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If myasthenia gravis is not a usual complication of interferon therapy, several cases have been described with the use of theses molecules in the treatment of hepatitis C, cancer or multiple sclerosis. We report a new case of serious myasthenia gravis during interferon alpha and ribavirin therapy for hepatitis C.

Introduction: Macrophage activation syndrome has never been reported as an adverse effect of infliximab., Case: Treatment with infliximab was prescribed for a 37-year-old man with fistulated Crohn's disease unresponsive to azathioprine. Three months after the last injection, he developed macrophagic activation syndrome, with febrile pancytopenia, hyperferritinemia, hypertriglyceridemia and an activated cephalin time twice the control level., Discussion: Elimination of the known causes of macrophage activation syndrome suggests it is related to the infliximab treatment, but its pathogenesis remains a mystery.

Introduction: Inflammatory hepatic pseudo-tumors are rare, non-neoplastic lesions, and their diagnosis is usually made on hepatectomy samples., Observation: The general health of a 77 year-old patient was suddenly altered and clinical examination (and scan) revealed a hepatic tumor. Diagnosis of inflammatory hepatic pseudo-tumor was evoked by analysis of a biopsy. In view of the age and the general state of the patient we chose prolonged antibiotic therapy rather than hepatic surgery. Nine months later, the tumor had regressed., Comments: Because they are rare (100 cases described), hepatic pseudo-tumors raise two questions: can diagnosis be made simply by biopsy or should one always analyze the complete sample and, if hepatectomy is contraindicated, is non-surgical treatment effective? The progression of our patient permits us to reply positively to both questions.

Fulminant herpes simplex viral hepatitis is uncommon in immunocompetent subjects. A 24-year-old woman presenting hepatomegaly with fever was hospitalized after returning from a trip to southern Africa. The patient was neither pregnant nor immunocompromised. Because of recent tropical travel, differential diagnosis included alphabetic hepatotropic virus infection, yellow fever, African hemorrhagic fever, and arbovirus infection. After ruling out other common viral etiologies, a definitive diagnosis of herpes simplex viral infection was made on the basis of clinical and laboratory findings showing high fever, leukopenia, and thrombopenia; of histological examination of the native liver after transplantation showing non-inflammatory confluent focal hemorrhagic necrosis; and on serologic tests demonstrating seroconversion for herpes simplex virus type 2. Outcome after transplantation was rapidly fatal but the death was not directly related to infection. The most likely etiology of fulminant hepatitis in a young woman returning from travel in a tropical area is hepatitis virus B or hepatitis virus E in cases involving pregnancy. However herpes simplex virus should be included in differential diagnosis even in immunocompetent subjects.

Lingual thyroid and intra lingual thyro-glossal cyst are two benign tumours of similar embryological pathogenesis respectively with the arrest in the ectopic position of the thyroid gland during its downward migration and from abnormal persistence of the thyro-glossal tract for the cyst. The occurrence of lingual thyroid is rare 1/100,000 patients and outnumbers the incidence of intra-lingual cyst which represents an estimated 2.1% of the thyro-glossal cysts or fistulas. Both lesions are a rare cause of dysphagia and dyspnoea due to oropharyngeal obstruction, and radionuclide scintigraphy combined with CT and/or MRI will establish the diagnosis. Surgical pharyngotomy with an infra-hyoid approach provides excellent access to the lesions and complete removal of the tumours.

The authors report two cases of mastoid osteoma: it is a rare benign tumor attached to the cortex of the mastoid bone, approximatively fifty cases have been described in the english language literature and eight in the french literature. The clinical and radiological characteristics combined with histopathologic evidence demonstrate the diagnosis of mastoid osteoma, the most common type being the compact osteoma. Differential diagnosis should be considered with others benign bone-forming lesions (osteochondroma, chondroma, osteoblastoma, exostosis, fibrous dysplasia...) and with malignant lesions (osteosarcoma...). Surgical removal proposed for cosmetic deformity is a simple procedure for the vast majority of small osteomas. Early surgical intervention is recommended to avoid the evolution toward giant osteoma with potential risks of surgical complications.

The authors report a case of myocarditis secondary to a Salmonella Virchow infection in a 20 year old non-immunodeficient man without a previous medical history. The outcome was favourable after treatment with fluoroquinolone. The features of this rare complication of non-typhic salmonella infection are discussed with respect to this and four other recently published cases.