Background
Area postrema syndrome (APS) is considered to be one of the most specific clinical presentations of neuromyelitis optica spectrum disorders (NMOSDs). In sub-Saharan Africa, NMOSDs and even more so those revealed by an APS, are rarely reported. However, studies among mixed populations have shown that NMOSDs disproportionately affect black people with relatively more frequent encephalic involvement. We report a case of APS revealing an NMOSD associated with central nervous system (CNS) tuberculosis in a young Togolese woman residing in Togo (West Africa).
Case presentation
A 28-year-old Togolese woman was admitted for left hemibody sensory problems with ataxia. These problems were observed while the patient was hospitalized for a few days in the hepato-gastroenterology department for persistent vomiting, abdominal pain and hiccups lasting for about a month. The examination confirmed left hemibody ataxia with nystagmus when looking to the left, pronounced left osteotendinous reflexes, and left hemibody hypoesthesia up to the base of the neck. Encephalic magnetic resonance imaging (MRI) showed a hypersignal lesion in the bulbar more lateralized on the left in the fluid-attenuated inversion recovery sequence, not enhanced after a gadolinium injection. Biological assessment showed the presence of
Mycobacterium tuberculosis
deoxyribonucleic acid in the cerebrospinal fluid and a sedimentation rate of 120 mm in the 1st hour. The result of the anti-AQP4 antibody test was positive. Two months from the onset of digestive problems with Lhermitte’s sign and hand and foot contracture access without vesico-sphincter problems were established. Cervical medullary MRI showed an additional intramedullary hypersignal lesion in the T2 sequence at the C2 level, not enhanced after a gadolinium injection. A second course of intravenous corticosteroids was administered, and anti-tuberculosis treatment was continued. The outcome was favorable. After 8 months of anti-tuberculosis treatment, the patient started immunosuppressive therapy (azathioprine 50 mg twice daily) to limit the risk of recurrence of NMOSD.
Conclusion
The recognition of an APS is an additional challenge for the diagnosis of NMOSDs, especially in countries with limited resources. CNS tuberculosis must be tested when faced with an NMOSD because it seems to be a major cause.
Introduction: Sickle cell disease, the most frequent hemoglobinopathy, is one of many causes of psychological repercussions. Objectives: To determine the prevalence of psychological disorders in children/adolescents living with sickle cell disease and to identify the associated factors. Patients and Method: An analytical cross-sectional study was conducted from June to September 2019 at the national sickle cell center and at the mother-child consultation of the University Hospital of Brazzaville. Children/adolescents aged six to 19 years old followed for sickle cell disease were included. Psychological disorders were assessed using the Diagnostic and Statistical Manual of Mental Disorders "DSM-5" which assesses depression and anxiety disorders, the Rosenberg Self-Esteem Scale, and the Brief Illness Perception Questionnaire which assesses representations of chronic diseases. SPSS 20.0 software was used for statistical analysis. Results: Out of 201 children/adolescents included, a drop in self-esteem was noted: 76.1%, anxiety 29.9%, depression 5.5% and a negative impact on daily life in all cases. These were significant negative consequences 39.3%. Advanced age, duration of illness, delay in school and puberty, use of upper-level analgesics, number of complications and hospitalizations, and occurrence of complications were associated with psychological disorders. Conclusion: The frequency of psychological disorders during the experience of the child/adolescent living with sickle cell anemia, requires that education, behaviour change communication be strengthened in order to improve the quality of care.
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