Purpose: The unfortunate association between myasthenia gravis and Graves' disease is not widely appreciated. It would be consistent with a genetic predisposition for autoimmune disease. The frequency of this association is variously appreciated in the literature. Case: We report a case of a 20 years old patient with a two years history of Graves' disease, who presented with a myasthenic syndrome leading to an acute respiratory failure. This was found to be reversible with prostigmine, and the diagnosis of myasthenia gravis (MG) was confirmed by EMG and positive immunology. There was a positive response to medical treatment. Discussion: The frequency of this association is variously appreciated in the literature. MG has been reported to be discovered simultaneously with, or prior to, the diagnosis of Graves' disease, but is most commonly subsequent to it. The similarity of symptoms makes diagnosis difficult. Furthermore, an excess of thyroid hormones worsens MG and the existence of MG imposes certain precautions in the management of hyperthyroidism. Conclusion: Research is called for into the surveillance and management of specific manifestations of the co-occurrence of these conditions.
IntroductionLe risque thromboembolique veineux en médecine a été largement incriminé dans la charge humaine et financière de l'ensemble de cette pathologie. Les facteurs de risque sont identifiés et côtés pour optimiser la prise en charge. Notre objectif était d’évaluer le niveau de risque thromboembolique et la pratique de la thromboprophylaxie.MéthodesIl s'agissait d'une étude rétrospective réalisée sur une durée de 12 mois dans le service de médecine interne du CHU le Dantec. L'inclusion des patients était systématique à l'exclusion des patients ayant une durée d'hospitalisation de moins de 3 jours et de ceux venus avec un traitement anticoagulant.RésultatsNous avons colligé 352 dossiers. Le sexe ratio était à 1,21 en faveur des hommes. L’âge moyen des patients est de 47ans. Le niveau de risque thromboembolique a été faible dans 23%, modéré dans 22%, élevé dans 36%, et maximal dans 19% des cas. Les facteurs de risque retrouvés sont représentés par l'alitement (98%), l’âge compris entre 41-74 ans (47%), les néoplasies (20,1%). L'insuffisance cardiaque et les affections respiratoires graves sont rapportées chez respectivement 9,3% et 8,5% des patients. Une prophylaxie était nécessaire chez 77% des patients hospitalisés mais seuls 12% des patients en avait bénéficié.ConclusionLa nécessité d'une prévention de la maladie thromboembolique veineuse est bien cernée par les praticiens mais se heurte à de nombreux obstacles d'où la nécessité d'une mise en place d'outils pratiques et fonctionnels de dépistages et de produits anticoagulants accessibles.
Kimura's disease, common pathology in the East, responsible of chronic neck swelling is rarely reported in sub-Saharan Africa. We reported a case which was observed in the internal medicine department of Aristide Le Dantec hospital in Dakar. This was a young 15-year-old, with no particular disease history, who had recurrent non-inflammatory swelling next to the left zygomatic bone associated with itching. Biology revealed an inflammatory syndrom, eosinophilia and increased serum IgE. The histological examination of the mass biopsy concluded to Kimura disease. The corticosteroid has reduced the size of the mass within a few weeks of treatment. Kimura's disease is unknown in our regions. His painless character and chronic evolution delay the time of diagnosis. This case proves the reality of this disease, which must find a place in the diagnosis approach of cervical swelling.
Introduction: Pernicious anemia is an autoimmune disease. It is characterized by the presence of an autoimmune atrophic gastritis and various autoantibodies that lead to a vitamin B12 deficiency responsible for a macrocytic anemia. It is frequently associated with other specific or non-organspecific autoimmune diseases. We report six patients with pernicious anemia associated with other autoimmune diseases. Patients and Results: There were six patients (4 females/2 males), mean age of 39.67 years. In all cases it was found macrocytic anemia. The average Hb was 6.08 g/dl and the average MGV: 110.67 fl. Bone marrow aspiration was performed in all patients. Megaloblastosis compatible with a lack of vitamin B12 or folic acid was constant. Determination of serum vitamin B12 was low in all cases while folic acid levels were within standards. Immunologically it was found in all patients, a positivity of anti-intrinsic factor antibody and/or antiparietal cells antibody at rates up to 67 times over normal ranges. Pernicious anemia was associated with autoimmune thyroid dysfunction in 4 patients. It was two cases of Hashimoto thyroiditis at hypothyroidic phase (high TSHus, thyréoperoxydase anti-antibody positive (over 10 N) in both cases and Graves' disease in the two other cases. Pernicious anemia was associated with a syndrome of primary antiphospholipid antibody in a case. Furthermore pernicious anemia was found in a patient autoimmune type 1 diabetes with strongly positive anti-GAD antibodies and rheumatoid arthritis by retaining it in the diagnosis of multiple autoimmune syndrome. Conclusion: These cases illustrate the existence of the association of pernicious anemia with other autoimmune diseases in our context. This should encourage practitioners to seek hided autoimmune diseases when they consider the diagnosis of pernicious anemia.
The lymph node is the revelation mode of several pathology. In tropical area, their etiology are dominated by tuberculosis and hemopathy. Some etiology such as histiocytosis are rarely mentioned. We report two cases of Rosai-Dorfman-Destombes disease. The first observation concerned a patient of 45 years without pathological antecedent, who had a inguinal and cervical tumoral lymph nodes. This evolved in a feverish poor general condition. Infection research was negative. Morphological explorations found deep lymph nodes. The excision biopsy examination concluded to Rosai-Dorfman-Destombes disease. The second observation concerned a patient of 40 years without pathological antecedent, who had a chronic non-inflammatory left supra-collarbone lymph node, associated with poor general condition and fever. X-ray showed mediastinal lymph nodes and ultra-sonography showed mesenteric lymph nodes, and latero-aortic lymph nodes. The examination of the excision biopsy was for Rosai Dorfman Destombes disease. The difficulty of diagnosis in our regions based on technical tray lack and our patients financial limits. Also this disease is rarely mentioned first. This is often the source of considerable diagnostic delay noted in our two patients and therefore the initiation of an untimely anti-tuberculosis treatment.
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