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onclusion.– En zone endémique, devant tout tableau d’hépatite,’ascite avec fièvre prolongée, le diagnostic de LV doit être forte-ent suspecté.

ttp://dx.doi.org/10.1016/j.revmed.2012.10.210

A083as rare de maladie de Castleman (HHV8 positif)ompliqué d’hypoglycémies secondaires à desnticorps anti-récepteurs à l’insuline. Fassbender a, V. Queyrel a, N. Tieulie a, L. Galicier b,. Debarle-Caron c, F. Mantoux d, O. Vire e, J.-G. Fuzibet a

Service de médecine interne, hôpital de l’Archet-1, Nice, FranceImmunologie clinique, hôpital Saint-Louis, Paris, FranceInserm UMRS 938, hôpital Saint-Antoine, faculté de médecine, Paris,ranceDermatologie, hôpital de l’Archet, Nice, FranceAnatomie et cytologie pathologique, polyclinique Notre-Dame,raguignan, France

ntroduction.– Castleman’s disease is a rare lymphoproliferativeisease associated with HHV8 infection, which can be revealed byyperplastic lymph nodes and by diverse systemic manifestations

n its multicentric form. Severe hypoglycemia with elevated levelsf insulin has been reported with several autoimmune disordersn the presence of anti-insulin receptors antibodies (type B insulinesistance). However, Castleman’s disease presenting with type Bnsulin resistance has never been reported in the literature so far.atients and methods.– We report the case of a patient, diagnosedith Castleman disease, who presented with severe hypoglycemia,

elapsing severe infections and hematological complications.esults.–A 72-year-old man was admitted in a community hospitalor intermittent fever, severe asthenia, splenomegaly and ingui-al lymphadenopathy. Apart from sarcoidosis at the age of 20, noelevant past medical history was noted. The biological findingsere consistent with tricytopenia and disturbed LDH (805 U/L). The

arried-out lymph node biopsy revealed a non-specific reactionalymphadenopathy. Corticosteroid therapy was started with respecto the past sarcoidosis history and secondary diabetes has occurred.he patient was transferred to our unit because of worsening condi-ions. Physical exam has found a significant hepatosplenomegalynd left axillary lymphadenopathies. CT Scan showed diffuselynfiltrated lymphadenopathies. The osteomedullar biopsy foundo malignant cells but lymphocytic infiltration of about 15–20%.erological exams searching for infectious origins such as HIVr hepatitis were negative. Laboratory exams aiming to find anmmunological cause were also negative. Based upon these data,eoplastic, infectious or autoimmune origins could be ruled out.t PET-Scan, diffuse osteomedullar fixations were evidenced withome hypermetabolic sub-diaphragmatic lymph nodes. Generaltatus worsened with fever, severe hypoglycemia and fluctuantaemophagocytic syndrome. One month later, the patient presen-ed with skin eruptions and the skin biopsy has found a Kaposiarcoma with presence of HHV8. The axillary biopsy was thenepeated and has demonstrated enhanced lymphocytic perifolli-ular population with HHV8 presence that was also confirmed byCR. The diagnosis of Castleman’s disease associated with Kaposiarcoma and macrophagic activating syndrome was reached. Areatment by rituximab and etoposide was undertaken. Several

ycotic and bacterial complications occurred during the course ofhe treatment and along the diagnostic period. The clinical pictureas especially remarkable for many severe episodes of hypogly-

emias and elevated serum insulin levels. The search for an antinsulin receptor antibody was strongly positive and confirmed type

insulin resistance. At 9-month from the diagnosis and 3-month

rom chemotherapy initiation, the patient is still alive and the hypo-lycemia has persistently disappeared.iscussion.– This observation is interesting for many reasons. Theiagnosis of Castleman disease has required a high index of awa-

cembre 2012, Nice / La Revue de médecine interne 33S (2012) A90–A198 A129

reness in an HIV negative patient with lymphadenopathies andcytopenia. It has also taken a very experienced anatomopatho-logist implication to rapidly investigate for HHV8 presence onsampling tissues. The difficulty to reach such a diagnosis highlightsthe importance of multidisciplinary approach to solve complexmedical problems. Management of this patient was hindered bydifferent hematologic and infectious complications that are notcommonly reported with Castleman disease. The type B insulinresistance depicted in this case was only described in autoimmunedisorders and to the best of our knowledge was found associatedfor the first time with Castleman disease. Moreover, this observa-tion provides further insights about the efficacy of Rituximab inautoimmune settings.Conclusion.– Castleman disease may be associated with autoim-mune disorders like type B insulin resistance.

http://dx.doi.org/10.1016/j.revmed.2012.10.211

CA084Tuberculose péritonéale : aspectsépidémiologique, clinique et thérapeutique. Àpropos de 55 casM. Ksiaa , H. Jaziri , A. Ben Slama Trabelsi , A. Souguir , S. AjmiGastro-entérologie, hôpital Sahloul, Sousse, Tunisie

Introduction.– Déterminer les aspects épidémiologiques, cliniqueset thérapeutiques de la tuberculose péritonéale dans le centre tuni-sien.Patients et méthodes.– Il s’agit d’une étude descriptive rétrospectiveincluant 55 patients atteints de tuberculose péritonéale hospitali-sés entre 2002 et 2010.Résultats.– Nos patients étaient repartis en 33 femmes et22 hommes. La moyenne d’âge était de 42 ans (extrêmes de 18 à78 ans). L’origine rurale était notée chez 48 patients. Seulementtrois patients avaient des antécédents personnels de tuberculose. Lemotif de consultation le plus fréquent était la douleur abdominaleretrouvée dans 70 % des cas. Quarante-neuf malades avaient uneascite exsudative avec un taux moyen de protide de 61 g/L. L’intradermo réaction était positive chez sept malades et la recherche deBK dans les crachats était positive dans un cas.Tous nos patients ont subit une exploration de la cavité péritonéalecœlioscopique dans 36 cas et par laparotomie dans 18 cas.L’examen anatomopathologique des biopsies péritonéales avaitpermis de retenir le diagnostic de tuberculose péritonéale dans tousles cas.Tous les patients ont été mis sous traitement antituberculeux pen-dant une moyenne de dix mois avec une bonne tolérance et bonneréponse au traitement avec une durée de suivie allant de six moisà 22 mois.Conclusion.– La tuberculose péritonéale pose toujours un problèmede santé publique. Son diagnostic n’est pas aussi aisé et il néces-site dans la majorité des cas le recours à l’exploration chirurgicalelaparoscopique ou plus fréquemment cœlioscopique.

http://dx.doi.org/10.1016/j.revmed.2012.10.212

CA085Je tique devant ce tremblement et pourtant. . .J. Robert , M. Billot , A. Vauthier , O. Berets , M. AlettiMédecine interne, HIA Percy, Clamart, France

Introduction.– La neuroborréliose (NB) correspond à des manifes-tations neurologiques d’une infection systémique à spirochètes ducomplexe Borrelia burgdorferi. Les formes cliniques variées en fontun diagnostic parfois non évident.

Patients et méthodes.– Un homme de 75 ans, sans antécédent, seplaignait depuis quatre jours de céphalées et d’un tremblementd’attitude et d’action des deux mains rendant presque impossible