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Resume Introduction La fievre, bien que frequente chez le patient presentant un cancer colique, en est rarement le symptome revelateur. Patients et methodes Nous rapportons une serie d’observations de cancer colique revele par une fievre, dans les trois hopitaux d’instruction des armees parisiens. Resultats Parmi les 11 patients etudies, il y avait sept hommes et quatre femmes, d’âge moyen 70 ans. Le cancer colique etait localise au niveau du sigmoide (n = 6), du colon gauche (n = 3) et du colon droit (n = 2). La tumeur etait au stade pTis (n = 1), I (n = 4), II (n = 3) et III (n = 3) selon la classification TNM 2002 de l’UICC. La fievre etait le principal motif d’hospitalisation et deux patients avaient une fievre prolongee inexpliquee recurrente. Une infection etait retrouvee dans toutes les observations sauf une. Les hemocultures isolaient Escherichia coli (n = 3), Streptococcus gallolyticus (anciennement bovis) (n = 2) et une bacterie anaerobie non identifiee (n = 1). Un patient avait une endocardite infectieuse a S. gallolyticus. L’imagerie medicale montrait un abces du foie (n = 3) ou peritumoral (n = 3). Dans sept cas, un antecedent familial de cancer du colon et des signes evocateurs de pathologie colique (hemorragie digestive minime et negligee, anemie ferriprive, masse abdominale palpable) auraient pu attirer l’attention. Conclusions La fievre revelant un cancer du colon peut survenir a un stade precoce de la maladie tumorale. Elle est principalement d’origine infectieuse, resultant d’une bacteriemie ou d’un abces locoregional. La presentation sous la forme d’une fievre prolongee inexpliquee est beaucoup plus rare. Un interrogatoire oriente, un examen clinique minutieux et une lecture attentive des cliches tomodensitometriques permettent de recourir precocement a la coloscopie.

Resume Introduction. – La pseudotumeur inflammatoire ganglionnaire (PTIG) est une etiologie rare des fievres prolongees. Observation. – Nous rapportons l'observation d'une femme, âgee de 40 ans, hospitalisee pour une fievre intermittente revelant des adenopathies sous-diaphragmatiques en rapport avec une PTIG. Conclusion. – La PTIG est une pathologie rare dont le cadre nosologique reste mal defini. Elle doit probablement etre consideree comme appartenant a un cadre different de celui des PTI d'autres organes. Le diagnostic se discute devant une adenopathie isolee ou une fievre prolongee et repose sur l'anatomopathologie, faisant discuter essentiellement un lymphome. L'evolution est favorable : elle peut se faire vers la guerison spontanee ou necessiter le recours a un traitement anti-inflammatoire non steroidien ou a une corticotherapie.

Mycoplasma pneumonia (MP) infection may be associated with several neurological complications. Encephalitis, which affects children and rarely young adults, is the most frequent.A 23-year-old man was admitted for pneumonia with encephalitis. Mycoplasma pneumoniae infection was documented by serology, and polymerase chain reaction in the cerebrospinal fluid. Despite serious initial presentation, outcome was favourable with levofloxacin treatment.MP infection should be considered as a potential aetiology in acute encephalitis in young people and in individuals with respiratory symptoms. Antibiotic therapy (fluoroquinolones or macrolides) should be used if MP is strongly suspected or in case of severe acute meningo-encephalitis.

To describe the epidemiological and clinical features of enteroviral meningitis as well as the biological profile of the cerebrospinal fluid (CSF).A retrospective study conducted in a single centre between 2004 and 2008. All aseptic meningitis due to Enterovirus were included.Fifty-nine patients were included. The triad including fever, headache and neck stiffness was reported in 62% of patients. Twelve patients (20%) had a neutrophilic leukocytosis and 23 (39%) an elevated CRP level. Twenty-eight patients (47%) had a prominent neutrophilic reaction in the CSF and nine (15.2%) had a low glucose concentration. A presumptive anti-bacterial treatment was initiated in 47 patients (80%) for an average of 3.2 days.Due to the lack of specificity of clinical features and biological manifestations of Enterovirus meningitis, the widespread use of real-time Enterovirus PCR is a priority for reducing the number of unnecessary anti-bacterial treatment. Guidelines based on clinical and biological features may be associated to help physicians in the differential diagnosis between bacterial and viral meningitides.

Fever happens frequently in colon cancer but it is rarely the presenting manifestation.We report a case series of patients with colon cancer revealed by fever in the three military hospitals in Paris.Of the 11 patients studied, seven were men and four were women, and their mean age was 70 years. Cancer was localized in the sigmoid colon (n=6), left colon (n=3) and right colon (n=2). Cancer staging (UICC TNM classification 2002) was respectively pTis (n=1), I (n=4), II (n=3) and III (n=3). Fever was the only reason for admission and two patients had a recurrent fever of unknown origin. All patients but one had bacterial infection. Blood cultures grew up in six cases, Escherichia coli (n=3), Streptococcus gallolyticus (ex bovis) (n=2) and anaerobic bacteria (n=1). There was one case of infective endocarditis caused by S. gallolyticus. Imaging showed a liver abscess (n=3) and a colon cancer complicated by an abscess (n=3). In seven patients, a familial history of colon cancer and symptoms of underlying colic disease were present (neglected rectal bleeding, iron deficiency anaemia, clinical evidence of an abdominal mass).Fever may reveal colon cancer at an early stage. Its main cause is a bacterial infection, such as bacteremia or abscess. Fever of unknown origin is a rare presentation. Detailed history, careful clinical examination and analysis of imaging contribute to recommend the prescription of colonoscopy.

Inflammatory pseudotumor of lymph node is a rare case in the etiology of fever of unknown origin.We report the observation of a woman, aged 40, hospitalized with intermittent fever revealing under-diaphragm adenopathy related to inflammatory pseudotumor of lymph node.Inflammatory pseudotumor of lymph node is a rare pathology whose nosological definition is unclear. It should probably be considered as belonging to a category different from the inflammatory pseudotumor of other organs. The diagnosis presents itself in case of isolated adenopathy or prolonged fever and is based on an anatomopathology that essentially calls to mind a lymphoma. The evolution of the condition is shown to be favorable : it can lead to a spontaneous remission, or call for a non-steroid anti-inflammatory treatment, or a steroid therapy.

Spontaneous splenic ruptures are rare but life-threatening complications of infectious diseases. Splenectomy is still the treatment of choice but numerous recent reports have documented favorable outcome with conservative treatment.We report three cases of splenic rupture occurring respectively with infectious mononucleosis, P. vivax infection and dengue fever. Diagnosis, treatment and indications are reviewed, an approach to management is suggested. The study included three military men respectively aged 23, 24 and 35 years, admitted for acute abdominal pain in the left upper quadrant. The abdominal computed tomography confirmed partial rupture (splenic hematoma) in the first two cases, and an hemoperitoneum in the dengue case. Splenic ruptures can reveal or complicate an evolving infection. Rupture can happen spontaneously or as a result of trauma, which may be minor and unnoticed. The typical presentation is acute, but progressive forms are described. The diagnosis is made by ultrasound and CT scan. Splenectomy dogma tends to be supplanted by conservative treatment. Non-operative management can be successful if appropriate criteria and a long period of follow-up are applied in carefully selected cases. When an operative approach is selected, conservative surgical treatment is attractive. Splenectomy should be reserved for patients with uncontrollable rupture or with recurrent splenic bleeding.Spontaneous splenic rupture are uncommon in infectious diseases. A multidisciplinary management is necessary. A conservative treatment should be considered in selected, closely monitored patients.

Resume Introduction. – Les ruptures spontanees de rate sont des complications rares, potentiellement fatales de nombreuses maladies infectieuses. Le traitement classique reste la splenectomie mais plusieurs travaux recents ont souligne l’interet d’un traitement conservateur. Exegese. – Les auteurs rapportent trois cas de ruptures de rate compliquant respectivement une mononucleose infectieuse, un paludisme a P. vivax et une dengue. Les aspects diagnostiques, les moyens therapeutiques et les indications sont passes en revue, un algorithme decisionnel est propose. Il s’agissait de trois militaires âges respectivement de 23, 24 et 35 ans hospitalises pour des syndromes douloureux de l’hypochondre gauche. La tomodensitometrie abdominale a confirme une rupture partielle (hematome splenique) dans les deux premiers cas et une rupture complete avec hemoperitoine au cours de la dengue. L’abstention chirurgicale a permis la guerison dans les deux formes partielles, la splenectomie ayant ete inevitable dans le cas de dengue. Les ruptures spleniques sont inaugurales ou viennent compliquer l’evolution de l’infection. Elles surviennent spontanement ou au decours d’un traumatisme mineur pouvant etre passer inapercu. La forme typique est aigue imprevisible, mais il existe des formes progressives. Le diagnostic repose sur l’echographie et la tomodensitometrie abdominale. Le dogme de la splenectomie tend a etre remplace par une approche conservatrice medicale ou chirurgicale. Sous reserve de criteres cliniques stricts et de la possibilite d’une surveillance, l’abstention chirurgicale peut s’appliquer a des cas selectionnes. En cas d’indication chirurgicale, les techniques de preservations spleniques sont seduisantes. La splenectomie etant reservee aux formes graves et aux echecs du traitement initial. Conclusions. – Les ruptures spontanees de rate sont rares au cours des infections. Leur prise en charge est idealement medicochirurgicale. Un traitement conservateur est possible chez des patients selectionnes, sous reserve de criteres cliniques stricts et d’un suivi clinique et radiologique prolonge.