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P156 Sleep disorders as a new sign of Horton disease?
S76
Abstracts
/ European
Journal
of Internal
patients were before the treatment and c-ANCA were found in their sera. sFas was determined with EIA. A decrease in sFas level was found in the patients as compared to the controls, 839-C430 and 3582?548 pg/ml, respectively. There was no correlation with c-ANCA level. It is suggested that impaired apoptosis is associated with Wegener granulomatosis and may contribute to the pathogenesis of the disease, although the results should be confirmed on larger group of the patients.
P154 Kikuchi-Fujimoto’s disease lupus: a clinical case E. Ferrao, M. Grade, L. Arez,
associated R. Tome
to
a sistemic
(Portimao,
14 (2003)
Sl-S159
(?34.79), ‘physical mobility’ (43.43225.17) and ‘sleep disorders’ (40.49234.83). The lowest attack concerned the ‘social loneliness’ dimension of NHP (18.68?26.50). Significant correlation was found amoung NHP global value with respect to muscular testing (p=O.Ol) and functioanl scale (p=O.O4). Conclusion: Very few studies has evaluated QoL concerning IBM wihch is a particular inflammatory myopathy respect to histological data, clinical presentation and evolution with or without treatment. The use of QoL questionnaire could be helpful in optimizing therapeutic management in IBM patients because it take account of global symptoms.
eritematosus
P)
Kikuchi-Fujimoto’s disease (KFD) is an uncommon clinical and pathological autolimited feature of benign prognosis that may mimic many other diseases. In the evolution of KFD autoimmune diseases like the Sistemic Eritematosus Lupus (SEL) may coexist and may precede, concur or have its onset after the diagnosis of the KFD. We present clinical case of a 39-year-old female without relevant antecedents who developed during pregnancy poliartritis (cuffs. knees, ankles, and proximal interphalangeals junctures) with spontaneous remission. Three months after the delivery, the patient was admitted for the study of a febrile syndrome of three weeks duration associated to odinophagia, neck and axilar adenopathies and cutaneous rash, that did not respond to antibiotic therapy. Clinical examination, besides the alterations described above, the patient also had high grade fever, face edema and parotideal bilateral hypertrophy. Laboratory study revealed pancitopenia (Hb 8.5 gr/dl; MGV 90.6 pfl, granulocytes 3400 u/l, platelets 100000 U/l); FDP 4773 mg/ml; ESR 80 mm in the first hour; CRP 200.9 mgll; GOT 103 U/l; AP 321 U/l;LDH 1857 U/l; preserved renal function: normal urinary sediment; abdominal ecography revealed hepatomegaly with homogeneous structure; celiac adenomegalies: bucal-cervical-torax-abdomen-pelvie CAT scan with supraclavicular. axilar, jugulocarotideal, helium and lumboaortic adenopathies with bilateral pleural effusion, ascitis and homogeneous hepatomegaly. The examination of bone marrow: ‘marked histiocitosis with fagocited material’ and histological study of cervical adenopathy: ‘necrosant histiocytic linfadenitis compatible with KFD’. Autoimmune study: complement compsuntion, ANA, Ab anti DNA, Ab anti SSA (Ro) and Anticardiolipine positive. Corticotherapy with prednisolone 1 mg/Kg/day and AAS 100 mg/day was initially given, with clinical and analytical improvement. Presently, after 20 months, the patient is asymptomatic, without signs of disease and with total normalization of the radiological examination, maintainning treatment with low dose steroids.
P155 Quality of life in sporadic inclusion body myositis A. Teixeira, S. Pelletier, C. Chantalat-Auger, D. Roux, Herson, P. Cherin (Paris, F)
Medicine
.I. Remy,
S.
Background: Sporadic Inclusion Body Myositis (IBM) has been recently recognized as the most common acquired inflammatory muscle disease occuring above the age of 50 years. IBM is generally refractory to standard immunosuppressant therapies with progressive great functionnal disability and possible important morbifdity or mortality. This could influence patients’ health status and their quality of life (QoL). Methods: We conduced the present study to assess the QoL in IBM hospitalized patients, through the use of Nottingham Health Profile (NHP) which is a generic scale of QoL taking account six demensions (physical mobility, emotional reactions, pain, sleep disorder, energyand social loneliness) and tested the correlation with muscular testing, and a functional scale. Results: Biggest attack was on ‘energ’ with 59.91 as mean value
P156 Sleep disorders as a new sign of Horton A. Teixeira, C. Chantalat-Auger. .I. Rtmy, (Paris,
disease? D. Roux, P. Cherin,
S. Herson
F)
We present the case of a man suffering from Alzheimer disease since three years who presented a sudden change in the quality of his sleep in who a diagnosis of Horton disease could be made. Case: A 90 years old man living at home with his wife, suffering from an Azheimer disease since three years treated with Donepezil 5 mg per day, was addressed to our internal medicine unit for a sudden change in his quality of sleep three weeks ago, associated with weight loss (3 kg). A treatment with anti depressive drug (Citalopram: twice a day) had been started by his home doctor with no change. Clinical evaluation at the admission revealed no abnormality, no history of headache or scalp pain, vision loss, tongue or jaw pain, polymyalgia. We just fouond an anorexia with no dysphasia, with could explain the weight loss, and the change in his sleep. He just couldn’t sleep during the night and wanted to sleep during the day and couldn’t explain this sudden change. Because of the presence of unexplained blood inflammation (C reactvie protein: 110 mg/l, normal 55 mg/l), we performed a temporal artery biopsy which revealed a characteristic Giant Cell Arteritis (GCA). A oral therapy was initiated with 0.7 mg/kg/day Prednisone with a spectacular change; clinical (disappearance of sleep disorder and anorexia in two days) and biological (disappearance of inflammation in one week). In our case report, the only sign which could lead to the diagnosis of GCA was the blood inflammation, probably the history of Alzheimer could change the value of the cross-evaluation especially by memory impairment. Conclusiont GCA is the most common of the vasculitis affecting the elderly population. Prevalence of Alzheimer is correlated to age and can change clinical presentation with a highest prevalence of atypical clinical presentation, Temporal artery biopsy is essential in confirming andf proposing a specific therapy to prevent possible ischemic complications.
P157 Pulmonary artery thrombosis and polymyalgia rheumatica M. Melero-Bascones, Y. Santiesteban-Lopez, I. Terrancle, J.A. SaezBarcelona, I. Hermida-Lazcano, L. Saez-Mendez, J.J. Solera-Santos (Albacete, E) Giant cell arteritis (GCA) is a systemic vasculitis affecting medium and large-sized arteries. GCA is often referred to in the context of polymyalgia rheumatica (PR) with temporal artery involvement. Pulmonary manifestations vary from 8-36% and include cough, interstitial infiltrates and pleural effusion. Pulmonary artery involvement is extremely rare. We present a case of pulmonary artery thrombosis in a patient recently diagnosed of polymyalgia rheumatica. Case report: A 79-year-old woman underwent medical examination because of dyspnea. One and a half months earlier she initiated steroid treatment for polymyalgia rheumatica with excellent response. On physical examination she was tachycardic, tachypneic and with acral cyanosis, cardiac and pulmonary sounds were normal and she had no
Abstracts
/ European
Journal
of Internal
patients were before the treatment and c-ANCA were found in their sera. sFas was determined with EIA. A decrease in sFas level was found in the patients as compared to the controls, 839-C430 and 3582?548 pg/ml, respectively. There was no correlation with c-ANCA level. It is suggested that impaired apoptosis is associated with Wegener granulomatosis and may contribute to the pathogenesis of the disease, although the results should be confirmed on larger group of the patients.
P154 Kikuchi-Fujimoto’s disease lupus: a clinical case E. Ferrao, M. Grade, L. Arez,
associated R. Tome
to
a sistemic
(Portimao,
14 (2003)
Sl-S159
(?34.79), ‘physical mobility’ (43.43225.17) and ‘sleep disorders’ (40.49234.83). The lowest attack concerned the ‘social loneliness’ dimension of NHP (18.68?26.50). Significant correlation was found amoung NHP global value with respect to muscular testing (p=O.Ol) and functioanl scale (p=O.O4). Conclusion: Very few studies has evaluated QoL concerning IBM wihch is a particular inflammatory myopathy respect to histological data, clinical presentation and evolution with or without treatment. The use of QoL questionnaire could be helpful in optimizing therapeutic management in IBM patients because it take account of global symptoms.
eritematosus
P)
Kikuchi-Fujimoto’s disease (KFD) is an uncommon clinical and pathological autolimited feature of benign prognosis that may mimic many other diseases. In the evolution of KFD autoimmune diseases like the Sistemic Eritematosus Lupus (SEL) may coexist and may precede, concur or have its onset after the diagnosis of the KFD. We present clinical case of a 39-year-old female without relevant antecedents who developed during pregnancy poliartritis (cuffs. knees, ankles, and proximal interphalangeals junctures) with spontaneous remission. Three months after the delivery, the patient was admitted for the study of a febrile syndrome of three weeks duration associated to odinophagia, neck and axilar adenopathies and cutaneous rash, that did not respond to antibiotic therapy. Clinical examination, besides the alterations described above, the patient also had high grade fever, face edema and parotideal bilateral hypertrophy. Laboratory study revealed pancitopenia (Hb 8.5 gr/dl; MGV 90.6 pfl, granulocytes 3400 u/l, platelets 100000 U/l); FDP 4773 mg/ml; ESR 80 mm in the first hour; CRP 200.9 mgll; GOT 103 U/l; AP 321 U/l;LDH 1857 U/l; preserved renal function: normal urinary sediment; abdominal ecography revealed hepatomegaly with homogeneous structure; celiac adenomegalies: bucal-cervical-torax-abdomen-pelvie CAT scan with supraclavicular. axilar, jugulocarotideal, helium and lumboaortic adenopathies with bilateral pleural effusion, ascitis and homogeneous hepatomegaly. The examination of bone marrow: ‘marked histiocitosis with fagocited material’ and histological study of cervical adenopathy: ‘necrosant histiocytic linfadenitis compatible with KFD’. Autoimmune study: complement compsuntion, ANA, Ab anti DNA, Ab anti SSA (Ro) and Anticardiolipine positive. Corticotherapy with prednisolone 1 mg/Kg/day and AAS 100 mg/day was initially given, with clinical and analytical improvement. Presently, after 20 months, the patient is asymptomatic, without signs of disease and with total normalization of the radiological examination, maintainning treatment with low dose steroids.
P155 Quality of life in sporadic inclusion body myositis A. Teixeira, S. Pelletier, C. Chantalat-Auger, D. Roux, Herson, P. Cherin (Paris, F)
Medicine
.I. Remy,
S.
Background: Sporadic Inclusion Body Myositis (IBM) has been recently recognized as the most common acquired inflammatory muscle disease occuring above the age of 50 years. IBM is generally refractory to standard immunosuppressant therapies with progressive great functionnal disability and possible important morbifdity or mortality. This could influence patients’ health status and their quality of life (QoL). Methods: We conduced the present study to assess the QoL in IBM hospitalized patients, through the use of Nottingham Health Profile (NHP) which is a generic scale of QoL taking account six demensions (physical mobility, emotional reactions, pain, sleep disorder, energyand social loneliness) and tested the correlation with muscular testing, and a functional scale. Results: Biggest attack was on ‘energ’ with 59.91 as mean value
P156 Sleep disorders as a new sign of Horton A. Teixeira, C. Chantalat-Auger. .I. Rtmy, (Paris,
disease? D. Roux, P. Cherin,
S. Herson
F)
We present the case of a man suffering from Alzheimer disease since three years who presented a sudden change in the quality of his sleep in who a diagnosis of Horton disease could be made. Case: A 90 years old man living at home with his wife, suffering from an Azheimer disease since three years treated with Donepezil 5 mg per day, was addressed to our internal medicine unit for a sudden change in his quality of sleep three weeks ago, associated with weight loss (3 kg). A treatment with anti depressive drug (Citalopram: twice a day) had been started by his home doctor with no change. Clinical evaluation at the admission revealed no abnormality, no history of headache or scalp pain, vision loss, tongue or jaw pain, polymyalgia. We just fouond an anorexia with no dysphasia, with could explain the weight loss, and the change in his sleep. He just couldn’t sleep during the night and wanted to sleep during the day and couldn’t explain this sudden change. Because of the presence of unexplained blood inflammation (C reactvie protein: 110 mg/l, normal 55 mg/l), we performed a temporal artery biopsy which revealed a characteristic Giant Cell Arteritis (GCA). A oral therapy was initiated with 0.7 mg/kg/day Prednisone with a spectacular change; clinical (disappearance of sleep disorder and anorexia in two days) and biological (disappearance of inflammation in one week). In our case report, the only sign which could lead to the diagnosis of GCA was the blood inflammation, probably the history of Alzheimer could change the value of the cross-evaluation especially by memory impairment. Conclusiont GCA is the most common of the vasculitis affecting the elderly population. Prevalence of Alzheimer is correlated to age and can change clinical presentation with a highest prevalence of atypical clinical presentation, Temporal artery biopsy is essential in confirming andf proposing a specific therapy to prevent possible ischemic complications.
P157 Pulmonary artery thrombosis and polymyalgia rheumatica M. Melero-Bascones, Y. Santiesteban-Lopez, I. Terrancle, J.A. SaezBarcelona, I. Hermida-Lazcano, L. Saez-Mendez, J.J. Solera-Santos (Albacete, E) Giant cell arteritis (GCA) is a systemic vasculitis affecting medium and large-sized arteries. GCA is often referred to in the context of polymyalgia rheumatica (PR) with temporal artery involvement. Pulmonary manifestations vary from 8-36% and include cough, interstitial infiltrates and pleural effusion. Pulmonary artery involvement is extremely rare. We present a case of pulmonary artery thrombosis in a patient recently diagnosed of polymyalgia rheumatica. Case report: A 79-year-old woman underwent medical examination because of dyspnea. One and a half months earlier she initiated steroid treatment for polymyalgia rheumatica with excellent response. On physical examination she was tachycardic, tachypneic and with acral cyanosis, cardiac and pulmonary sounds were normal and she had no