Conclusions: This case demonstrated the necessity of multiple immunomodulatory therapies for severe AAV. Treatment of relapses remains challenging especially for frequent relapses which required intensification of immunosuppressive regimen.Trimethoprim-sulfamethoxazole as PJP prophylaxis was evidencebased recommendation, which could also reduce the risk of relapse in GPA. Macrolide antibiotics are used primarily for prevention of bronchiectasis exacerbations as per European Respiratory Society guidelines. Anti-inflammatory effect of macrolide was well known in the literature, however macrolide effect on the autoimmune conditions has not been previously described.Previous studies suggested that bronchiectasis is highly prevalent in AAV, which was shown to be responsive to immunosuppression. There are no guidelines for using antibiotics for prevention in GPA with lower airway involvement. Thus this appears to be the first time in literature, macrolide antibiotics have been shown to be effective in suppressing flare ups of GPA. We think this strategy may be worth looking at if bronchiectasis or lower airway involvement exists prior to the onset of GPA.Introduction: Crescentic glomerulonephritis (CGN) is a diagnostic and therapeutic emergency. There are many causes of type 2 CGN. The objective of our study is to determine the characteristics of the infection related CGN (ICGN). Methods: This is a retrospective study between 1990 and 2015 including patients with infectious origin ICGN. We determined the demographic, clinico biological, histological, therapeutic and evolutive parameters. Results: We collected 20 patients. Mean of age was 40 AE 19,8ans (range de16-77ans).sex ratio was 3. The onset was sudden in 70% of cases. A rapidly progressive GN (RPGN), nephritic syndrom, nephritic syndrome were observed respectively in 50%, 25% and 25%. Mean plasma creatinine was 884 AE 498mmol / L. Cryoglobulinemia was positive in 20% of cases. Mean crescentic glomerulis was The 56 AE 39%. The infection was endocarditis, a skin infection, an ORL infection, dental abscesses, purulent pericarditis, pulmonary focus and acute pyelonephritis and septic arthritis in respectively 25%, 20%, 10%, 5%, 15%, 15%, 15% and 15%. The therapeutic management required the use of emergency hemodialysis in 11 patients (55%). All patients received antibiotic therapy. 40% of patients received corticosteroids and 25% received corticosteroids plus cyclophosphamide. Death occurred in 25% ofpatients, ESRF was observed in 55% and partial or total improvement of renal function was observed in 10% of cases. Conclusions: ICGN are rarely described in occidental literature. The most common causes as shown in our series are endocarditis and deep infections. Treatment is controversial combination antibiotic therapy alone or combined with corticosteroid therapy or even immunosuppressant and plasmapheresis.
However rare, solitary neurofibroma must be considered in the differential diagnosis of unilateral benign tumor involving nasal and paranasal sinuses. A transnasal endoscopic approach should be considered for treatment.
Background: Rhinoscleroma is a chronic and specific granulomatous infectious disease caused by enterobacteria of the family Klebsiella: "Klebsiella rhinoscleromatis"; it reaches the nasal cavities in 95% of cases. The objective of our study is to report the clinical, diagnostic and therapeutic aspects of our patients.
Observations/Medical findings:The study took place at the ENT department of the Fann National University Hospital Center in Dakar, and it was based on two female subjects who are 26 and 60 years old, respectively. The medical examination of the subjects indicated a granulomatous lesion blocking the two nasal cavities. A biopsy performed on each patient revealed a rhinoscleroma. Both patients received doxycycline-based medical treatment with endoscopic endonasal surgery like "Debulking. " The patients all recovered nasal breathing after airway clearance. However, we noted a scar retraction of the nasal cavities in the first patient.
Conclusions:As the disease recurs, rhinoscleroma is becoming more and more a cosmopolitan affection. The diagnosis is histological. Well-conducted medical treatment allows healing in early forms while surgery is complementary in advanced forms. The fear of a recurrence calls for an extended follow-up.
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