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Venous thromboembolism has been reported in association with cytomegalovirus (CMV) infection both in immunocompromised and immunocompetent patients. In this population, it is yet undetermined whether CMV alone provokes VTE or other predisposing conditions are involved.1007 VTE patients consecutively recruited in one academic hospital were analyzed retrospectively in order to identify acute CMV infection. Acquired and inherited risk factors were screened. Only adults and immunocompetent patients were included.Among 1007 consecutive VTE patients, we identified 10 patients with synchronous acute CMV infection. Patients with coexistent VTE and acute CMV infection were younger (37.5 years vs. 56.6 years; p = 0.0088) and exhibited a female predominance (90% vs. 56%; p = 0.026), in comparison to the whole cohort. Hereditary thrombophilia was identified in 9 out of 10 patients. Acquired risk factors for VTE like estrogens administration and pregnancy were equally prevalent in patients with and without CMV infection.Acute CMV infection is a potential contributor to VTE whenever other prothrombotic conditions are required. This should help clinicians to privilege a limited duration of anticoagulant treatment like in other provoked VTE.

The presence of the 20210A allele of the prothrombin gene has recently been shown to be a risk factor of venous thromboembolism, probably mediated through increased prothrombin levels. The aim of the study was to determine the frequency of the prothrombin 20210A allele in 193 consecutive unselected patients with venous thromboembolism and 100 healthy controls and to analyze the clinical profile associated with this new inherited thrombophilic factor. In agreement with previous reports, we found a frequency of 7.3% of heterozygous carriers of the 20210A allele among patients and 1% among controls. We confirm that plasma prothrombin levels are more elevated in the individuals bearing the prothrombin 20210A allele compared with those who do not. We did not find any relationship between the presence of the prothrombin 20210A allele and either a family history of thromboembolism, the rate of recurrences or the age at disease onset. However, the co-inheritance in the same individual of both prothrombin 20210A allele and factor V Leiden was associated with a significantly lower age at disease onset suggesting a synergistic contribution of both abnormalities.

Heparin-induced thrombocytopaenia is a dreaded, although infrequent, complication of heparin therapy. We report two cases of heparin-induced thrombocytopaenia (HIT) type II occurring in a patient treated with standard (unfractionated) heparin and in another patient given a low-weight molecular heparin. The clinical course of the first patient illustrates the potentially severe thrombotic complications of HIT. Both cases were treated successfully by danaparoid sodium. Clues to the diagnosis and treatment are briefly discussed.

The aim of this retrospective study was to define a diagnostic strategy and to evaluate the efficacy of cotrimoxazole (CTMX) for presumed cerebral toxoplasmosis in patients with AIDS. Twelve patients with toxoplasma encephalitis were reviewed. The best diagnostical signs of reactivated acute cerebral toxoplasmosis were the association of neurological symptoms indicative of focal cerebral lesions, and a radiological picture showing ring contrast enhanced hypodense mass-lesions; serology was unreliable for the diagnosis. Five patients out of twelve were treated without delay and until death with CTMX. Only these improved their clinical and radiological status obviously. Moreover, their median survival time was clearly longer (160 days, versus 9 days) and their autopsy demonstrated the absence of active necrotizing lesions of toxoplasma encephalitis. So, CTMX seems to be an efficient therapy for suspected cerebral toxoplasmosis in AIDS. Nevertheless, further prospective randomized therapeutic trials are required to confirm this impression.

SummaryWe report a case of endocarditis due to Lactobacillus plantarum, occuring on a mitral valve, as a complication of obstructive cardiomyopathy. The route of entrance is maxillary osteitis of a dental origin.Endocarditis due to Lactobacillus is a rare infection. Its major characteristic is an occasional resistance to treatment with /j-lactamines. In our case infection recurred in spite of chemotherapy with ampicillin (6 weeks) and gentamicin (14 days). A new treatment with penicillin and gentamicin for 6 weeks resulted in cure. We ascribe the initial therapeutic failure to a moderate sensitivity of the strain to /3-lactamines (M.I.C. 1,25 /ig/ml for penicillin G). We have not observed any tolerance to/5-lactamines.Endocarditis due to Lactobacillus should be treated with a combination of a /Mactamine with an aminoglycoside, in the event of the isolated strain being little sensitive to /3-lactamines.

SummaryThe authors report 19 cases of adult onset Still’s disease (AOSD) and compare them with 25 cases of juvenile systemic Still’s disease. They emphasize the diagnostic difficulties in the early stages of the disease, the various systemic complications and the common evolution to chronic erosive joint lesions. In the authors’ experience, AOSD represents about 5 per ccnt of cases admitted for fever of unknown origin.

SummaryIt is useful to distinguish Streptococcus bovis among the group-D streptococci. S. bovis has different culture characters and is highly penicillin-sensitive. The discovery of this agent in blood cultures is strongly suggestive of some particular pathological conditions.In one year, we observed five patients presenting positive blood culture for S. bovis.There were four cases of infective endocarditis. This confirms the great affinity of this bacterium for the endocardium. We successfully treated all four patients with penicillin alone, for five to six weeks.There is a frequent association between S. bovis bacteriaemia and colonic adenocarcinoma. We performed thus a radiographic examination of the colon in four cases. One patient actually had a colonic carcinoma, and two others had benign colonic polyps. It seems probable that benign polyps also predispose to Streptococcus bacteriaemia or endocarditis