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Aim: We aimed to present a rare case of pseudotumoral tuberculosis of the cervix. Introduction: Tuberculosis has many localizations. Urogenital and particularly cervical involvement is rare. Case Presentation: Our observation concerned a case of pseudotumoral tuberculosis of the uterine cervix simulating a cancer. The clinical signs were pelvic pain and metrorrhagia, which were non-specific. The ulcerative-bourgeons appearance of the cervix was suggestive of cancer. Histology allowed the diagnosis to be made by showing an inflammatory granuloma and the absence of malignant cells. Despite the absence of bacteriological evidence, the clinical, biological, and histological presumptive arguments and the good therapeutic response made it possible to correct the diagnosis. The prognosis of our patient was mainly functional due to the risk of infertility. Conclusion: The interest of this observation lay in the rarity of this tuberculosis localization, especially in an immunocompetent subject, and the predominant place of histology.

Graves’ disease and Hashimoto’s thyroiditis are two common autoimmune diseases. Their association with other autoimmune diseases is not exceptional. However, the co-occurrence of these two diseases is not often described. In this case, report, we describe the observation of a patient who had long been followed for exophthalmos and pretibial myxedema as a sign of thyrotoxicosis. Examination of this patient revealed a clinical picture of clinical and biological hypothyroidism related to Hashimoto’s thyroiditis. This case had made it possible to retain an association between Hashimoto’s thyroiditis and basedowdisease, which is rarely described. This observation underscores the importance of monitoring these patients with autoimmune disease systematically even if there is no clinical manifestation.

Introduction: Autoimmune thyroiditis is relatively common in medicine. However, comprehensive studies are few in number, especially in Africa and particularly in Senegal. The aim of this study was therefore to determine the epidemiological, clinical, profile of Autoimmune Thyroid Diseases (OITD). Materials and Methods: This was a retrospective descriptive study from 2016 to 2019 of the records of patients who consulted or were hospitalised for autoimmune dysthyroidism in the internal medicine department of the Aristide Le Dantec Hospital. During this period, 1227 new consultations were recorded; they concerned three specialized consultations including endocrinology. The autoimmune origin was confirmed in 159 patients, i.e. in 45.69% of cases the AIDM then 12.96% of all consultations. The autoimmune origin was established on clinical, biological and immunological grounds. The data were collected from the medical records of the patients and recorded on a pre-established individual survey sheet taking into account the objectives of the study. The data collected was entered into the Sphinx V5 software on an established form. The analysis was carried out with the following software: Excel 2010 and Epi info 7.2. Results: Among this dysthyroidism, 159 patients had a confirmed autoimmune thyroid disease. On all new consultations, OITD represented 12.96% of internal medicine consultations. The sex ratio M/F was 0.18. The majority of our patients (57.86%) were aged between 25 and 44 years with extremes ranging from 11 to 63 years. In Graves’ disease, the notion of an irritative spine was found in 60.27% of cases. Signs of thyrotoxicosis were present in 92.7% of cases. There was a goiter in 81.1% of cases with a vascular character in 76.47% of cases. Anti-THR antibodies were positive in 96.15% of cases. Complications were noted in 9 patients (6.5%) such as cardiothyreosis in 8 patients (5.7%) and malignant orbitopathy noted in 1 patient (0.8%). In Hashimoto’s thyroiditis, signs of hypometabolism were evident in 87.50% of patients. Anti-TPO antibodies were positive in all patients. All patients had received thyroid hormone supplementation. Thyroid autoimmune disease was associated with other autoimmune diseases in 6.2% of cases. Conclusion: Autoimmune thyroiditis is common in our daily practice in Senegal; it is dominated by Grave’s disease. Hypothyroidism was the most common manifestation of Hashimoto’s thyroiditis. The inaccessibility of antithyroid antibody testing is an obstacle to the diagnosis and management of these conditions.

Introduction: Rheumatoid arthritis (RA) is associated with increasing of cardiovascular (CV) morbidity and mortality due to accelerated atherosclerosis. Several studies showed also the increasing of the prevalence of subclinical atherosclerosis, but there are little data from sub-Saharan Africa. The aim of our study was to assess the prevalence of cardiovascular risk factors, subclinical carotid atherosclerosis and the ability of the Systematic Coronary Risk Estimation (SCORE) modified by European League Against Rheumatism (EULAR) to predict the high CV risk in our patients. Patients and Method: We conducted a cross sectional study in Senegalese patients with RA. The RA was retained according to 2010 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) criteria. Patients with RA were assessed in a clinical research consultation. Results: We included 50 RA patients. The mean age was 44 years (+/- 12.37) and the sex-ratiowas 0.06. The frequency distribution of traditional cardiovascular risk factors was: hypertension (HT) (30%), diabetes-mellitus (6%), smoking (2%), no-exercise (22%), obesity (16%), metabolic syndrome (8%). Fifty-eight percent of patients were classified at low cardiovascular risk according to mSCORE. 51.7% of patients classified as moderate-risk according to mSCORE, were reclassified as high cardiovascular risk according to carotid ultrasound evaluation (gold-standard). The sensitivity of the mSCORE in the prediction of high CV risk was low at 20%. In the present study, the prevalence of carotid subclinical atherosclerosis was 20%. Age (>45 years) and HT were correlated to subclinical atherosclerosis. Conclusion: In the present study, the prevalence of atherosclerosis in RA patients was higher than expected frequency in comparison with the prevalence in Senegalese general population. We showed that CV risk was underestimated by mSCORE which had a low sensitivity in the prediction of high risk. We showed also the importance of carotid ultrasound for an appropriate stratification of the risk.

Introduction: The extended administration of corticoids by oral way for a length of more than 3 months defines the long-term-corticosteroid-therapy. This one, used in numerous indications, displays most often at the risk of undesirable effects linked sometimes to the habits of prescription of the doctors. Patients and Methods: In order to study the prescription modalities of this treatment, we conducted a cross-sectional, multicentric and descriptive study from June 1st, 2017 to August 1st, 2017, over a period of 2 months. It involved a questionnaire given to medical specialists of all medical specialties and practicing in the University Hospital of Dakar. Results: 170 doctors were interviewed. Dermatologists and internists were mostly found 19.4% and 18.8% or 33% and 34% doctors. Systemic autoimmune diseases alone accounted for 48% of prescription reasons. Prednisone was prescribed in 88% of cases. The immunosuppressive dose of 1 mg/kg was most often prescribed. Practitioners very heterogeneously prescribe most adjuvant measures to prolonged systemic corticosteroid therapy. Thus, the recommendation of a low-sodium diet (38% of physicians), and the systematic prescriptions of proton pump inhibitors (44.7% of physicians) and vitamin-calcium supplementation were frequently performed by physicians (34% of physicians). While the low carbohydrate diet was advocated by less than a quarter of doctors and the prevention of pneumocystosis and osteoporosis were rare (respectively 61% and 52% of prescribers did not). Conclusion: The global analysis of the habits of our medical specialists concerning the use of long-term glucocorticoids reflected a diversity of indications, heterogeneity of practices, with certain habits not in accordance with the usual recommendations.

Introduction: Venous thromboembolic disease (VTE) is a real public health problem worldwide. The practice guide produced periodically by the American College of Chest Physicians (ACCP) has become the international standard. However, thromboprophylaxis remains underused. Methodology: We carried out a descriptive cross-sectional study. The goals of that study were to evaluate the effectiveness of the practice of thromboprophylaxis in the various medical services of the Dakar Public Hospitals. Our investigation was conducted for two weeks in September 2017. Results: 160 patients were included (81 men and 79 women) in our series, with male predominance: sex ratio of 1.02. The average age was 48. Infectious pathologies were the predominant clinical pictures (35% of cases). The thromboembolic risk factors (RF) mainly found were represented by prolonged bed rest, followed by cardiovascular (RF): age greater than 60 years (31.2%), hypertension (8.8%), obesity (4.4%) and diabetes (3.8%). The thromboembolic RF of patients hospitalized in these medical services has been evaluated empirically. We noted a lack of use of the VTE risk assessment scores. 40.9% (n = 56) of patients received overall VTE prophylaxis, a rate corresponding to almost half of those at risk (51.4%). This result reflects an under-use of thromboprophylaxis in the Dakar medical environment and a low level of adherence by practicians to the guidelines on VTE prophylaxis. Conclusion: It is therefore recommended to develop a national strategy to assess patients at risk for VTE, as well as measures to educate and inform doctors about the appropriate forms of thromboprophylaxis.

Introduction: The occurrence of tuberculosis (TB) during the follow-up of Connective tissue diseases (CTD) is a particular situation often posing real diagnostic problems. This is an association described in the literature. Patients and methods: We conducted a retrospective and descriptive study at the internal medicine department of Aristide Le Dantec Hospital. The purpose of this study was to determine the treatment that patients followed for CTD and suffering from TB took before the occurrence of this one. Results: During a study period of 11 years and 6 months, 21 cases of TB were diagnosed in 602 cases of CTD (0.03%). The predominance was female with a sex ratio (H/F) of 0.6. The median age was 42 years old. The majority of cases originated from the Dakar region (13 patients or 61.9%) and 85.7% had previous follow-up exclusively in modern medicine and 21 cases (95%) received the CTD’s treatment. This consisted of prednisone (90.5%) combined with methotrexate (52.4%), azathioprine (23.8%) or cyclophosphamide (19.4%). The respective medians doses of these drugs were 12.5 mg per day for prednisone, 13.5 mg per week for methotrexate and 100 mg per day for azathioprine. The median duration of patient follow-up was 36 months. The cumulative dose of prednisone during this period was 23.6 g and that of methotrexate 2.25 g. CTD were dominated by rheumatoid arthritis (RA) (57.1%), and systemic lupus (19%). Isolated cases of systemic scleroderma, primary Sjogren, SHARP syndrom, mixed connective tissue disease, and multiple autoimmune syndrom were noted. TB was localized in 95% of cases, readily bilateral and poorly disseminated. The respective medians diagnostic delays for systemic disease and TB were 21 months and 5 months. Tuberculin intradermal reaction was performed in 16 cases and was positive in 9 cases, sputum bacilli was performed in 19 cases and was positive in 15 cases. Conclusion: The association of TB and CTD was characterized by its rarity, its poorly disseminated character and its frequency on RA field.

Background: The morbidity and mortality of systemic lupus erythematosus are largely due to accelerated atherosclerosis. This is partly related to the high prevalence of traditional cardiovascular risk factors. The aim of our study was to determine the frequency of these factors in lupus patients compared to a control population in a department of internal medicine. Methods: We realized a case-control study in patients with systemic lupus erythematosus according to ACR criteria in 1997. Patients were matched by age and gender with controls subjects without autoimmune disease. We studied the frequency of traditional cardiovascular risk factors in both populations. The study was done in the department of internal medicine of Aristide Le Dantec teaching Hospital, in Senegal, during the period from August 2017 to December 2018. The statistical analysis was performed with SPSS 23.0 software and the level of significance was retained for a p-value < 0.05. Results: We recruited 100 subjects including 50 patients and 50 controls. The mean age was 33.5 ± 11.3 years in cases and 33.3 ± 11.3 years in controls. Dyslipidemia was significantly associated with systemic lupus erythematosus (p = 0.009). Levels of triglycerides (p < 0.001) and uricemia (p < 0.001) were significantly higher in patients. The level of HDL cholesterol (p = 0.028) was lower in cases. Thus, low HDL cholesterolemia (p = 0.001), hypertriglyceridemia (p < 0.001), and hyperuricemia (p = 0.043) were more common in the cases. Renal failure was associated with systemic lupus erythematosus (p < 0.001). Difference in LDL-cholesterol (p = 0.103), hypertension (p = 1) and metabolic syndrome (p = 1) between cases and controls was not significant. Obesity and overweight were predominant in controls (p = 0.028). Conclusion: Traditional cardiovascular risk factors including dyslipidemia and hyperuricemia were more common in patients. Similarly, renal failure was associated with lupus.

We report four observations of myasthenia gravis associated with other autoimmune diseases. Myasthenia gravis can be associated with all autoimmune diseases with a predominance of dysthyroidism. Among the autoimmune diseases associated with myasthenia gravis in our series, there were associations with hyperthyroidism, sjogren syndrome, Biermer’s disease. You would have to know how to look for another autoimmune disease in front of all myasthenia gravis by looking for the slightest sign of appeal that could point you towards another pathology.

Introduction. Le processus d’initiation de l’arthrose relève de plusieurs facteurs parmi lesquels l’obésité occupe une place importante expliquant l’individualisation récente du concept d’arthrose métabolique. Nos objectifs étaient d’évaluer le statut pondéral des patients arthrosiques en milieu de Médecine Interne au Sénégal et d’analyser les éventuelles comorbidités associées à l’arthrose. Patients et méthodes : Une étude transversale et descriptive, de juin 2016 à février 2017, a inclus les patients suivis pour une arthrose primitive quel qu’en soit la localisation aux services de Médecine Interne de l’Hôpital Aristide Le Dantec et de l’Hôpital Principal de Dakar. Les données sociodémographiques, les aspects de l’arthrose, les mesures anthropométriques et les comorbidités ont été recueillis et analysés à l’aide du logiciel Sphinx Plus2 Excel. Résultats : Cent quatorze patients ont été inclus ; leur âge moyen était de 60,16 ans (extrêmes de 39 et de 94 ans) avec un sex-ratio de 0,16 (98 femmes). La localisation de l’arthrose était le genou (71,9 %), le rachis (50 %), l’épaule (5 %), la hanche (4 %), les pieds (3 %) et les mains (3 %). L’IMC moyen était de 28,97 Kg/m2 avec 30,7 % des patients en surpoids et 33,1 % en obésité. L’obésité était notée chez 47 % des patients atteints de gonarthrose et 35,5 % de lombarthrose. L’obésité abdominale concernait 64 % des femmes et 30 % des hommes. L’hypertension artérielle, le diabète et l’hypercholes-térolémie étaient observés respectivement chez 42, 10 et 6 % des patients. Conclusion : la surcharge pondérale, l’obésité et les autres facteurs de risque cardiovasculaires sont des situations fréquentes chez les patients arthrosiques vus dans les services de Médecine Interne au Sénégal. Ces constatations rappellent l’importance des mesures hygiéno-diététiques dans la prise en charge et la prévention de l’arthrose.

Background The association of macrophage activation syndrome and primary Sjögren’s syndrome has been rarely reported in the literature. We report the first observation of this association in Africa, south of the Sahara, and we discuss the diagnosis and therapeutic challenge. Case presentation A 26-year-old Mauritanian and Berber woman was followed for primary Sjögren’s syndrome. After a voluntary cessation of her usual background treatment, she was admitted to our department for an outbreak of her illness. A clinical examination revealed anemic syndrome, peripheral polyarthritis, coughing rales at both pulmonary bases, and fever at 39.5 °C. On biologic examination, there was bicytopenia with anemia at 5.70 g/dl, lymphopenia at 796/mm3, a biological inflammatory syndrome with a sedimentation rate at 137 mm in the first hour, C-reactive protein at 97 mg/l, hyperferritinemia at 1778 mg/l (9 normal value), and hypergammaglobulinemia at 20.7 g/l of polyclonal appearance. The triglycerides were 1.95 g/l (1.4 normal value) and the lactate dehydrogenase level was 491 IU/l (1.5 normal value). Cytological examination of a medullary puncture revealed an image of hemophagocytosis. An infectious screening was negative. Thoracic computed tomography showed non-specific interstitial lung disease. A diagnosis of macrophage activation syndrome complicating primary Sjögren’s syndrome was selected with a probability of 97.2%, according to H-Score. The evolution was favorable under a treatment including etoposide (VP-16). Conclusion Macrophage activation syndrome is a rare entity, rarely reported during primary Sjögren’s syndrome. Its spontaneous evolution is invariably fatal. There is no consensus on therapeutic treatment. Etoposide is a therapeutic option especially in forms refractory to corticosteroid therapy.

Introduction L’epidemiologie du SGS est surtout etudiee en Occident. Notre objectif etait de determiner le profil epidemiologique du SGS dans un service de rhumatologie. Patients et methodes Etude retrospective realisee dans le service de rhumatologie du CHU Aristide Le Dantec de Dakar, sur une periode de 8 ans (janvier 2012 et deembre 2020). Les patients etaient suivis en consultation externe ou hospitalises. Le diagnostic du SGS etait etabli apres confrontation des arguments epidemiologiques, cliniques, paracliniques et therapeutiques, en accord avec les criteres de classification de 2002. Pour chaque observation, avaient ete analysees les donnees demographiques, diagnostiques, therapeutiques et evolutives. Resultats Ainsi, avaient ete colligees 568 observations (prevalence hospitaliere : 6,13 %) ; chez 508 femmes (89 %) et 60 hommes (11 %), d’âge moyen au diagnostic de 47,50 ans (extremes : 2 ans–0 ans). Les formes pediatriques etaient notees chez 19 patients (3,34 %). Les patients originaires du Senegal etaient de 505 cas (89 %) et ceux des pays limitrophes de 63 cas (11 %). Ils etaient celibataires dans 18 % des cas et maries dans 82 % des cas, non scolarises a la langue officielle (le francais) dans 36 % des cas et sans profession dans 38 % des cas. Le delai diagnostique etait de 7 ans en moyenne. Le mode de debut etait progressif dans 51 % des cas, brutal dans 14 % et insidieux dans 35 % des cas. Le SGS primitif etait note chez 370 patients (65,15 %), le SGS secondaire chez 143 patients (21,7 %) et celui associe chez 145 patients (2,85 %). Le syndrome sec present chez tous les patients etait domine par l’atteinte buccale 85 % des cas, suivi par ordre de frequence decroissante du syndrome sec oculaire : 63 % des cas, digestif : 27 % des cas, cutane : 16,5 %, nasal : 15 %, genital : 13,5 % et tracheo-bronchique : 11,8 % des cas. Les atteintes extra-glandulaires systemiques etaient notees chez 441 patients (77,65 %). Elles etaient dominees par l’atteinte articulaire. L’ESSPRI etait inferieur a 5 chez 21 % des cas et superieur a 5 chez 79 % des cas. L’ESSDAI etait faible chez 51 %, modere chez 30 % et forte chez 19 % des cas. Les facteurs predictifs de survenue de lymphomes etaient presents chez 8 % des patients. Le traitement associait les larmes artificielles, les sialagogues (1,05 % des cas), les antalgiques (74 %), les traitements de fond classiques (corticoides, hydroxychloroquine, sulfasalazine, methotrexate, azathioprine) : jusqu’a 96 % des cas, biotherapies (0,35 %), infiltrations cortisoniques (42,5 %), traitement physique (4 %). L’evolution fut favorable sauf chez 7 patients decedes (12,3 %). Les deces etaient dus a une embolie pulmonaire (4 cas), un syndrome de Stockes-Adams (1 cas), une infection a COVID19 (1 cas) et une sclerose laterale amyotrophique (1 cas). Conclusion Notre etude indique une frequence en progression de la maladie dans notre pratique, sans aucun doute en raison de sa meilleure connaissance. Elle est dominee par sa forme primitive (65,15 %), suivie de celle secondaire (21,7 %) et associee (2,85 %). Nos resultats rejoignent globalement ceux de la litterature, notamment occidentale, avec cependant une plus grande frequence des atteintes systemiques (77,65 %).

La paralysie périodique hypokaliémique thyrotoxique est une complication rare de l'hyperthyroïdie. Plus souvent rapportée chez les sujets asiatiques, elle est peu décrite dans la population noire. Son mécanisme peu élucidé, serait lié à une hyper activité de la pompe Na+/K+. Nous présentons deux cas de cette affection survenant chez des sujets noirs africains. La présentation clinique était identique chez les deux malades. Elle était faite d´une paralysie musculaire proximal des membres inférieurs. Cette paralysie était associée à une hypokaliémie sévère et survenait chez des patientes suivies pour maladie de Basedow sans autre pathologie associée. L´évolution a été rapidement favorable sous supplémentation potassique. Le traitement de l´hyperthyroïdie a permis d´éviter les récidives. Ces observations montrent l´importance d´évoquer le diagnostic de paralysie périodique hypokaliémique thyrotoxique malgré la rareté dans la population noire africaine.

Introduction: Antisynthetase syndrome is an original entity and rare autoimmune myositis and systemic disease, characterized clinically by a wide spectrum of clinical manifestations and the presence of autoantibodies directed against aminoacyl RNAt synthetases. We describe this disease in 03 Senegalese patients. Observations: The first patient was a 49-years-old black woman who was referred in our department after 06-months of follow-up for a misdiagnosis of tuberculosis. The clinical examination revealed polyarthritis, muscle weakness, chronic cough with crackling rales at the pulmonary bases, Raynaud phenomenon and dry syndrome. The second patient, a 21-years-old black woman, had polyarthritis and a progressive muscle weakness. The clinical examination showed also cutaneous signs including an erythema on the dorsal part of the fingers and the presence of the heliotrope erythema on the eyes. The last patient was a 52 years-old black woman. His clinical examination showed polyarthritis, muscle weakness and an appearance of mechanics’ hands. The creatinine phosphokinase was at 6.26 × N, 40.3 × N and 33.64 × N respectively in our patients. The chest computer tomography revealed an interstitial lung disease with a pattern of non-specific interstitial pneumonia in all three patients. The autoantibodies anti-Jo1 was also positive in all patients. The diagnosis of antisynthetase syndrome was retained with an overlap of antisynthetase and Sj?gren’s syndrome in the first observation. The evolution was favourable in our 03 observations with a therapeutic combination including Prednisone-Azathioprine and Kinesitherapy. Conclusion: Antisynthetase syndrome has been exceptionally reported in sub-Saharan Africa. It must be particularly mentioned in front of the triad: myositis, arthritis and interstitial lung disease. The identification of an auto-antibody directed against RNA t synthetases, particularly anti-Jo1, is essential for its diagnosis. Prognosis is related to interstitial lung involvement. The evolution has been favourable in our patients receiving Glucorticoid-Azathioprine combination therapy.

Introduction: The central, psychiatric and peripheral neurological manifestations of lupus are among the most severe visceral disorders and are grouped under the general term of “neuro-psychiatric systemic lupus erythematosus” (NPSLE). We conducted a cross-sectional observational study within our Department of Internal Medicine aimed at describing the clinical and evolutionary aspects of central neurological disorders of SLE, excluding lupus myelopathy. Patients and Methods: This was a retrospective and observational cross-sectional study carried out from 1 January 2015 to 31 October 2017, in the Department of Internal Medicine of Aristide le Dantec University Hospital in Dakar (Senegal). All patients hospitalized during this period who met the 1997 ACR classification criteria of SLE and who presented with a central neuropsychiatric syndrome attributable to SLE (as defined by ACR 1999) were included. Patients with isolated headache, acute myelitis or secondary neurological involvement attributable to a toxic, metabolic, infectious or tumour-related cause were excluded from our study. Results: During the study period, 10 patients with neuropsychiatric lupus involvement were treated at our institution, including 9 women and 1 man; the median age was 29 years (20 - 55 years). Neurological involvement occurred during the course of lupus evolution in 9/10 cases. The median time to SLE evolution was 18 months (0 - 60 months). Neuropsychiatric syndromes as defined by the 1999 ACR were commonly associated and more than half of our patients had multiple neuropsychiatric syndromes. There were 5 cases of confusion syndrome and coma, 4 cases of seizure, 3 cases of psychosis, 2 cases of acute cerebrovascular disease and 1 case of aseptic meningitis. Among the extra-neurological manifestations of SLE, haematological and dermatological involvements were common. Renal involvement affected half of the patients. The other manifestations were: polyarthritis in 3 patients, serositis in 2 patients, 5 cases of fever, 4 cases of deterioration of the general state, and one isolated case of ophthalmological involvement. Therapeutically, 8 patients received a bolus of methylprednisolone and 3 patients received a bolus of cyclophosphamide. Oral corticosteroids and hydroxychloroquine were administered to all patients, and azathioprine was administered in 2 patients. The evolution was favorable in 4 patients, other 2 patients maintained neurological sequelae and 2 patients were transferred to intensive care. Death was recorded in 4 patients. Conclusion: Neuropsychiatric manifestations of lupus are rare and sometimes severe, potentially life-threatening. In our patients, we have identified some of the most severe neurological syndromes according to the ACR nomenclature. The neurological involvement is exceptionally revealing, as these syndromes are often associated and integrated into a systemic context of lupus. The evolution is rapidly unfavorable and requires early diagnosis and optimal management.

Introduction: Hemorrhage by ruptured cerebral aneurysm is a rare and severe complication of systemic lupus erythematosus (SLE). We reported a case of this complication. Observation: A 24-year-old woman black Senegalese patient was followed in our department since for a systemic lupus with cutaneous and articular involvement and class III and V Lupus nephritis. She was readmitted for acute headache and early postprandial vomiting. The examination showed a meningeal syndrome, a subacute lupus eruption in the trunk, panniculitis and fever. The cerebral computer tomography showed spontaneous haemorrhage from saccular aneurysm. She was managed by immediate aneurysm clipping and medical treatment including bolus of methylprednisolone and immunosuppressive therapy was maintained. The outcome was favourable, but there was neurological damage such as brachial weakness. Conclusion: Hemorrhage by ruptured cerebral aneurysm is a rare and severe complication of SLE. The risk of damage is also significant. Immediate neurosurgical management and aggressive medical treatment may improve the prognosis.

Systemic lupus erythematosus (SLE) is associated with accelerated atherosclerosis and increasing cardiovascular risk which is recognized as a major cause of morbidity and death. Whether subclinical atherosclerosis has been evaluated by several methods, there are very limited data about Ankle-Brachial Index (ABI) in patients with systemic lupus erythematosus. The aim of the present study was to compare this index, between SLE patients and controls. We conducted a case-control study in the Department of Internal Medicine of our institution during the period from August 1, 2017 to December 31, 2018. We included 100 subjects, including 50 SLE patients and 50 control cases. This included 44 women and 6 men in patients with an identical distribution in controls. The mean age was 33.5 ± 11.3 years for cases and 33.3 ± 11.3 years (p-value: 0.93) for controls subjects. There was higher frequency of cardiovascular risk factors such as dyslipidemia (p-value at 0.009), low level of serum HDL-cholesterol (p-value 0.001), hypertriglyceridemia (p-value at 0.000) and hyperuricemia (p-value at 0.000) in patients with SLE. Overweight/obesity was higher in controls subjects (p-value at 0.028). There was no statistically significant difference in the frequency of diabetes-mellitus, smoking and high blood pressure. The abnormally ABI was recorded in 19 patients with SLE (38%) and 8 controls (16%) with a p-value: 0.01 and odds ratio: 3.22. Eight patients (16%) and four controls (8%) had low ABI without significant difference (p-value: 0.11 but odds-ratio at 2.98). Eleven patients with SLE (22%) and five controls (10%) had high ABI (p-value: 0.05 and odds-ratio: 3.24). In patients with SLE only disease activity (cSLEDAI) at the inclusion of the study was correlated to abnormal ABI. Conclusion: This study showed an increasing prevalence of abnormal ABI in black African patients with SLE compared to controls with a correlation between disease activity and abnormal ABI.

Objective: Describe the design and implementation of an electronic medical record—E-INTMED—customized for Internal Medicine in Dakar, Senegal. Methodology: This study was carried out in a public teaching hospital in Dakar Senegal. It entailed collaboration between physicians specialized in various fields in Internal Medicine and Computer Scientists to carry out the compilation of data and their electronic transcription to produce a prototype which met users’ needs. Results: E-INTMED software is structured around several hierarchical tables allowing users to register and store all relevant patients’ information. E-INTMED structures patient’s data to provide a clear overview of their medical history and users’ activity performance. E-INTMED makes medical users’ life so much easier. Users can generate and send letters and prescriptions quickly and efficiently using the customized templates which they can modify or create new ones. In addition to these capabilities, all of the features expected in an Internal Medicine EHR are handled by E-INTMED, such as lab orders and results, mechanisms for continuity of care, embedding and access to images and documents, and so much more. E-INTMED provides medical students with a number of educational, practical and administrative advantages. Conclusion: Computerization of medical records has become a necessity today. Crossing the line to Electronic medical records could help to improve medical practice and medical training.

Sarcoidosis is a systemic granulomatosis from an unknown etiology, particularly affecting the lungs and the lymphatic system. It is associated with an immune deficiency involving an excessive immune response mediated by TH1 lymphocytes. Its evolution can lead to serious complications such as pulmonary fibrosis, pulmonary hypertension, bronchial stenosis and opportunistic infections. Opportunistic infections rarely occur on an underlying sarcoidosis condition. We report a rare case of pulmonary aspergillary and cryptococcal co-infection, on a patient with sarcoidosis who was finally lost to follow up. It was about a 47 years old female patient, diagnosed in 2015 for mediastino-pulmonary and neurological sarcoidosis. She was in therapeutical rupture after a 3-month period of corticotherapy at a dosage of 20 mg daily. The patient has been lost of sight for 3 years and was seen again on November, 22nd, 2018 at the Internal Medicine/Rheumatology Department of DALAL JAMM Hospital. At his admission she presented: a low grade hemoptysia, a chronic cough, a shortness of breath on exertion CRD Stage 2. At the biological investigation, the CRP was at 71.9 mg/l. Calcium serum levels were at 102.6 mg/l. Sputum culture and AFBS were negative. The screening serology of aspergillary Ig G was positive at 12.4 UA/ml. Thoracic High Resonance CT pointed suggests a Stage 2 Sarcoidosis complicated with aspergillary graft. The bronchoscopy showed out a severe suppurated bronchopathy. Microscopic examination of the BAF found some Cryptococcus neoformans settlement. We concluded a diagnosis of pulmonary aspergilloma and cryptococcosis co-infection with an underlying condition of Stage 2 Sarcoidosis. We successfully treated our patient with an oral intake of Itraconazole at a dosage of 400 mg daily over a period of 10 days. This is a rare and life-threatening triple association. In our case, the patient was lost to follow up for a long period and this was considered as the first morbidity risk factor.

Introduction: Systemic diseases have been the subject of few studies in the African literature and have probably been under-estimated. The objective of our study was to specify their spectrum, their epidemiological aspects and diagnostic delay in Internal Medicine Departments of Dakar (Senegal). Material and Method: It was a multicentric retrospective and descriptive study regarding all systemic diseases during 119 months from 1st January 2005 to 30 November 2014 in 5 hospital centers down Dakar. Systemic diseases were retained according to their international consensus criteria. Results: During the studying period, 726 patients were included with 632 women and 94 men (sex ratio of 0.14). The average age was 43.76 years. Inflammatory rheumatoid family history was noted in 10.06% of cases. Rheumatoid arthritis (RA) was the predominant affection, recorded on 564 patients, isolated or associated with other systemic diseases. It was followed in a decreasing order, in the systemic auto-immune diseases sub-groupe, by systemic lupus (56 cases), Sjogren’s syndrome (32 cases), Systemic Sclerosis (26 cases), Idiopathic inflammatory myopathies (21 cases), Undifferentiated connective tissue diseases (20 cases), Anti Phospholipid’s syndrome (6 cases) and Mixed connective tissue disease (6 cases). A diagnosis of systemic vasculitis was recorded in 19 patients. The other systemic affections were represented by systemic sarcoidosis (8 cases), Adult-onset Still’s disease (03 cases), amyloidosis (02 cases) and 02 cases of systemic syndrome associated to immunodeficiency. The mean diagnostic delay duration before the diagnostic was 3.46 years. Conclusion: Systemic diseases in internal medicine are characterized by their diversity, the clear predominance of RA, and significant diagnostic delay.

Parathroid Carcinoma is a rare cause of primary hyperparathyroidism (PPH). His diagnosis is a real challenge. We report an observation and discuss the diagnostic guidelines before surgery.A 31-year-old Senegalese woman was admitted to our department for the exploration of diffuse bone pain and multiple pathological fractures. Physical examination revealed a right lateral mass of the neck. Serum calcium level was 142.2 mg / l and serum parathyroid hormone 42 N. Ultrasound and cervical tomodensitometry showed a parathyroid mass compressing the thyroid and trachea. The extension assessment revealed osteolytic lesions and T4-T5 epiduritis evoking metastases. Surgery and histology were performed. According to the histopathology and clinical context, the tumor was identified as a parathyroid carcinoma.The preoperative evaluation of a patient with severe hypercalcemia and high PTH levels should include the possible diagnosis of parathyroid carcinoma, especially in symptomatic patients or in case of palpable neck mass.

La localisation cervicale de la tuberculose est rare et peut prendre l'apparence d'un cancer du col utérin. La présentation pauci-symptomatique et l'évolution insidieuse sont à l'origine d'un retard diagnostique. Les symptômes communément rencontrés sont non spécifiques, ce qui contribue au retard thérapeutique et majore le risque d'infertilité qui reste la séquelle quasi inéluctable. Nous rapportons un cas de tuberculose du col utérin dont le diagnostic de prime abord n'a pas été évident. En effet une patiente a été adressée à notre département pour suspicion de cancer du col utérin. Le diagnostic de suspicion de cancer a été alors retenu devant un col qui saignait au contact avec une tomodensitométrie abdominopelvienne en faveur d'une tumeur du col utérin. Une biopsie de confirmation histologique a été indiquée. On a retrouvé à l'examen anatomopathologique, un granulome épithélio-giganto-cellulaire avec nécrose caséeuse, compatible avec une tuberculose cervicale. La recherche d'un terrain était négative. Un traitement antituberculeux instauré a conduit à la guérison. Retenue souvent sur la base d'éléments présomptifs, la décision diagnostique et thérapeutique de tuberculose du col cervicale reconnait la place de l'examen anatomopathologique.

We report a rare association of seronegative myasthenia gravis and a Biermer’s anemia (or pernicious anemia). A Senegalese patient of 31 years has been followed for a vitamin B12 deficiency anemia, 12 months before his hospitalization in our department. She has been admitted for an intense and invalidating fatigability in spite of the correction of anemia, associated to a right ptosis. This clinical picture has electively been improved to the prostigmine test. The electromyography had revealed a compatible decrement with a diagnosis of myasthenia. The positivity of the antibodies anti gastric parietal cells and the twice negativity of the antibody against acetylcholine receptor (AChR) and muscle-specific kinase (MuSK) had permitted to deduct a diagnosis of seronegative myasthenia and Biermer’s anemia. The evolution was favorable under substitutive B12 vitamin therapy associated to corticotherapy and azathioprine. We insist on the research and the early treatment of a myasthenia, in a context of Biermer’s anemia, before suggestive clinical signs in spite of the negativity of the anti-Rach antibodies and anti-Musk.

Introduction: The Behcet’s disease is deemed to be scarce in Black Africa where data are still scattered. The purpose of our study is to describe the epidemiological, clinical, paraclinic and evolutive particularities of the patients whose presenting symptoms of the Behcet’s diseases were a venous thrombosis. Patients and Methods: It was a descriptive, multicenter, and cross-sectional study lasting 15 months. We brought together all the cases of the Behcet’s disease revealed by venous thrombosis. The diagnosis was based on clinical criteria of the international group of study of the Behcet’s disease in 2007. Results: We have grouped 10 revealing thrombosis cases of the Behcet’s diseases during our study period. The average age was 34. The average wait period between the appearances of the early symptoms and the diagnosis of the very disease was 30 months. The admission motives were the abdominal pain (2 cases), a thrombophlebitis of the lower limb (2 cases), headaches (1 case), coma (1 case), a thrombophlebitis of the upper limb (3 cases). The thrombotic symptoms were exclusively venous-located. The seats of the thrombosis were the vena cava superior in 30% of the cases, the vena cava inferior in 20% of the cases, the veins of the lower limb in 20% of the cases, the cerebral vein in 20% of the cases, and the auxiliary vein in 10% of the cases. The treatment of the deep venous thrombosis consisted in all the cases of an effective anticoagulation associated with the colchicine. Primarily, the corticotherapy with a high dose was used in all the patients. One of them in the comatose stage, manifesting both cerebral thrombophlebitis and aseptic meningitis, had died. Conclusion: Behcet’s disease is a disease of the young adult, but it must be evoked even in old age, with a view to appropriate management, in order to avoid the complications of the disease. Although it is rare in our regions, it should be sought in the etiological assessment of venous thrombosis whatever the location.

Introduction: We assess the severity of the rheumatoid arthritis in a Senegalese African black population. Patients and methods: It is a retrospective study achieved in the service of Internal Medicine of Aristide Le Dantec teaching hospital of Dakar between January 2005 and December 2016 in patients suffering from rheumatoid arthritis. We specified for every patient the predictive data of severity of the rheumatoid arthritis. Results: Four hundred and three patients have been gathered (39 men and 364 women), with the mean age of 45.8 years. An active tobacco addiction was noticed in 10 patients. The diagnostic delay was on average of 72 months. Characteristic articular deformations were noticed in 215 patients (53.3%). They were correlated to male (p = 0.038), to age (p = 0.001) and to the activity of the rheumatoid arthritis (p = 0.0445). Systemic manifestations have been observed in 213 cases (52.9%), particularly anemia (50.8%). They were correlated to the anti-CCP antibodies (p = 0.047). The ESR was increased at the first hour in 84.4% of cases (median: 43 mm; extreme: 1and 160). CRP was elevated in 63.71% of cases (median of 12 mg/l; extreme: 1 and 384). The rheumatoid factor was positive in 57.6% of the cases. The anti-CCP antibodies were present in 89.2% of the cases. Articular erosions were objectified in all cases. A DAS 28 superior to 5.1 was noticed in 71% of cases. Conclusion: The rheumatoid arthritis was severe in our study.

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.

Summary of Lupus and Basedow Disease Association: The association lupus auto-immune thyroid disease is well known. Lupus is most commonly associated with Hashimoto’s thyroiditis. As for Graves’ disease, it is most often associated with pernicious anaemia, vitiligo, idiopathic purpura and myasthenia gravis. To our knowledge, we report the first case of lupus associated with Graves’ disease in sub-Saharan Africa. Observation: A female patient of 52 years old has been followed since February 2010 for systemic lupus diagnosed on biological and immunological clinical ACR criteria. There was no skin ailment and kidneys involved. Combined treatment with high-dose corticosteroids early and rapid decrease and hydroxychloroquine was established with good clinical and biological evolution. One year later the patient developed thyrotoxicosis syndrome and vascular goitre without exophthalmos associated with the presence of antibodies anti receptor of TSH leading to the diagnosis of Graves’ disease. The patient has been treated with synthetic anti-thyroid and beta blocker allowing the regression of clinical symptoms and the normalization of thyroid hormones. Since then, the patient had not shown other signs of systemic affection. Conclusion: Systemic diseases are often associated with autoimmune thyreopathies. But association of lupus with Graves’ disease has been rarely described in the literature. One should always watch out for the occurrence of thyroid disease in front of any systemic disease and vice versa.

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 Les thérapeutiques innovantes du myélome multiple sont peu accessibles en Afrique subsaharienne. Le but de cette étude est de décrire les particularités diagnostiques et évolutives observées dans notre pratique de prise en charge des myélomateux. Méthodes Une étude rétrospective (2005 - 2016) descriptive à visée analytique, mené à l’hôpital Le Dantec (Sénégal) a concerné les myélomateux inclus selon les critères de l’International Myeloma Working Group (2003, 2014). Résultats Ont été colligés 136 dossiers (69 hommes, 67 femmes) de patients d’âge moyen 59 ans ± 10,1 ans et qui ont un âge inférieur à 65 ans dans 69,1% des cas. Les signes révélateurs ont été des douleurs osseuses (96,3%), une insuffisance rénale (36,8%), une infection (23,5%), une fracture pathologique (17,6%), une compression médullaire (16,9%), et une hypercalcémie maligne (16,2%). L’isotype a été IgG dans 61,3% des cas et Kappa dans 65% des cas. Les malades ont été classés stade III (59,4%) et I-II (40,6%) de l’index staging system. Sous traitement conventionnel (Méphalan-Prédnisone: 67,6%, innovant: 5,9%), la survie médiane a été de 20 mois (1-78 mois). La survie est meilleure, en l’absence de complications neurologiques, infectieuses et au score I-II de l’Index Staging System. Conclusion Dans notre étude, le myélome multiple est fréquemment diagnostiqué avant 65 ans, au stade de forte masse tumorale. La survie globale peut être améliorée par un dépistage précoce et un accès aux thérapeutiques adéquates.

Les caracteristiques cliniques et le profil des auto-anticorps de 35 patients senegalais suivis pour lupus erythemateux (LES) ont ete analyses apres dosage des anticorps antinucleaires (AAN) par IFI, des Ac anti-ADN natif par Elisa et des Ac anti-Sm, anti-RNP, anti-SSA anti-SSB, anti-CCP2, anti-J0, anti-Scl70 par immunodot. Un âge moyen de 33 ans (18-50 ans) et un sex-ratio F/M de 16 ont ete retrouves. Les atteintes rhumatologiques (85,7 %) et cutanees (79,4 %) ont ete les manifestations les plus frequentes. Les AAN et les Ac anti-ADNn etaient positifs respectivement chez 85,7 % et 62,5 % des patients. Les Ac anti-RNP, les anti-Sm, les anti-SSA, les anti-SSB et anti-CCP2 ont ete retrouves chez 30 a 70 % des malades. Chez les jeunes patients, les taux d’Ac anti-ADNn et Ac anti-Sm (P < 0,05) sont plus eleves que chez les patients de plus de 40 ans. La presence simultanee de signes cutanes et rhumatologiques est caracterisee par la hausse des taux d’Ac anti-ADNn, anti-SSA et anti-SSB chez les patients concernes. Notre etude montre l’interet du dosage des Ac anti-ADNn, anti-SSA et anti-SSB dans le suivi des patients lupiques, surtout en cas d’association de signes cutanes et rhumatologiques.

Introduction La tuberculose extra-pulmonaire inclut toute infection a Mycobacterium tuberculosis touchant un organe autre que le poumon. Selon la plus grande etude dakaroise confirmee par les donnees occidentales ; les presentations frequemment rencontrees en medecine interne sont les localisations ganglionnaires, sereuses, vertebrales et meningees. Nous rapportons les formes inhabituelles de tuberculose extra-pulmonaire rencontrees dans notre pratique courante au service de medecine interne du CHU Le Dantec. Patients et methodes Il s’agit d’une etude transversale, descriptive qui est menee du 1 janvier 2015 au 1 juillet 2016, soit 16 mois. Nous avons inclus tous les cas de tuberculose extra-pulmonaire de presentation inhabituelle au service de medecine interne du CHU Dantec durant cette periode. Le diagnostic de tuberculose a ete retenu soit devant une preuve bacteriologique et/ou histologique, soit devant des arguments cliniques, paracliniques et evolutifs. Resultats Dix-hiut cas de formes atypiques de tuberculose extra-pulmonaire sont notes. Il existait une predominance masculine avec un sex-ratio F/H de 0,3. L’âge moyen etait de 34 ans. Tous les patients sont suivis au service de medecine interne du CHU Dantec. Le delai diagnostique moyen etait de 13 mois. Les presentations cliniques sont dominees par les atteintes rhumatologiques (8 cas) et digestives (3 cas). Parmi les manifestations osteoarticulaires on notait 5 formes polyarticulaires sous forme de rhumatisme de Poncet dont les localisations initiales etaient pulmonaires dans 3 cas et ganglionnaires dans 2 cas ; 2 formes monoarticulaires a type de coxalgie et d’une atteinte sternoclaviculaire ; une forme osseuse sternale. La localisation intestinale notamment ileocaecale etait la seule topographie dans les 3 cas d’atteinte digestive. Les 2 cas de vascularites tuberculeuses sont survenus dans un contexte de miliaire pulmonaire. L’un est confirme par une culture d’une piece operatoire apres traitement chirurgical d’une rupture d’anevrysme de l’aorte abdominal ; l’autre localise au niveau des membres inferieurs est diagnostique sur la base d’arguments presomptifs. On notait 2 cas de tuberculose gynecologique a localisation mammaire et ovarienne confirmes a l’histologie. Les 3 autres malades presentaient un tuberculome, une tuberculose urogenitale et une tuberculose mandibulaire. Un terrain favorisant n’etait retrouve que chez ces derniers. Le traitement anti-bacillaire preconise etait le regime 2RHZE/4RH dans 16 cas et 2RHZE/10RH dans 2 cas. L’evolution fut favorable chez 16 patients. On notait 2 deces. Discussion Le rhumatisme de Poncet doit etre evoque devant tout contexte de polyarthrite debutante surtout en milieu tropical. Les patients presentaient une crise de type reaction de Herxheimer au debut du traitement antituberculeux. D’autres formes de mycobacteries pourraient etre en cause. Conclusion Les localisations rares et inhabituelles de la tuberculose extra-pulmonaire posent souvent un probleme de diagnostic differentiel avec d’autres affections, notamment granulomateuses ; systemiques et tumorales metastatiques, d’ou le retard diagnostique constate.

La maladie de Basedow est une affection auto immune associant une thyrotoxicose à des manifestations de fréquence variable comme le goitre, l'ophtalmopathie et le myxœdème prétibial. Son diagnostic est souvent facile, tandis que sa prise en charge demeure encore difficile. L'instauration d'un traitement médical simple expose à un risque de récidive. Au Sénégal et en Afrique Sub-saharienne peu d'études ont porté sur la maladie de Basedow. L'objectif de l'étude était de décrire les aspects épidémiologique, clinique, thérapeutique et évolutif de la maladie de Basedow en milieu hospitalier à Dakar. Il s'agissait d'une étude rétrospective menée du 1er janvier 2010 au 31 décembre 2013 dans le service de Médecine Interne du centre hospitalier universitaire Aristide Le Dantec. Durant la période, 108 patients suivis en consultation externe pour maladie de Basedow, ont été inclus sur un total de 834 patients suivis en consultation externe. le diagnostic a été retenu devant les signes cliniques, biologiques et immunologiques. Cent huit patients, atteints de maladie de Basedow ont été inclus sur un total de 834 consultations. Le sex ratio était de 7,3 et la moyenne d'âge de 34,6 ans. Les principaux motifs de consultation étaient : les palpitations et l'amaigrissement dans respectivement 46,3% et 39,8% des cas. Le syndrome de thyrotoxicose était présent chez 93,5% des patients, un goitre était noté chez 87% des patients et une exophtalmie chez 78,7% des patients. La principale complication était à type de cardiothyréose retrouvée chez 11,1% des patients. Tous les patients ont eu un traitement par antithyroïdiens de synthèse. L'évolution a été favorable dans 19,4% des cas. Une récidive à été notée dans 57% des cas et dans 23,1% des cas les patients ont été perdus de vue. La maladie de Basedow est la cause de la plus fréquente d'hyperthyroïdie. Le tableau est dominé par les manifestations cliniques liées à l'hyper métabolisme de l'organisme. Dans cette étude, il apparait que la thyroïdectomie n'est pas de première intention si l'on connait le nombre élevé de récidive après le traitement médical.The Pan African Medical Journal 2016;25

Amyloidosis is a protein folding disorder in which normally soluble proteins are deposited extracellularly as insoluble fibrils. When stained with Congo red dye, it produces apple-green birefringence under polarized light. The main amyloid proteins are AL, AA, ATTR and Aβ(2)-M. The incidence of amyloidosis in sub-Saharan Africa ranges from 0.28 to 0.57% in autopsy series. Secondary AA amyloidosis is the most frequent, found in 42 to 66% of amyloidoses. Chronic infections, especially tuberculosis, are the main cause. AL amyloidosis is found in 21 to 34% of amyloidosis cases, half of them due to myeloma. Other types of amyloidosis seem rare, but are probably underdiagnosed. The clinical presentation in sub-Saharan Africa is similar to that in Western series. Further experimental and clinical studies will allow a better assessment of the characteristics of amyloidosis in sub-Saharan Africa.

Introduction Le syndrome d’hyperlymphocytose CD8 associe au VIH ou « diffuse infiltrative lymphocytosis syndrome » (DILS) est caracterise par la presence d’une hyperlymphocytose CD8 sanguine polyclonale associee a une infiltration lymphocytaire tissulaire survenant lors d’une infection par le VIH [2]. Nous rapportons un nouveau cas de DILS pris au depart pour une sarcoidose. Observation Il s’agissait de Mlle A.M., 40 ans, tabagique sevree depuis 3 mois ; suivie en ophtalmologie pour panuveite depuis 5 ans sous prednisone 1 mg/kg. Ce traitement etait irregulierement pris par la patiente. A l’admission, elle presentait un syndrome sec oculo-buccal, une polyadenopathie superficielle sus- et sous-diaphragmatique, une parotidomegalie bilaterale symetrique avec aspect en poire, des crepitants bilateraux asymetriques au niveau des bases pulmonaires. L’hemogramme montrait une anemie a 10 g/dL de type inflammatoire et une lymphopenie. La radiographie thoracique mettait en evidence un important syndrome interstitiel. Le scanner thoracique montrait des images pulmonaires micro nodulaires bilaterales avec des adenopathies au niveau du mediastin superieur non compressives et des foyers de fibrose lobaire inferieure. Les biopsies bronchiques montraient un remaniement inflammatoire non specifique. Le lavage broncho alveolaire retrouvait une alveolite lymphocytaire majoritairement constituee de cellules T CD8. L’examen ophtalmologique retrouvait des lesions sequellaires de panuveite. Le dosage de l’enzyme de conversion etait normal ainsi que la calcemie et la calciurie. L’electrophorese des proteines plasmatiques montrait une hypergammaglobulinemie polyclonale 22 g/L. La recherche des anticorps (anti-SSA et SSB) etait negative. Le phenotypage lymphocytaire sanguin retrouvait 161 CD4/mm3 et 1855 CD8/mm3 (rapport CD4/CD8 = 0,086 [N > 0,68]). Les recherches d’une infection bacterienne a germes banals ou specifiques furent negatives. Cependant la serologie VIH1 etait positive. La charge virale etait de 110 copies/mL. La biopsie d’une adenopathie cervicale retrouvait une hyperplasie lymphoide folliculaire floride. La biopsie des glandes salivaires montrait une infiltration lymphoplasmocytaire d’origine virale. Un diagnostic de DILS etait pose et un traitement antiviral etait prescrit ainsi qu’une corticotherapie. L’hyperlymphocytose CD8 regressait apres 4 semaines de traitement. Discussion Le syndrome d’infiltration lymphocytaire CD8 diffuse lie au VIH apparait generalement dans les premieres annees suivant la contamination et est caracterise par la presence d’une lymphocytose sanguine CD8 persistante avec une infiltration lymphocytaire CD8 d’un ou de plusieurs organes. Les atteintes pulmonaires (syndrome interstitiel ou nodulaire) et salivaires (parotidite avec syndrome sec, infiltration des glandes salivaires accessoires) sont generalement au premier plan, pouvant mimer une sarcoidose ou un syndrome de Sjogren. Conclusion Le syndrome d’hyperlymphocytose CD8 associe au VIH (ou DILS) est une entite rare mais doit etre systematiquement evoque devant la presence d’une parotidomegalie et/ou d’autre atteintes d’organes associee a une lymphocytose CD8 polyclonale.

Introduction: We reported a case of hemophagocytic syndrome complicating microscopic polyangitis presented by crescentic glomerulonephritis. Case Presentation: A 22-year-old female patient originated from Dakar, Senegal presented with nephrotic syndrome and rapidly progressive glomerulonephritis. On physical examination, we noticed hyperchromic diffuse punctilious purpura skin lesions predominant on the trunk, the neck and the upper thigh. Immunology investigations revealed strongly positive anti SSA/Ro and antiSSB. Anti-neutrophil cytoplasmic antibodies had positive results with a peri-nuclear type fluorescence, specific to myeloperoxidase. In optic microscopy, renal biopsy showed a crescentic glomerulonephritis with circumferential cellular and fibrous proliferation affecting 85% of glomeruli. The diagnosis of microscopic polyangitis with renal and skin involvement was retained. The patient received methylprednisolone and cyclophosphamide 700 mg/m 2 every 15 days for the first 3 pulses and every 21 days thereafter. After the 5 th month, she developed obnubilation, fever and central pancytopenia. Bone marrow aspiration was performed, which showed medullary invasion by macrophages with signs of hemophagocytosis. Diagnosis of hemophagocytic syndrome complicating a microscopic polyangitis was retained and methylprednisolone pulses started. The patient was under hemodialysis after follow-up of about 9 months with stable clinical state. Conclusions: The occurrence of SAM in pauci-autoimmune vasculitis is rarely described, particularly in Africa. Our case is an illustration of the reality of this association.

La maladie de Basedow est une affection auto immune associant une thyrotoxicose à des manifestations de fréquence variable comme le goitre, l'ophtalmopathie et le myxœdème prétibial. Son diagnostic est souvent facile, tandis que sa prise en charge demeure encore difficile. L'instauration d'un traitement médical simple expose à un risque de récidive. Au Sénégal et en Afrique Sub-saharienne peu d'études ont porté sur la maladie de Basedow. L'objectif de l'étude était de décrire les aspects épidémiologique, clinique, thérapeutique et évolutif de la maladie de Basedow en milieu hospitalier à Dakar. Il s'agissait d'une étude rétrospective menée du 1er janvier 2010 au 31 décembre 2013 dans le service de Médecine Interne du centre hospitalier universitaire Aristide Le Dantec. Durant la période, 108 patients suivis en consultation externe pour maladie de Basedow, ont été inclus sur un total de 834 patients suivis en consultation externe. le diagnostic a été retenu devant les signes cliniques, biologiques et immunologiques. Cent huit patients, atteints de maladie de Basedow ont été inclus sur un total de 834 consultations. Le sex ratio était de 7,3 et la moyenne d'âge de 34,6 ans. Les principaux motifs de consultation étaient : les palpitations et l'amaigrissement dans respectivement 46,3% et 39,8% des cas. Le syndrome de thyrotoxicose était présent chez 93,5% des patients, un goitre était noté chez 87% des patients et une exophtalmie chez 78,7% des patients. La principale complication était à type de cardiothyréose retrouvée chez 11,1% des patients. Tous les patients ont eu un traitement par antithyroïdiens de synthèse. L'évolution a été favorable dans 19,4% des cas. Une récidive à été notée dans 57% des cas et dans 23,1% des cas les patients ont été perdus de vue. La maladie de Basedow est la cause de la plus fréquente d'hyperthyroïdie. Le tableau est dominé par les manifestations cliniques liées à l'hyper métabolisme de l'organisme. Dans cette étude, il apparait que la thyroïdectomie n'est pas de première intention si l'on connait le nombre élevé de récidive après le traitement médical.

Introduction Les services de medecine interne exercent des missions variables, ils doivent cependant affirmer leur choix de recrutement dans la prise en charge des polypathologies, des difficultes diagnostiques et des maladies systemiques [1] . En Afrique noire subsaharienne, l’activite medicale des services de Medecine Interne est mal connue et les circuits de prise en charge des maladies systemiques sont peu codifies. Nous avons mene une etude transversale de 6 mois au service de medecine interne du CHU Le Dantec de Dakar (Senegal). Les objectifs de cette etude, etaient de determiner : – la repartition des differents groupes de pathologies rencontres en secteur d’hospitalisation et la place des maladies systemiques ; – les motifs d’admission des maladies systemiques et d’evaluer leur morbi-mortalite. Patients et methodes Il s’agissait d’une etude transversale et descriptive sur une periode allant du 1er fevrier 2016 au 30 juillet 2016. Elle portait sur tous les patients hospitalises pour une maladie systemique remplissant les criteres internationaux de consensus. Un questionnaire a ete etabli et la fiche d’enquete etait remplie au chevet des patients, en cours d’hospitalisation. Les donnees generales, cliniques avec les complications, immunologiques et evolutives etaient saisies et analysees grâce au logiciel SPSS 16,0. Resultats Durant la periode d’etude, 261 patients ont ete hospitalises dont 33 patients admis pour un diagnostic de maladie systemique soit une prevalence de 12 %. Les maladies systemiques occupaient le 4e rang des groupes de pathologies les plus frequemment rencontrees. L’âge moyen etait de 37 ans, le sex-ratio (H/F) de 0,06. Le delai moyen d’hospitalisation etait de 19,1 jours. Plus de trois-quarts de nos patients avaient un suivi medical anterieur et le diagnostic initial etait connu chez seulement 14 patients. Le lupus et la polyarthrite rhumatoide etaient les deux affections systemiques predominantes, rencontrees respectivement dans 51,5 % et 15,2 % des cas. L’activite de la maladie lupique (selon le SLEDAI) etait moderee a forte dans 94 % des cas et l’activite de la PR (DAS 28) etait forte dans 80 % des cas. Les complications infectieuses etaient notees chez plus de la moitie des patients (51,5 %) admis pour une maladie systemique ; les complications viscerales etaient documentees dans 67 % des cas. Une iatrogenie (non infectieuse) a ete notee chez 4 patients. Quatre patients etaient decedes, d’une poussee de la maladie dans 2 cas, d’un choc septique dans 1 cas et de cause indeterminee dans le dernier cas. Conclusion Les maladies systemiques sont des pathologies emergentes, de plus en plus etudiees en Afrique noire subsaharienne. Les complications infectieuses et viscerales constituent une source importante de morbidite. Il est primordial de mettre en place des registres de suivi de ces affections et un reseau africain de recherche dans ce domaine. Les services de medecine interne devraient occuper une place centrale dans la prise en charge des maladies systemiques.

Introduction L’insulinoresistance de type B est une forme particuliere de diabete caracterisee par une forme extreme d’insulinoresistance et par la presence d’anticorps anti-recepteurs de l’insuline. Il s’agit d’une affection peu decrite et qui s’associe a d’autres maladies auto-immunes avec la maladie lupique en tete de fil. Il s’agit d’affection exposant a de multiples complications infectieuses en particulier pouvant etre mortelles. Nous rapportons l’observation dune patiente suivie pour une insulinoresistance de type B avec de multiples complications infectieuses. Observation Il s’agit d’une patiente nee en 1984, une geste, un pare avec accouchement d’un mort ne, suivie pour un diabete etiquete type 1 avec anticorps anti-GAD et anti-IA2 negatifs sous insulinotherapie. Sa soeur etait suivie pour une polyarthrite rhumatoide. Le diagnostic d’une insulinoresistance de type B a ete pose devant la necessite d’utiliser de fortes doses d’insuline allant jusqu’a 500 UI/jour, la positivite des anticorps anti-recepteurs de l’insuline. Le diagnostic d’insulinoresistance de type B survenait sur terrain de nephropathie lupique, associe a un syndrome des anticorps anti-phospholipides. Les anticorps anti-CCP2 etaient par ailleurs positifs chez la patiente. Sur le plan therapeutique, elle a beneficie d’un traitement a base de cyclophosphamide a raison de 4 bolus en raison de son insulinoresistance et de sa nephropathie lupique, d’une insulinotherapie a tres fortes doses. Par ailleurs, elle etait sous corticotherapie associee au traitement adjuvant et sous antiagregants plaquettaires. L’evolution a ete marquee par la survenue de multiples complications infectieuses dont une infection urinaire a E. coli, une pneumopathie tuberculeuse a Mycobacterium tuberculosis sur laquelle s’est greffee une pneumopathie dyspneisante sans germes identifies ayant bien evolue sous association amoxicilline acide–clavulanique. L’evolution etait defavorable apres un an de suivi dans un contexte d’alteration profonde de l’etat general et d’un etat septique. Discussion L’insulinoresistance de type B reste tres peu decrite dans la litterature, elle necessite le plus souvent de tres fortes doses d’insuline. Elle se caracterise par son association a d’autres maladies auto-immunes (nephropathie lupique, syndrome des anticorps antiphospholipides) et la necessite d’utiliser un traitement immunosuppresseur majeur. Cette association reste un facteur majeur pouvant exposer les patients aux nombreuses complications en particulier infectieuses pouvant etre mortelles. Conclusion L’insulinoresistance de type B est une pathologie rare et peu decrite. Son caractere auto-immun, son association a d’autres maladies auto-immunes, son traitement immunosupresseur majeur exposent a de multiples complications surtout infectieuses.

Contexte. Peu de donnees sont disponibles sur le traitement de la polyarthrite rhumatoide (PR) en Afrique subsaharienne, et le retard diagnostique y est important. En raison des conditions socioeconomiques parfois defavorables en Afrique subsaharienne, le choix therapeutique depend des disponibilites locales. Les traitements de fond conventionnels (DMARD) sont d’autant plus efficaces qu’ils sont instaures precocement. Les biotherapies ne sont pas disponibles. L’objectif de ce travail etait d’analyser l’evolution a six mois de 205 patients senegalais atteints de PR sous traitement de fond conventionnel. Methode. Nous avons realise une etude retrospective de janvier 2005 a juin 2009 en consultation de rhumatologie au CHU Le Dantec, Dakar, Senegal. Tous les patients inclus repondaient aux criteres ACR de la PR. Le traitement a ete evalue par les criteres de reponse ACR et EULAR. Resultats. Deux cent cinq patients ont ete inclus. Corticoides, hydroxychloroquine (HCQ), methotrexate (MTX) et sulfasalazine (SPZ) etaient prescrits respectivement chez 205, 190, 137 et 11 patients. La combinaison corticoides, MTX et HCQ etait prescrite chez 122 patients, et la combinaison corticoides et HCQ chez 63. Vingt-six pour cent des patients avaient interrompu leur traitement de fond pendant cinq jours par mois en moyenne suite une rupture de stock et/ou a des difficultes financieres. Le nombre moyen de rendez-vous durant ces six premiers mois etait de quatre. Quarante-huit pour cent des patients n’avaient pas respecte tous leurs rendez-vous. Apres six mois, on observait une amelioration significative de toutes les variables, sauf le nombre d’articulations gonflees. Les reponses ACR20, 50 et 70 etaient respectivement obtenues chez 50 %, 31 % et 6,9 % des patients. Les reponses EULAR etaient bonnes chez 53,9 % des patients, moderees chez 12,7 %, et mauvaises chez 23,1 %. L’echec therapeutique a ete note chez 10,3 %. Durant les six mois, un patient sur deux a du modifier son traitement, avec dix arrets (cinq pour desir de grossesse, deux pour survenue de grossesse, et trois pour tuberculose). Conclusion. Le traitement de la PR au Senegal repose sur la combinaison methotrexate, hydroxychloroquine et corticoides. L’evolution a six mois est favorable mais non satisfaisante. Sept a dix pour cent au minimum des patients necessiteraient une biotherapie. Un suivi optimal mais surtout une strategie therapeutique codifiee reduiraient a coup sur ce taux. Ainsi, un renforcement de la formation des medecins et une integration des affections osteoarticulaires dans un vaste programme d’information et d’education des populations aideraient a mieux prendre en charge les rhumatismes inflammatoires chroniques en Afrique subsaharienne malgre les ressources therapeutiques limitees.

Introduction Les maladies systemiques constituent un groupe heterogene de maladies et syndromes auto-immuns et/ou auto-inflammatoires diffus, interessant habituellement plusieurs appareils [1] . En Afrique noire, ces affections ont fait l’objet de travaux restreints [2] . L’objectif de notre etude etait de determiner les aspects epidemiologiques et la classification des maladies systemiques dans les services de medecine interne a Dakar. Patients et methodes Il s’agissait d’une etude multicentrique retrospective et descriptive portant sur toutes les maladies systemiques durant la periode de janvier 2005 a novembre 2014 dans 5 centres hospitaliers de Dakar. Les maladies systemiques etaient retenues sur la base de leurs criteres de consensus internationaux. Resultats Durant la periode d’etude, 726 patients ont ete inclus dont 632 femmes et 94 hommes (sex-ratio de 0,14). L’âge moyen etait de 43,76 ans. Le delai moyen du diagnostic etait de 3,46 ans. Les antecedents de rhumatisme inflammatoire familial etaient notes dans 10,06 % des cas. Pres d’un tiers de nos patients avaient un suivi anterieur. La polyarthrite rhumatoide etait l’affection predominante, retrouvee chez 568 patients, isolee ou associee a d’autres maladies systemiques. Elle etait suivie par ordre decroissant, dans le sous-groupe des maladies auto-immunes systemiques, du lupus (56 cas), du syndrome de Sjogren (32 cas), de la sclerodermie (26 cas), des myopathies inflammatoires (21 cas), des connectivites indifferenciees (20 cas), du syndrome des antiphospholipides (6 cas) et du syndrome de Sharp (6 cas). Un diagnostic de vascularites systemiques etait retenu chez 19 patients. Elles etaient dominees par les vascularites secondaires aux connectivites et la maladie de Behcet. Les autres affections systemiques etaient representees par la sarcoidose (8 cas), la maladie de Still (3 cas), les amyloses (3 cas), un cas de maladie de Castleman multicentrique et un syndrome systemique associe a une lymphopenie CD4 idiopathique. Les associations de plusieurs maladies auto-immunes etaient notees chez 41 patients. Un syndrome auto-immun multiple a ete retenu chez 7 patients. Conclusion Les maladies systemiques, en medecine interne a Dakar, sont caracterisees par leur diversite, leurs associations frequentes, la nette predominance de la polyarthrite rhumatoide et un important retard diagnostique.

Several studies have suggested that rheumatoid arthritis (RA) is uncommon in rural sub-Saharan Africa. The aim of this study is to determine the potential differences between patients with RA living in rural areas and those living in urban areas. We performed a cross-sectional study from June 2006 to May 2009. We included all patients with RA (1987 ACR criteria) seen at the Rheumatology Unit of the Le Dantec Teaching Hospital, Dakar, Senegal. We compared the main socio-demographic and clinical characteristics of patients living in rural areas to those living in urban areas. We included 180 patients in our study, of whom, 143 (79.4 %) lived in urban areas and 37 (20.6 %) in rural areas. The median age was 44 years [range 34–55] in patients from rural areas vs. 41 years [range 30–53] in patients from urban areas, without any statistical significance (p = 0.24). Patients under the age of 60 mostly lived in urban areas (p = 0.03). The extra-articular manifestations were significantly more frequent in patients living in rural areas (p = 0.02). There was no statistical significance when comparing the delay in diagnosis, number of swollen joints, disease activity, hand deformities, and concentration of autoantibodies (RF and ACPA) in both populations. The percentage of patients seen from the rural areas of Senegal is low (20.6 %) compared to those seen from the urban areas. The number of extra-articular manifestations is the main difference between patients living in rural and urban areas. The role played by environmental factors seems important. Further incidence studies are needed.