Early onset of scleromyxedema Arndt‐Gottron associated with a monoclonal gammapathy: Successful treatment with intravenous immunoglobulins

Arndt‐Gottron (S‐AG) syndrome or scleromyxedema is a scarce disease characterized by a generalized papular and sclerodermoid eruption and systemic manifestations that can lead to significant morbid‐mortality. Interesting, S‐AG can be associated with a paraprotein. We report an exceptional scleromyxedema case associated with a benign monoclonal gammapathy in an old woman.

Encapsulating Peritoneal Sclerosis after kidney Transplantation: Success of Medical Treatment

Encapsulating peritoneal sclerosis (EPS) is an infrequent but serious complication of long-term peritoneal dialysis (PD). EPS may become clinically apparent when patients are on PD (classical EPS) or after undergoing kidney transplantation (post-transplantation EPS). This presentation of EPS seems to occur shortly after kidney transplantation in former PD patients. In this report, we present our experience in our first case of patient diagnosed with EPS after kidney transplantation.

Acquired Bartter Syndrome in Primary Sjögren Syndrome

Renal tubular involvement in Sjögren's syndrome (SS) often described with renal tubular acidosis, nephrogenic diabetes insipidus, or rarely with Fanconi syndrome. SS presenting with clinical features of Bartter's syndrome or Gitelman's syndrome is rare. We report a case of a female patient who presented an acquired Bartter syndrome with a primary SS.

Tubulointerstitial nephritis due to sarcoidosis: Clinical, laboratory, and histological features and outcome in a cohort of 24 patients

Renal involvement is rare in systemic sarcoidosis. Among renal manifestations, tubulointerstitial nephritis (TIN) is the most commonly reported finding. We conducted the current study to investigate the clinical, laboratory, and histological features and to analyze the outcome of TIN due to sarcoidosis. We present a retrospective, single-center study of patients followed for sarcoidosis and presenting with TIN related to this systemic disease. Twenty-four patients were assessed (22 females/2 males). The mean age at diagnosis of TIN was 46.3 years. Extrarenal manifestations were dominated by thoracic involvement (95.8%), peripheral lymph nodes (54.2%), and skin lesions (33.3%). The mean proteinuria level was 0.68 g/24 h. Renal failure was diagnosed in 83.3% of cases with a median estimated glomerular filtration rate at 14.3 mL/min/1.73 m². Nine patients presented with hypercalcemia and 12 patients with hypercalciuria. Renal biopsy was performed in 58.3% of cases. Six of the 14 patients presented with noncaseating granulomatous interstitial nephritis and eight with interstitial nephritis without granuloma. Granulomatous infiltration of renal parenchyma was complicated by vasculitis in two cases. Corticosteroid therapy was used in all patients. On follow-up analysis, four patients progressed to end-stage renal disease (ESRD) after a mean duration at 45.5 months. In the remaining patients, kidney function statistically significantly improved after one month of treatment compared to the time when the diagnosis was initially established (P = 0.031). We found that the predictive factors of progression to ESRD were multiorgan involvement (P = 0.032), advanced fibrosis F3 (P = 0.0006), and extensive interstitial granulomas (P = 0.007) and these were independently correlated with ESRD. Corticosteroid therapy seems to be effective in sarcoid TIN, but some degree of persistent renal failure is possible which can be predicted from both histologic findings and initial response to steroid therapy.

AB0451 PRIMARY SJOGREN’S SYNDROME IN MEN

Background:

Primary Sjogren’s syndrome (PSS) is characterized as an autoimmune exocrinopathy, but this disorder also may involve extraglandular organs, giving rise to multisystem disease. Although the first case reported by Dr Mikulicz was a 42 year old man [1], there are only few reports describing the clinical picture of Sjogren’s Syndrome in males

Objectives:

To determine whether there were any clinical and biological differences between male and female tunisian patients with primary Sjogren’s syndrome (PSS).

Methods:

We studied 60 patients with pSS according to American-European Consensus Group (AECG), attending an Internal Medicine departement in Tunisia. The nine (15%) male patients in this cohort comprised the male group described in this study

Results:

The average age of men at diagnosis was 53.2 years [31 to 73 years]. Male SSp was revealed by sicca symptoms (55.5%), by extra glandular manifestations (33.3%). Fourty-four percent of our male patients had a positive result for a minor salivary gland biopsy (grade III or IV).

Extraglandular manifestations during the course of the disease were present in 6 cases (66%) of our male patients with pSS. weight loss and raynaud’s phenomenon were more common in men. a significantly greater percentage of men had neurological involvement (66.6%vs 23,7) and and pulmonary involvement, notably a restrictive syndrome (66.6% vs 31,1%, p=0.043). The positivity of Anti-nuclear antibodies, anti-SSb and rheumatoid factor were significantly less common in males.

Anemia was significanty more common in the male patients (p=0,049). No cases of Lymphoma in the male patients in our series.

Eighty-eight percent of the men were treated with corticosteroids. In our series, the use of immunosuppressants was not necessary in male patients.

Conclusion:

Although pSS is typically a disease affecting women, clinicians should be aware that it may be diagnosed in male patients. Although men were at the same risk for the development of extraglandular complications, there were significant serologic and immunogenetic differences. In Sharp contrast to women with Sjogren’s syndrome, men with Sjogren’s syndrome were more seronegative in our series.

References:

[1]Mikulicz J. Discussion at Verein fur wissenschaftliche Heilkunde zu königsberg. Berl Klin Wocchenschr 1888; 25:759.

[2]Gondran G, Fauchais A, Lambert M, Ly K, Launay D, Queyrel V, et al. Primary Sjogren’s syndrome in men. Scandinavian journal of rheumatology. 2008;37(4):300-5.

[3]Virdee S, Greenan-Barrett J, Ciurtin C. A systematic review of primary Sjogren’s syndrome in male and paediatric populations. 2017;36(10):2225-36

Disclosure of Interests:

None declared

Extensive sphenoid chordoma mimicking a prolactinoma

The chordoma is a benign cartilaginous tumor whose sphenoidale localization is exceptional. This tumor has considerable difficulties of both diagnosis and treatment. We report the observation of a Tunisian adult who presented features of hypopituitarism set wrongly on account of a prolactinoma.

Prolonged fever and intra-cardiac thrombosis revealing Behçet's disease

BACKGROUND

Prolonged fever (PF) is a challenging problem for physicians since it can be the first manifestation of a large variety of pathologies. Exceptionally, intra-cardiac thrombus (ICT) could explain PF and reveal Behçet's disease (BD). We are reporting a 45-year-old man with BD who has these unusual manifestations.

CASE REPORT

A 45-year-old man presented with PF and inflammatory biological syndrome during a few months. Echocardiography showed an inhomogeneous and mobile mass in the left auricle. During his hospitalization, the patient had multiple oral aphtosis. The angioscanner showed a sacciform aneurysm of the coeliac trunk. The diagnosis of BD was retained and he was treated with high doses of steroids and cyclophosphamide with a favorable follow-up.

CONCLUSION

The search for BD should be systematic in view of any suggestive manifestation of severe cardiovascular complications like ICT especially in a young adult man from a high endemicity region.

Successful resolution of Hemophagocytic lymphohistiocytosis associated to brucellosis in the adult

Hemophagocyticlymphohistocytosis (HLH) is a proliferation of histiocytes with importanthemophagocytosisoccurring in different organs such as the spleen and the bone marrow. HLH is now increasingly diagnosed in the context of infections, malignancies and connective tissue diseases. Although brucellosis is an endemic infection in Tunisia, its association with HLH is a very rare condition which should be considered in patients with splenomegaly and cytopenia. Here, we describe brucellosis associated HLH in a 31 year-old man. The patient was admitted to our hospital with fever, sweating, and fatigue. Physical and laboratory findings revealed splenomegaly, pancytopenia, elevated serum transaminases, triglycerides, lactate dehydrogenase, and ferritin, and bone marrow hemophagocytosis. The Brucella agglutination test was positive. The patient improved after treatment with Rifampin and doxycyclin.