{"id":1848,"date":"2008-10-01T01:00:00","date_gmt":"2008-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/des-metastases-hepatiques-au-gout-de-caseum\/"},"modified":"2018-10-20T18:39:48","modified_gmt":"2018-10-20T16:39:48","slug":"des-metastases-hepatiques-au-gout-de-caseum","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/des-metastases-hepatiques-au-gout-de-caseum\/","title":{"rendered":"\u00ab\u00a0DES METASTASES HEPATIQUES AU GOUT DE CASEUM\u00a0\u00bb"},"content":{"rendered":"

2008<\/strong><\/p>\n

Grasset D,Vernet C,Bicheler V,Bouret JF,Niculescu C,Saout L,Gavard J,Pouedras P,TrahnDinh V,Belkadi M,
\nServices de gastroent\u00e9rologie,chirurgie visc\u00e9rale,anatomopathologie,microbiologie et radiologie.Centre Hospitalier Bretagne Atlantique ,20 BD Gal M Guillaudot ,56017 Vannes<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02008-06-15 –\u00a0 –<\/p>\n

________________________________<\/p>\n

Andr\u00e9 G ,n\u00e9 en 1960 , est hospitalis\u00e9 pour douleurs persistantes et f\u00e9briles de l’hypochondre droit avec sueurs importantes sans frissons.Ant\u00e9c\u00e9dents:h\u00e9morro\u00eedectomie en 2001, colopathie fonctionnelle (coloscopies normales sauf petits polypes hyperplasiques en 2000 et 2006).Son p\u00e8re est d\u00e9c\u00e9d\u00e9 d’un cancer ORL m\u00e9tastatique \u00e0 42 ans.Il ne prend aucun m\u00e9dicament ,il travaille comme livreur de fen\u00eatres et n’a pas fait de voyages hors de la Bretagne .Il s’\u00e9tait bless\u00e9 l’index du doigt en jardinant un mois auparavant et avait re\u00e7u un traitement de 8 jours d’oxacilline ,avec une \u00e9volution tr\u00e8s rapidement favorable.L’examen clinique ne retrouve qu’une discr\u00e8te h\u00e9patom\u00e9galie sensible.
\n Biologie:11000GB(8000PN,200Eosino,2100Lympho),Hb:11.9g\/dl,VGM:88fl,Plaquettes:356000,VS:61\/,
\nCRP:128ng\/lFibrinog\u00e8ne:6.3g\/l,Albumine:40g\/l,AlphaGb:4.2g\/l,GammaGb:14.5g\/l,TP:80%,GGT:2N,
\nPAlc:N,AST:1.8N,ALT1.3N,Bili:N,TSH:N,LDH:N,AFP:N,ACE:N,CA19.9:N,Cr\u00e9atinin\u00e9mie:N,Ionogramme:N.
\n Echographie abdominale et TDM thoraco-abdominale:foie multinodulaire avec l\u00e9sions arrondies de 1 \u00e0 3 cm de diam\u00e8tre dans les 2 lobes rep\u00e9r\u00e9es surtout \u00e0 la phase art\u00e9rielle ,sans zones liquidiennes. L’aspect \u00e9voque un foie m\u00e9tastatique , sans primitif d\u00e9celable ni autre anomalie par ailleurs. FOGD:N. Echocardiographie:N.
\n Bilan infectieux n\u00e9gatif:H\u00e9mocultures et mycobact\u00e9rioculture st\u00e9riles,bandelette urinaire n\u00e9gative , BK crachats n\u00e9gatifs,IDR \u00e0 la tuberculine:5mm,IFN gamma (quantif\u00e9ron)n\u00e9gatif,s\u00e9rologies VIH,CMV , amibiase,fi\u00e8vreQ,rickettsiose,yersiniose,chlamydia,leptospirose n\u00e9gatives.Enzyme de conversion:N
\n Andr\u00e9 G est trait\u00e9 ,dans l’hypoth\u00e8se de microabc\u00e8s bact\u00e9riens ,par l’association de Ceftriaxone et Ciprofloxacine pendant 20 jours puis par Ciprofloxacine seule pendant 10 jours suppl\u00e9mentaires . L’\u00e9volution est lentement favorable en 1 mois ,et le bilan biologique se normalise.Par contre les images h\u00e9patiques restent identiques et toujours \u00e9vocatrices de m\u00e9tastases conduisant \u00e0 une biopsie dirig\u00e9e sous scanner :foie sain avec multiples granulomes gigantocellulaires et n\u00e9crose cas\u00e9euse ;la coloration de Ziehl est n\u00e9gative.<\/p>\n

Le diagnostic \u00e9tabli permet une mise au point sur les GRANULOMATOSES HEPATIQUES isol\u00e9es chez l’immunocomp\u00e9tent ,en particulier dans sa forme microabc\u00e9d\u00e9e.<\/p>\n","protected":false},"excerpt":{"rendered":"

2008 Grasset D,Vernet C,Bicheler V,Bouret JF,Niculescu C,Saout L,Gavard J,Pouedras P,TrahnDinh V,Belkadi M, Services de gastroent\u00e9rologie,chirurgie visc\u00e9rale,anatomopathologie,microbiologie et radiologie.Centre Hospitalier Bretagne Atlantique ,20 BD Gal M Guillaudot ,56017 Vannes H\u00e9patologie – \u00a02008-06-15 –\u00a0 – ________________________________ Andr\u00e9 G ,n\u00e9 en 1960 , est hospitalis\u00e9 pour douleurs persistantes et f\u00e9briles de l’hypochondre droit avec sueurs importantes sans frissons.Ant\u00e9c\u00e9dents:h\u00e9morro\u00eedectomie […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[19],"class_list":["post-1848","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-19"],"yoast_head":"\n"DES METASTASES HEPATIQUES AU GOUT DE CASEUM" - 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