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We describe the case of a patient presenting with painful arthropathy of the distal interphalangeal joints of the fingers. She was initially believed to have chronic inflammatory rheumatism. High thyroid stimulating hormone values were discovered leading to the diagnosis of primary severe hypothyroidism. Rapid response of articular manifestations to thyroid hormone substitution suggests that hypothyroidism could be the cause of this articular impairment.

IntroductionThrombosis has been widely reported in coeliac disease (CD) but central retinal vein occlusion (CRVO) is rarely described.Case presentationA 27-year-old woman presented with acute visual loss and was diagnosed with CRVO. Her protein S and protein C levels were low and CD was diagnosed on the basis of endoscopic, immunological and histological results. A gluten-free diet resulted in favourable evolution.ConclusionCD should be considered in young patients with thrombosis, especially if in an unusual location. Treatment is based on a gluten-free diet.LEARNING POINTSCoeliac disease (CD) should be considered in young patients with central retinal vein occlusion (CRVO).Several mechanisms can cause thrombosis in CD.CRVO in CD is often reversible with a gluten-free diet.

Introduction to describe the epidemiological, clinical, therapeutic and evolving characteristics of Behçet´s disease and identify prognostic factors. Methods we have realized a retrospective, single-center study, conducted over a period of 26 years and including 130 patients presenting Behçet´s disease and hospitalized in an Internal Medicine Department. Results the mean age of the Behçet´s disease at onset was 30.3 ±8.8 years and that at diagnosis was 34.6 ±9.4 years. The sex ratio (male/female) was 2.5. The mean delay of diagnosis was 53.5 months. Oral aphthosis was constant. The frequency of the manifestations was: genital aphtosis 71.5%, pseudofolliculitis 84.6%, erythema nodosum 11.5%, positive pathergy test 50%, ocular disease 36.9%, venous thrombosis 30%, arterial disease 4.6%, joint damage 30.8%, neurological disease 19.2% and digestive disease 0.8%. The male gender was significantly associated with ocular involvement (p =0.02), venous disease (p =0.01) and occurrence of relapses (p =0.01). The mean follow up was 68.5 ± 77.3 months. The poor survival prognostic factors were male gender, ocular involvement, venous disease, cardiovascular disease, a duration of follow up ≤12 months and a diagnostic delay ≤ 24 months. Conclusion: improving the prognosis of Behçet´s disease requires a shortening of the time to diagnosis, multidisciplinary collaboration, intensive treatment of functional threats, regular monitoring, and patient adherence.

Introduction Kaposi’s sarcoma (KS) is an angioproliferative disorder first described in 1872 by Moritz Kaposi. Four main clinical presentations of KS have been described: classic, endemic, iatrogenic and epidemic. KS involvement of the lymph nodes is extremely uncommon in the classical variant form, especially if it precedes the skin manifestations. We describe the case of an elderly HIV-negative patient presenting with lymphadenopathy who was found to have KS. Case Report A 67-year-old patient was admitted for exploration of polyadenopathies in the context of a general decline in health. Physical examination revealed an erythematosus left lower limb rash associated with angiomatous nodules and multiple lymphadenopathies. The diagnosis of erysipelas in the left leg was retained and the patient was treated with good evolution of the rash but persistence of the angiomatous nodules and the polyadenopathies. Skin and lymph node biopsies led to a diagnosis of KS. The patient is proposed for polychemotherapy. Conclusion KS must be suspected in lymphadenopathies despite the absence of typical cutaneous signs of the disease and in immunocompetent patients. LEARNING POINTS Involvement of the lymph nodes is extremely uncommon in the classical variant form of Kaposi’s sarcoma (KS). Human herpes virus-8 is an important cofactor in all forms of KS. Pathology and immunohistochemistry are key to diagnosing KS. KS must be suspected in lymphadenopathies without typical cutaneous signs of the disease and in immunocompetent patients.

Pulmonary involvement in Behçet's disease is not usual, and the occurrence of spontaneous pneumothorax is evena rarer complication. We report the case of a secondary spontaneous pneumothorax occurring in a patient aged 21 diagnosed of Hughes-Stovin syndrome treated with colchicine, corticosteroids and cyclophosphamide. The patient experienced chest pain with acute dyspnea. The examination found an increase in the sonority during percussion of the thorax with a decrease in respiratory sounds in auscultation. Chest X-ray and thoracic CT scan showed the presence of a left medium-sized pneumothorax that extended rapidly and became bilateral. The patient was transferred to a resuscitation unit undergoing a chest drainage. The course was marked by severe respiratory distress requiring intubation. The pneumothorax was probably caused by the rupture of pneumatocele in the pleural cavity. Several factors have contributed to pneumatocele formation, including pulmonary pneumonitis and mechanical ventilation in a lung already weakened by the inflammatory process of Behçet's vasculitis.The patient had died with an unexplained etiology.

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