{"id":2016,"date":"2015-10-01T01:00:00","date_gmt":"2015-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/une-meningite-bien-maligne\/"},"modified":"2018-10-20T18:40:15","modified_gmt":"2018-10-20T16:40:15","slug":"une-meningite-bien-maligne","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/une-meningite-bien-maligne\/","title":{"rendered":"Une m\u00e9ningite bien maligne."},"content":{"rendered":"<p><strong>2015<\/strong><\/p>\n<p><em>Sophie Pellegrin, Nathalie Meary, Florence Skinazi, Helene Labadie<br \/>\nService de gastroent\u00e9rologie, H\u00f4pital Delafontaine, 93200 Saint Denis<\/em><\/p>\n<p><strong>Endoscopie <\/strong>&#8211; \u00a02015-02-12 &#8211;\u00a0CC &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Un homme de 76 ans est hospitalis\u00e9 en urgence pour une fi\u00e8vre \u00e0 39\u00b05, un ralentissement psychomoteur et une alt\u00e9ration de l&rsquo;\u00e9tat g\u00e9n\u00e9ral. Il s&rsquo;agit d&rsquo;un patient martiniquais, alternant r\u00e9guli\u00e8rement sa vie entre la m\u00e9tropole et les Antilles. Une maladie de Horton a \u00e9t\u00e9 diagnostiqu\u00e9e quatre mois auparavant n\u00e9cessitant un traitement par Cortancyl 30 mg\/j. Le patient est par ailleurs trait\u00e9 pour une antihypertension art\u00e9rielle par Amlor, Kardegic, Fortzaar, Bisoprolol et Tahor.On note un ant\u00e9c\u00e9dent de d\u00e9parasitage avant le d\u00e9but de la corticoth\u00e9rapie.<br \/>\n A l&rsquo;arriv\u00e9e aux urgences, le Glasgow est \u00e0 14, la TA \u00e0 140\/94. Il n&rsquo;y a pas de signe de localisation neurologique, des douleurs abdominales anciennes avec des selles souvent molles. Une ponction lombaire ram\u00e8ne une liquide eau de roche avec 2217 \u00e9l\u00e9ments, une prot\u00e9inorachie \u00e0 1,74 g\/l, une glycorachie \u00e0 4,55, une formule panach\u00e9e avec 43% de lymphocytes, 46% de neutrophile, un coccigram+ alphah\u00e9molytique au direct. La culture pousse \u00e0 Enteroccus faecium. La recherche d&rsquo;une porte d&rsquo;entr\u00e9e fait pratiquer une gastroscopie qui est normale et une coloscopie qui montre une colite \u00e9rosive aphtoide \u00e9tendue du colon gauche au caecum.Les biopsies du colon retrouvent une colite aigu\u00eb en pouss\u00e9e avec de nombreux polynucl\u00e9aires \u00e9osinophiles, des microfoyers granulomateux constitu\u00e9s de cellules \u00e9pith\u00e9lio\u00efdes et d&rsquo;\u00e9osinophiles sans inclusion virale. Un examen parasitologique des selles retrouve des larves d&rsquo;anguillules nombreuses.La recherche d&rsquo;anguillule dans le LCR est n\u00e9gative. Les biopsies pratiqu\u00e9es au cours de la coloscopie ont \u00e9t\u00e9 compliqu\u00e9es de rectorragies avec d\u00e9globulisation \u00e0 7g et la coloscopie de contr\u00f4le n&rsquo;a pas montr\u00e9 de l\u00e9sion responsable du saignement. Un d\u00e9parasitage par Ivermectine a \u00e9t\u00e9 pratiqu\u00e9. L&rsquo;\u00e9volution clinique a \u00e9t\u00e9 favorable.<br \/>\nLe diagnostic retenu est celui d&rsquo;anguillulose maligne compliquant une corticoth\u00e9rapie, r\u00e9v\u00e9l\u00e9e par une m\u00e9ningite \u00e0 enterococcus faecium.Le contexte clinique, l&rsquo;aspect endoscopique doit faire rechercher une origine parasitaire et le diagnostic diff\u00e9rentiel est \u00e0 faire avec une MICI. Le caract\u00e8re h\u00e9morragique des biopsies est souvent d\u00e9crit au cours des anguilluloses coliques.<br \/>\nDans cette hypoth\u00e8se, il peut \u00eatre important de savoir sensibiliser les anatomopathologistes \u00e0 la recherche des granulomes souvent centr\u00e9s sur les oeufs d&rsquo;anguillule.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2015 Sophie Pellegrin, Nathalie Meary, Florence Skinazi, Helene Labadie Service de gastroent\u00e9rologie, H\u00f4pital Delafontaine, 93200 Saint Denis Endoscopie &#8211; \u00a02015-02-12 &#8211;\u00a0CC &#8211; ________________________________ Un homme de 76 ans est hospitalis\u00e9 en urgence pour une fi\u00e8vre \u00e0 39\u00b05, un ralentissement psychomoteur et une alt\u00e9ration de l&rsquo;\u00e9tat g\u00e9n\u00e9ral. Il s&rsquo;agit d&rsquo;un patient martiniquais, alternant r\u00e9guli\u00e8rement sa vie [&hellip;]<\/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":[6],"tags":[26],"class_list":["post-2016","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-26"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Une m\u00e9ningite bien maligne. - Abstracts des congr\u00e8s de l&#039;ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/une-meningite-bien-maligne\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Une m\u00e9ningite bien maligne. - 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