibiotic resistance in a university hospital.

METHOD

Retrospective study during 1997 and 1998.

RESULTS

One hundred eighty nosocomial infections were recorded in 154 patients. The incidence was 1.3 per 1 000 patient-days. Pneumonia was the second most frequent type of nosocomial infections after urinary tract infection, but caused the highest mortality. Gram-negative bacteria were the predominant agents (81%) with a major antibiotic resistance.

CONCLUSION

A strict application of the preventive measures and surveillance program is warranted to control outbreaks of these infections.

[Pseudo-Takayasu in Behcet's disease]

Behcet's disease is a chronic multisystem vasculitis that is frequent in Lebanon. The great arteries involvement is rare. We report here an unusual case of subclavian artery occlusion (pseudo-Takayasu) with a literature review.

[Unusual presentation of typhoid fever. Apropos of 3 cases]

Typhoid fever is still an endemic disease in Lebanon with a risk of mortality especially in the immunosuppressed patients. We report 3 atypical observations and discuss cardiopulmonary, neurological, hematologic and urinary manifestations of this disease.

[Behçet disease. Genetic factors, immunologic aspects and new therapeutic methods]

PATHOGENESIS

The pathogenesis of Behcetp3disease is still unknown, although a genetic predisposition appears to play an important role with a strong association with the MICA gene located between the HLA-B and TNF genes rather than HLA B51. Abnormal immune responses affect especially cellular immunity and significant T-cell proliferative responses by the gamma ô subset of T cells are shown after stimulation with heat shock protein peptides. Systemic levels of the soluble TNF R-75 and IL 12 could be the best biological markers of disease activity.

NEW THERAPEUTIC APPROACHES

Systemic colchicine being implicated in polynuclear neutrophil over-production of toxic super-oxides, its prescription for controlling eye involvement should be reevaluated. Steroids and immunosuppressive drugs are still the treatment of choice for severe manifestations of the disease. Beneficial effects of cyclosporine are established in uveitis. Tacrolimus (FK 506) and pentoxifylline may be valuable.

Acute cocaine intoxication in a smuggler. One case report and a review of the literature

The smuggling of cocaine into many countries by ingestion of wrapped cocaine packets and gastro-intestinal concealment is a common and well-recognized practice. This is a report of the case of a smuggler carrying 14 ingested packets of cocaine and who presented an acute intoxication with a rare complication, rhabdomyolysis, which were managed medically and the packets removed surgically. A discussion and a review of the literature are undertaken.

[Scleroderma with anomalies of the thyroid function. 7 cases]

Thyroid function, studied in 36 scleroderma patients revealed 7 abnormal cases: 6 hypothyroid patients secondary to autoimmune thyroiditis and 1 hyperthyroidism secondary to Graves' disease. In the hypothyroid subgroup, 3 cases presented a localized systemic sclerosis and the 3 others presented a diffuse systemic sclerosis; Sjögren syndrome was found in 2 of these patients. The hyperthyroid patient presented a diffuse systemic sclerosis. Because of the association between scleroderma and thyroid diseases, we suggest to perform thyroid screening regularly for all patients with systemic sclerosis.

[Neonatal lupus erythematosis and atrial-ventricular block. A case report and review of the literature]

Neonatal lupus erythematosus is a rare syndrome. It is characterized by a transient lupus dermatitis and congenital heart block. The immunopathogenesis of the disease has been linked to the presence of the SSA antibody. In this report, we describe a symptomatic congenital heart block in a 13-year-old male whose mother had documented systemic lupus erythematosus. We also discuss how to manage a woman with lupus erythematosus and positive antiSSA/Ro antibodies. We conclude that patients with neonatal lupus and their mothers should be observed closely before delivery and for prolonged periods for signs of active disease.

[Werner's syndrome]

BACKGROUND

Werner's syndrome associates early aging in young adults, small height, cataract, glucose intolerance, hypogonadism, skin ulcers, vascular calcifications and osteoporosis.

CASE REPORT

We report a new case of Werner's syndrome in a 34-year-old man with suggestive alterations of the skin and endocrine anomalies in addition to hypospadias, urethral stenosis, bilateral mega-ureter and chronic renal failure.

DISCUSSION

The diagnosis of Werner's syndrome in our patient was unquestionable because of the clinical presentation and the familial context. However, the urology anomalies have not been reported in this syndrome. A simple coincidence cannot be excluded.

[Inflammatory intestinal diseases and their extra-intestinal manifestations observed at Liban]

101 cases classified as inflammatory bowel disease at the Hôtel-Dieu de France Hospital between 1982 and 1994 were investigated. Files containing a sure diagnosis and complete clinical and biological investigations were included. 65 files were retained for the study: 48 cases had ulcerative colitis (UC), 17 had Crohn's disease (CD). UC averaged 4.7 admissions per 10,000 admissions to the hospital, while CD averaged 1.54 per 10,000. The UC/CD ratio was 2.8 and the Female/Male ratio was 1.4 for UC and 0.9 for CD. Medium follow-up was 6.4 years. 30% of our group was followed for more than 10 years. Overall frequency of extra-intestinal manifestations was similar to that reported worldwide. This is especially true for UC. However, no cases of ankylosing spondylitis, sclerosing cholangitis or erythema nodosum were found. One case of pyoderma gangrenosum was found in the series of CD. Extra-intestinal manifestations were found in 54% of UC patients and 94% of CD patients, probably because milder cases of this disease were misclassified as infectious diarrhea.

[Neurologic manifestations in Behçet's disease. 16 cases in a cohort of 110 patients]

OBJECTIVE

To discuss neurological involvement of Behçet's disease and therapeutical possibilities.

PATIENTS

Among 110 patients with Behçet's disease, 16 were found to have neurological involvement. All these patients fulfilled Japanese and International Study Group criteria for diagnosis of Behçet's disease.

RESULTS

Central nervous system involvement was found in 15 patients and peripheral nervous system involvement in one. Meningoencephalitis and/or transverse myelitis were the most frequent features (69%) followed by tumor-like manifestations (13%); cerebral venous thrombosis was identified in 1 patient with occlusion of the left lateral sinus. Focal deficits were the major presenting signs and cranial paralysis were present in 19% of patients. In meningoencephalitis, the cerebrospinal fluid findings were lymphocytic pleocytosis and elevated protein level. Cerebral CT Scan, performed in 6 patients, was normal in 33% of cases. MRI, performed in 4, showed abnormal signals distributed over hemispheric white matter, the brainstem and the thalamus in one patient, an occlusion of the left lateral sinus in the second one and a tumor-like lesion in the third. MRI abnormalities were associated with concording clinical deficits.

CONCLUSION

Neurological involvement in Behçet's disease con be classified into 3 clinical aspects: meningoencephalitis (and/or myelitis), cerebral venous thrombosis and tumor-like features. Corticosteroids, when prescribed early, are useful and are associated with better prognosis.

[Nervous system brucellosis in Lebanon. Report of six cases]

The authors report 6 cases of nervous system brucellosis (3 males, 3 females) and present the different clinical features of this localization. Meningoencephalitis is observed in 4 patients and is associated with subarachnoid hemorrhage in one. Pure meningitis occurred in one case and acute myelitis in another one. Cerebrospinal fluid composition is studied in all these patients. Rifampicine associated with Cotrimoxazole, for at least 3 months, is very helpful in nervous system brucellosis because of their good central nervous system penetration but neurological sequelae are noted in one case of meningoencephalitis with chronic infection and in the case of myelitis.

Behçet's disease in Lebanon: report of 100 cases

PURPOSE

To present clinical features of Behçet's disease in Lebanon and to evaluate the efficacy of treatment.

PATIENTS AND METHODS

The 100 patients are seen at Hotel-Dieu de France Hospital of Beirut between 1980 and 1992. Diagnostic criteria are those of the Behçet Syndrome Research Committee of Japan.

RESULTS

Recurrent oral ulcers are present in 95% of cases, genital ulcers in 78%, ocular manifestations are more frequent than those of several studies whereas skin lesions and vascular signs are less frequent. Joint involvement are recorded in 65% of cases and neurological one in 14%. The effectiveness of colchicine therapy is confirmed for mucocutaneous lesions and arthritis. Immunosuppressive agents are more beneficial than steroids alone on serious uveitis. An aggressive treatment with corticosteroids and immunosuppressive drugs improve the prognosis of meningoencephalitis.

CONCLUSION

Behçet's disease doesn't have any specific characteristics in Lebanon despite some variation in the frequency of lesions.

[Hypothalamo-hypophyseal and gastric metastasis of a breast neoplasm. Clinical case and a review of the literature]

The authors report the case of a young woman with advanced breast cancer who developed diabetes insipidus due to pituitary involvement and also gastric metastases. This patient had a normal brain CT scan. Gastric metastases were diagnosed when she was operated for a perforated gastric ulcer. Although very rare, and even if the brain CT scan is normal, pituitary metastases should be diagnosed in the presence of suggestive clinical symptoms. Abdominal pain also warrants investigation in these patients in an early attempt to document any possible gastric metastases.

[Behçet's disease. Apropos of 32 cases]

The study of 32 cases of Behçet's disease has enabled the authors to ascertain that the disease presents no particular characteristics in Lebanon, except certain variations in the frequency of the symptoms. Their study includes two familial cases, or approximately 3 p. cent and confirms the severity of these forms. Colchicine proves to be an effective treatment able to cure cutaneous and articular symptoms and perhaps stabilize the ocular lesions. The long-term efficacy of steroid therapy in ocular manifestations is not certain. Chlorambucil caused a stabilization of ocular lesions in four patients.