Revue medicale de Liege最新文献

Cat scratch disease is a bacterial infection due to Bartonella henselae. The microbial agent is most frequently transmitted to humans through a scratch or bite of an infected cat. Ocular involvement occurs in approximately 6% of human infections. We report the case of a healthy 27-year old patient presenting with unilateral scotoma. Multimodal imaging revealed an isolated cotton wool spot (CWS) with no other inflammatory signs on ophthalmological examination. Medical history was unremarkable, although the patient reported living with a cat. Biological and cardiovascular evaluations were normal, except for evidence of recent Bartonella henselae infection. Follow up showed significant resolution of the CWS under antibiotic treatment along with a reduction of the subjective scotoma. Cat scratch disease may cause different ocular manifestations such as uveitis, choroiditis, neuroretinitis, Parinaud oculoglandular syndrome, exudative maculopathy or retinal vascular occlusions. Based on our literature review, an isolated CWS as the sole sign of cat scratch disease is a very rare presentation. Eye care professionals should be aware of this atypical presentation in order to investigate and treat properly those patients.

Mycoplasma pneumoniae is a common respiratory infection, principally in children and young adults. Approximately 25 % of the cases present extrapulmonary signs such as skin and mucous rashes. In 2015, MIRM (Mycoplasma pneumoniae-Induced Rash and Mucositis) was individualized as a new entity. The clinical case of a 20-year old man is presented with atypical pneumonia and majormucositis.

Thyroid storm is a rare but severe complication of thyrotoxicosis, posing a life-threatening risk to patients. The causes are numerous, ranging from Graves' disease and toxic goiter to amiodarone use or even following trauma. In the event of a thyroid storm, clinical manifestations may be multiple. Cardiovascular complications are the most critical and may lead to cardio-respiratory arrest. This clinical entity is difficult to diagnose, often resulting in delayed management. In addition to symptomatic management, treatment primarily includes antithyroid drugs and beta-blockers as well in case of thyroid storm glucocorticoids to block the conversion of T4 to T3. Thyroid surgery or radioactive iodine therapy are also part of the therapeutic armamentarium. Hemodynamic support via extracorporeal membrane oxygenation (ECMO) may be considered in cases of collapse. Given the severity of thyroid storm, it is essential to consider this diagnosis in any patient presenting with symptoms compatible with hyperthyroidism.

The cyclodialysis cleft is a rare complication (2 %) in the spectrum of blunt trauma presenting ocular hypotony. This is a separation between the ciliary body and the sclera. This results in the formation of a new space between the anterior chamber and a suprachoroidal space, often inducing major ocular hypotony. Treatment requires medical treatment or even surgical treatment for severe cases. A certain degree of recession of the iridocorneal angle could persist after closure of the cleft of cyclodialysis, causing at short- or at long-term ocular hypertonia.

Metronidazole, an antiparasitic treatment with bactericidal activity, may be neurotoxic. The exact pathophysiology of this complication is unknown. While it is related to the cumulative dose, it does vary from patient to patient. We are describing the case of a 43-year-old woman, who was admitted into the hospital for treatment of a liver abscess and an ascitic fluid infection. This patient presented with cerebellar syndrome and motor slowing 29 days after starting metronidazole. Cerebral MRI showed a FLAIR hypersignal of the dentate nuclei without associated enhancement or diffusion restriction. This is typical of metronidazole toxic encephalopathy. Treatment had to be stopped. The patient's clinical course rapidly improved. A follow-up MRI scan after 10 days showed the complete resolution of dentate nuclei lesions.

We report the case of a 15-year old boy admitted for febrile episodes lasting over 4 months without any other clinical signs. On the basis of a positive blood culture, chronic Neisseria meningitidis bacteremia, without associated meningitis, was highly suspected. Further work-up revealed no immunosuppression or terminal complement deficiency. A 7-day intravenous treatment of ceftriaxone resulted in complete recovery. This case highlights chronic Neisseria meningitidis as a rarely encountered pathology and describes an atypical presentation, compared with descriptions in the literature.

We report the case of a young man presenting with dysphagia and frequent food impactions, which led to the diagnosis of eosinophilic esophagitis based on endoscopic examination and confirmed anatomopathologically. Despite a triple therapy regimen including a high-dose proton pump inhibitor, an elimination of allergenic foods based on prick tests, and oral budesonide, there was no significant and sustained clinical or endoscopic improvement. In this context, through a compassionate use program, we initiated biotherapy with dupilumab, a monoclonal antibody targeting interleukin 4 and interleukin 13 receptors, which was recently approved for the treatment of refractory eosinophilic esophagitis by the European Medicines Agency. We report our experience over 6 months with this innovative treatment, which has been reimbursed in Belgium under certain conditions since November 1st, 2024.

Extracranial carotid artery aneurysms are extremely rare, representing less than 1 % of all peripheral arterial aneurysms. The main symptom is a pulsatile mass. Other symptoms are derived from compression of adjacent structures, cerebral events or rupture. Treatment can be surgical, endovascular or conservative. We report a clinical case of a 66-year-old woman who was diagnosed an extracranial left internal carotid artery aneurysm measuring 4 cm in the context of a pulsatile cervical mass. Treatment consisted of a total occlusion by the embolization of the left internal carotid after performing a balloon test occlusion. Outcome was favourable without stroke at 2 year.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare CD-30+/ALK- T-cell lymphoma. The combination of a textured breast implant, bacterial contamination and genetic predisposition appears to be necessary for the development of BIA-ALCL. The National Comprehensive Cancer Network (NCCN) has established guidelines for both diagnosis and treatment. Early detection of the disease is essential to ensure a cure. At an early stage and for the vast majority of patients, treatment consists of implant removal with associated total capsulectomy. We share our experience with the presentation of a case of BIA-ALCL discovered following the appearance of a periprosthetic seroma, 19 years after the fitting of breast implants.

Intestinal intussusception in adults is less common than in paediatric patients, and may be difficult to diagnose due to non-specific symptoms. Abdominal pain is the main clinical sign, but other symptoms such as nausea or transit disorders may also be present. Abdominal computerized tomography is the key investigation for the diagnosis, with sensitivity approaching 100 %. In 90 % of cases of intussusception in adults, a mass is at the origin of the intussusception. The causes may be benign (lipomas, Meckel's diverticulum) or malignant (metastases, digestive tumours). Management is surgical, with resection of the affected segment and the underlying lesion, due to the risk of serious complications such as perforation or tumour dissemination if a reduction is attempted.