{"id":2424,"date":"2023-01-24T13:46:53","date_gmt":"2023-01-24T12:46:53","guid":{"rendered":"https:\/\/angh.net\/abstracts\/un-passager-clandestin\/"},"modified":"2023-01-24T13:46:53","modified_gmt":"2023-01-24T12:46:53","slug":"un-passager-clandestin","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/un-passager-clandestin\/","title":{"rendered":"Un passager clandestin"},"content":{"rendered":"<p><strong>2022<\/strong><\/p>\n<p><em>Zlata CHKOLNAIA , Marion JAGER, Caroline De KERGUENEC<br \/>\nService de gastroent\u00e9rologie H\u00f4pital Delafontaine 93200 Saint Denis<\/em><\/p>\n<p><strong>Gastroent\u00e9rologie <\/strong>&#8211; \u00a02022-05-06 &#8211;\u00a0CC &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Une patiente ivoirienne de 39 ans est hospitalis\u00e9e au CH de Saint Denis pour des naus\u00e9es, des vomissements et une intense douleur abdominale \u00e9pigastrique. Le transit est ralenti, la patiente a perdu 15 kg depuis quelques mois, l\u2019asth\u00e9nie est tr\u00e8s marqu\u00e9e. On note pour seul ant\u00e9c\u00e9dent un VIH trait\u00e9 depuis 6 mois.<br \/>\nA l\u2019examen clinique, l\u2019abdomen est souple, tr\u00e8s sensible dans l\u2019\u00e9pigastre, les bruits hydro a\u00e9riques sont faibles.<br \/>\nAu plan biologique, la NFS est normale, CRP \u00e0 9 mg\/L, hyponatr\u00e9mie \u00e0 130 mmol\/L, hyperkali\u00e9mie \u00e0 5,5 mmol\/l. Albumin\u00e9mie \u00e0 24 g\/L, CD4 \u00e0 134\/mm3, charge virale VIH \u00e0 1,99 log. Le cortisol s\u00e9rique est effondr\u00e9.<br \/>\nLe scanner thoraco-abdomino-pelvien est compatible avec une tuberculose pulmonaire et une possible occlusion intestinale haute sur bride avec un \u00e9paississement r\u00e9gulier de la paroi du c\u00f4lon ascendant. Une c\u0153lioscopie exploratrice est r\u00e9alis\u00e9e et est normale. Les pr\u00e9l\u00e8vements per op\u00e9ratoires, l\u2019ECBU et les h\u00e9mocultures poussent \u00e0 E. coli.<br \/>\nNous suspectons une tuberculose p\u00e9riton\u00e9ale et surr\u00e9nalienne et d\u00e9butons un traitement par hydrocortisone et c\u00e9phalosporines de troisi\u00e8me g\u00e9n\u00e9ration.<br \/>\nTrois jours plus tard, des macules \u00e9ryth\u00e9mateuses serpigineuses de l\u2019abdomen apparaissent, suivies d\u2019une d\u00e9tresse respiratoire aigu\u00eb avec confusion et hyperthermie \u00e0 40\u00b0C.<br \/>\nUne ponction lombaire est r\u00e9alis\u00e9e en r\u00e9animation. Le r\u00e9sultat est en faveur d\u2019une m\u00e9ningite \u00e0 E. coli avec 4000 \u00e9l\u00e9ments dans le LCR.<br \/>\nToutefois, cette \u00e9ruption cutan\u00e9e s\u2019av\u00e8re typique pour les yeux d\u2019une interne avertie d\u2019une pathologie extraordinaire et gravissime.<br \/>\nQuelle est votre hypoth\u00e8se diagnostique?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2022 Zlata CHKOLNAIA , Marion JAGER, Caroline De KERGUENEC Service de gastroent\u00e9rologie H\u00f4pital Delafontaine 93200 Saint Denis Gastroent\u00e9rologie &#8211; \u00a02022-05-06 &#8211;\u00a0CC &#8211; ________________________________ Une patiente ivoirienne de 39 ans est hospitalis\u00e9e au CH de Saint Denis pour des naus\u00e9es, des vomissements et une intense douleur abdominale \u00e9pigastrique. Le transit est ralenti, la patiente a perdu [&hellip;]<\/p>\n","protected":false},"author":1,"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":[4],"tags":[35],"class_list":["post-2424","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-35"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Un passager clandestin - 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\/un-passager-clandestin\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Un passager clandestin - 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