Les ischémies cérébrales chez les jeunes sont différentes par leurs étiologies et leur pronostic. Le profil étiologique en médecine interne est particulier vu le niveau tertiaire de recrutement. L'objet de notre travail est de faire connaître certaines étiologies particulières de cette pathologie chez le sujet jeune. Etude rétrospective des dossiers de jeunes patients au service de médecine interne à Casablanca, sur une période de 2000-2014. Tous les patients ont bénéficié d'une imagerie cérébrale avec des séquences angiographiques, précisant la nature et la topographie de l'AVCI. Un bilan étiologique dicté par la clinique a été mené. Vingt et cinq patients ont été colligés, avec un sex-ratio à 0,73 et un âge moyen de 36±7. Le tabagisme était présent dans 32% des cas, le diabète et l'hypertension artérielle ont été notés dans 8% des cas. Les épisodes d'amnésie et de migraine ont été notés dans 24%. La prise d'oestroprogestatifs et l'antécédent de fausses couches ont été notés dans 12%. Les étiologies étaient dominées par: lupus systémique aigu (32%) associé à un syndrome des antiphospholipides (80%), maladie de Behcet (16%), maladie de Takayasu (12%). En plus de l'antiagrégation, 76% de nos patients ont eu un traitement aux corticoïdes et immuno-suppresseurs. La médecine interne participe à la prise en charge des AVCI, notamment dans le volet étiologique. Les étiologies des ischémies cérébrales du sujet jeune sont multiples, la recherche doit être rigoureuse afin d'identifier des causes particulières, évaluer le risque de récidive et préciser la stratégie thérapeutique.

Common variable immunodeficiency (CVID) is the most frequent primary immunodeficiency and has a reported prevalence of approximately 1:25,000 to 1:50,000. The fact that it is rarely considered as a diagnosis in adults can lead to diagnostic delay, especially in older patients, and to complications such as bronchiectasis and excess mortality. However, practitioners should first exclude common causes of hypogammaglobulinaemia before considering CVID. Here we present a case of CVID revealed by prolonged fever and complicated with granulomatous manifestations and bronchiectasis in an older woman without a history of recurrent infections.

No abstract

Budd-Chiari syndrome (BCS) is considered a rare but serious complication of Behçet's disease (BD). This study was performed to define the prevalence, clinical and biological features, treatment, and clinical course of BSC associated with BD in a Moroccan population. We retrospectively analyzed the medical records of 1578 patients fulfilling the international diagnostic criteria for BD, including those with BSC. Eighteen male and 3 female patients, with a mean age of 36 ± 8.6 years. The inferior vena cava was involved in 81% (n = 17) of cases. All forms of BCS were noted: the chronic form in 52.4% (n = 11), the subacute form in 38% (n = 8), and the fulminant form (2 cases). Ascites was the main clinical sign and was present in 62% of patients (n = 13). Other venous thromboses (superior vena cava and lower limbs) were associated with BSC in 52.4% of patients (n = 11). Arterial involvement was noted in 28.6% (n = 6). Cardiac manifestations were present in 19% (n = 4) of the patients. All the patients received anticoagulants associated with corticosteroids. Immunosuppressants were used in 95% (n = 20). One patient received infliximab. Severe complications were noted in 38% (n = 8) of patients (digestive bleeding, confusion, infections and liver failure). Four patients have died during the study period. BCS in patients with BD is not uncommon and can be life threatening. It is frequently associated with other vascular manifestations that can be difficult to treat, particularly in the presence of pulmonary artery aneurysms. Prognosis improved with the use of immunosuppressants. Biologics can be promising in the early stages.

No abstract

Behcet disease is a proteiform vasculitis, and it can have multiple presentations. One of these presentations is digestive involvement commonly known as entero-Behcet. It is a challenging presentation of Behcet disease, because of its similarity with other inflammatory digestive diseases, especially Crohn disease, which makes its diagnosis difficult and uncertain in many cases. It is also challenging to treat, and its treatment can go from corticosteroids and immunosuppressive therapy to biologics. The absence of a standardized protocol to treat patients can be confusing for practitioners treating entero-Behcet. This incites doctors treating entero-Behcet to have multidisciplinary meetings to discuss patients’ cases. This review will give an insight into pathophysiology, diagnosis, and management of entero-Behcet to help practitioners taking care of this challenging aspect of entero-Behcet.

No abstract

Cardiac involvement represents an increasingly frequent complication in systemic lupus, with pericarditis being the most classic cardiac manifestation. However, the most severe and fatal form seems to be myocarditis. We present the case of a patient with systemic lupus complicated by cardiogenic shock secondary to troponin-negative acute myopericarditis and successfully treated with mycophenolate mofetil and corticosteroid therapy. A 33-year-old woman with no past medical history presented with asthenia and inflammatory arthralgia. She was admitted in June 2021 for acute heart failure. Transthoracic cardiac ultrasound showed dilated cardiomyopathy with global hypokinesis (20-25% of ejection fraction) and right ventricular dysfunction without significant mitral and aortic valve disease. She had raised proBNP (probrain natriuretic peptide), low troponin, normochromic normocytic anemia at 10.4 g/dL, positive direct Coombs, lymphopenia at 460/mm 3 , serum creatinine at 23.9 mg/L, and proteinuria/creatininuria 2.48 g/g. Cardiac magnetic resonance imaging (CMR) suggested the diagnosis of myopericarditis. The etiological assessment did not identify an infectious, toxic, or medicinal cause. The clinical picture suggested the possibility of an autoimmune disease. The patient presented with lesions suggestive of cutaneous vasculitis, with oral ulcers with polyarthritis. The autoimmune workup showed anti-nuclear antibodies at 1:1,280, antinative DNA antibodies at 210 IU/mL (normal < 10 IU/mL), and positive anti-SM Abs. The diagnosis of lupus myopericarditis complicated by cardiogenic shock was made, which was associated with acute renal impairment. The patient was initiated on heart failure medications along with corticosteroids and mycophenolate mofetil. On day 15, the left ventricular ejection fraction improved to 45-50%, with clinical improvement in signs of heart failure and general condition. The existence of myopericarditis without obvious etiology, especially when there are extra-cardiac signs such as skin and joint involvement, should lead us to look for systemic lupus in order to start etiological treatment in addition to cardiac medical treatment. Until now, there is no standard treatment for lupus myocarditis, but the use of mycophenolate mofetil seems to be a promising treatment.