Introduction: Pure extra-thoracic sarcoidosis is rare and poorly characterized in the literature. Herein we present features of pure extra-thoracic sarcoidosis, in comparison with sarcoidosis with intra-thoracic involvement, in a population from the south of Tunisia. Methods: Retrospective, descriptive and comparative study of the patients presenting systemic sarcoidosis and attending the Department of Internal Medicine at the Hedi Chaker University Hospital, Sfax, Tunisia, for 21 years, from January1996 to December2016. Results: Twenty-four patients presented pure extra-thoracic sarcoidosis (30% of the cases of systemic sarcoidosis). There was a female predominance (79%). The mean age was 50 years. The main features were polyadenopathies (10 patients:41,7%), cutaneous involvement (10 patients:41,6%), inflammatory polyarthralgia (8 cases:33.3%), general symptoms (6 patients:25%), uveitis (6cases:25%), cholestasis (3cases) and kidney involvement (2cases). Lymphopenia, hypercalcemia, and hypercalciuria were observed each one in 12.5% of the cases, and high angiotensin converting enzyme (ACE) level in 38,5% of the cases. The histological proof was required in all the patients. Statistically significant associations identified were mainly hepatic involvement with general symptoms (p=0.035), peripheral lymphadenopathies (p=0.035) and kidney damage (p=0.022), and cutaneous involvement with articular manifestations (p=0.032). Systemic corticosteroids were used in half of the cases, with a good outcome in 21 cases, and recurrence in two cases. One patient was lost to follow up. The comparison to the form with mediastino-pulmonary involvement showed less lymphadenopathies(p=0.001), less lymphopenia (p=0.006), and less frequent use of corticosteroids(p=0.044). Conclusion: Our series was characterized by the frequency of the pure extra-thoracic form and the diversity of the systemic manifestations.
Introduction: Muscular involvement during hypothyroidism is rare and often infra-clinical. Symptomatic forms simulating authentic inflammatory myopathy remain exceptional and difficult to diagnose. We report a particular observation of primary hypothyroidism presenting initially by a "myositis-like" syndrome.Case Report: A 66-year-old woman with no medical history was explored for myalgia associated with proximal muscular weakness, which had been evolving for the past month, with an increase in muscle enzymes: CPK at 1570 IU/l and LDH at 607 IU/l. She was sent to us for suspicion of polymyositis. The electromyogram was noncontributory and the muscle MRI was without abnormalities. Anti-nuclear antibodies and anti-soluble antigen antibodies were negative.The thyroid assessment showed TSH at 15.45 μIU/ml, fT4 at 10.55 pmol/l, anti-thyroglobulin antibodies positive at 1000 IU/ml, and anti-thyroperoxidase positive at 488.5 IU/ml confirming the diagnosis of Hashimoto's thyroiditis. Under thyroxine, the evolution was favorable with disappearance of muscular complaints and normalization of muscular enzymes. Conclusion:The "myositis-like" syndrome is an exceptional presentation of hypothyroidism that represents a real diagnostic challenge for the clinician, especially since a true combination of thyroiditis and myositis is possible. It is recommended to screen for thyroid dysfunction in front of presentation suggestive of myositis, especially that this myosite-like syndrome may be the first inaugural manifestation of hypothyroidism.
Introduction The early diagnosis of bipolar II disorder remains difficult in clinical practice, hence the importance of psychometric tests.ObjectivesTo detect hypomania in patients followed for a major depressive disorder (MDD) and to determine factors which are correlated with it.MethodsThis was a cross-sectional, descriptive and analytical study. It involved 40 psychiatric outpatients, who were followed for MDD (isolated or recurrent episode) at the Hedi Chaker University Hospital in Sfax (Tunisia), from January 26 to February 10, 2020. The study was conducted using a questionnaire and the Angst Hypomania Checklist-20 (HCL-20).Results The sex ratio (M/F) was 0.66 with an average age of 54.8 years. MDD started at an average age of 41.45 years. According to HCL-20, half of our sample had hypomania. The presence of hypomania was correlated with young age (p = 0.022), academic failure (p = 0.038) and smoking (p = 0.003). In addition, there was a statistically significant relationship between the presence of hypomania and the characteristics of the disease: number of depressive episodes ≥ 2 (p = 0.013), psychotic features (p = 0.038), melancholic features (p=0,025) and premature discontinuation of treatment (p = 0.003).ConclusionsOur study confirmed that bipolar depression is still underdiagnosed and poorly treated. Questioning a patient about a history of hypomania would be a delicate task and would require the help of a scale, in particular the HCL -20.
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