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Diabetic muscle infarction (DMI) is a rare complication of long-standing poorly controlled diabetes mellitus. We herein describe the case of a 56-year-old man with a 10-year history of poorly controlled type 2 diabetes mellitus with multiple microvascular and macrovascular complications who presented with the sudden onset of left thigh pain and swelling. MRI suggested muscle infarction. A muscle biopsy demonstrated coagulation necrosis in the skeletal muscle with inflammation and infarction in the walls of small blood vessels. Physicians should consider DMI in the differential diagnosis of patients with diabetes who present with painful, swollen muscles without systemic signs of infection.

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ObjectiveUnipolar mania is a clinical reality in our daily practice. Many authors suggested that bipolar patients can have only manic episodes without depressions. These findings lead us to explore more this particularity.MethodsWe conduct a retrospective, descriptive and comparative study including 173 patients, followed for bipolar disorder type I, according to the Diagnostic and Statistical Manual of Mental Disorders fifth edition criteria, during the period between January 2008 and December 2015. Two groups were identified. The first one was composed of 98 patients who had presented only manic episodes. The second group contained the rest of the sample. Unipolar mania was defined as the presence of three or more manic states without a depressive episode during the period of the study.ResultsOne hundred seventy three patients were included in the study. The average age of the sample was 43 years old. The first episode was manic in 129 patients (74.6%). The dominant polarity was manic in 90.8% of the cases. Seasonal characteristic and psychotic symptoms were observed in respectively 11.0% and 53.2% of the sample. Rapid cycling evolution was observed among 2.3% of patients. The unipolar manic profile accounted for 56.6% of the population. This result is equivalent to an annual incidence of 8%. Comparing the two groups, we did not find a significant difference concerning the sociodemographic and clinical variables except for the number of suicide attempts (p=0.014).ConclusionOur study shows that unipolar mania is clinical evidence. More studies should be conducted in order to understand its nosological and psychopathological foundations.

Les objectifs de notre étude est d’étudier les caractéristiques cliniques et immunologiques du syndrome de Gougerot Sjogren primitif (SGSp) du sujet âgé et les comparer à une population témoin plus jeune. Nous avons analysé rétrospectivement les dossiers de 60 patients atteints de SGSp consécutifs, suivis au service de Médecine interne du CHU Taher Sfar de Mahdia, en Tunisie, durant une période de 7 ans (janvier 2007 à décembre 2013). Les patients avec SGSp étaient classés en deux groupes selon l’âge de début de la maladie: groupe de sujets âgés (≥ 65 ans) et groupe de sujets jeunes (<65 ans). Chez 18 patients (30%), le SGSp a débuté après 65 ans. Il s'agissait de 17 femmes (94,5%) et un homme (5,5%). L’âge moyen du début du SGSp était de 70,5 ans ±3,1. Le délai moyen du diagnostic était de 38,6 mois ±26,8. Les manifestations glandulaires étaient constantes. La comparaison entre le groupe du SGSp du sujet âgé et celui du sujet jeune montrait que le délai moyen du diagnostic du SGSp était significativement plus long chez les sujets âgés. Les manifestations pulmonaires étaient significativement plus fréquentes chez les sujets âgés. En revanche, les fréquences des anticorps antinucléaires, anti-SSA et anti-SSB étaient significativement plus élevées chez les sujets jeunes. Bien que le SGSp soit une maladie typique d'adultes d’âge moyen, les cliniciens ne devraient pas ignorer que cette maladie peut être diagnostiquée aussi chez les patients âgés. Notre étude montre que l’âge du début avancé influence le profil clinique et immunologique du SGSp.

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Pyogenic sacroiliitis and pyomyositis are uncommon infectious diseases and their diagnoses are often delayed. They are typically seen in children and young adults and are rare in middle-aged people especially in those affected by rheumatic diseases. We present the first case of a Staphylococcus aureus related pyogenic sacroiliitis associated with iliacus and gluteal pyomyositis occurring in a patient with systemic lupus erythematosus. Antibiotic treatment was administered for a total of 6 weeks with a total recovery. Pyogenic sacroiliitis and pyomyositis, although remaining rare events, should be remembered as severe complications in immunosuppressed patients with inflammatory diseases. Early clinical suspicion, imaging diagnosis, and adequate therapy are decisive for the satisfactory outcome.