La Revue de médecine interne
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Letter Case Reports
[Lemierre syndrome due to Porphyromonas spp. in a 21 year-old patient].
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The pathophysiological interest of tumor necrosis factor-alpha (TNF-alpha) has been recently reported in inflammatory and infectious diseases. Thus, TNF-alpha blockade has become a new field of therapeutical research. ⋯ Further studies will define the place of anti-TNF-alpha biological agents among the other available treatments of rheumatoid arthritis and Crohn's disease. Because of their high cost, these drugs will probably be limited to patients with active inflammatory disease despite more conventional treatments.
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Tolosa-Hunt syndrome is characterized by painful ophthalmoplegia due to idiopathic granulomatous inflammation of the cavernous sinus. Steroid therapy dramatically reverses the symptoms and clinical signs. Because they also may respond to steroids, tumors such as lymphoma and meningioma and orbital tumors can make differential diagnosis difficult. ⋯ When faced with a clinical picture suggestive of the existence of Tolosa-Hunt syndrome clinical workup is mandatory and should lead to diagnosis of exclusion.
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Spontaneous dissection of cervical and visceral arteries are rare and usually associated with an underlying arterial disease. ⋯ The respective roles of arterial dysplasia, chronic ergotism, renovascular hypertension and migraine are discussed.
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Thyreotoxic hypokalemic periodic paralysis (THPP) has mainly been described in Asian people. It is rare in Caucasians, and only 12 cases were reported in Blacks. ⋯ Whatever the patient's race, acute paralysis with hypokalemia requires testing for hyperthyroidism, even in the absence of suggestive clinical signs.