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Hematologic involvement is a common manifestation during systemic lupus erythematosus (SLE). Pancytopenia represents an infrequent mode of revelation, most often of peripheral origin, exceptionally secondary to a bone marrow disorder and particularly to an autoimmune myelofibrosis (AIMF). This entity, distinct from a primary myelofibrosis (MFP), is characterized by reticulin fibrosis of the bone marrow lack of atypical bone marrow cells, the presence of auto-antibodies and absence of classical signs of myeloproliferation. Generally the AIMF associated to the SLE had a favorable evolution and appears to often respond to corticosteroids and/or immunosuppressive treatments. This case illustrates the original association of an SLE revealed by a pancytopenic MFAI in a male patient with a dramatic improvement under corticosteroids.

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Anemia is a major public health problem worldwide despite remarkable improvement in living conditions. The World Health Organization (WHO) classifies it as one of the ten most serious problems in the world. This study aims to describe the epidemiologic and etiologic profiles of the cases of anemia treated during our training. We conducted a retrospective study involving 150 patients carried out over 5 years, from January 2011 to December 2015. The average age of our patients was 48.8 years and women were more likely to be affected than men, with a sex ratio of 1.78. The mean hemoglobin was 8 g/dl, ranging from 3.4 to 11.4 g/dl. Iron deficiency anemia was the leading etiologic diagnosis made in 60% of cases, followed by megaloblastic anemia in 21% of patients and haemolytic anemia in 7.33% of cases. The occurrence of anemia in adults may represent a real diagnostic challenge for the internist as it is sometimes associated with an emergency context. Specialized examinations may be necessary.

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Acquired amegakaryocytic thrombocytopenic purpura is a very rare condition characterized by severe thrombocytopenia linked to the reduction or disappearance of megakaryocytes in the bone marrow. It may be primary idiopathic or secondary to many pathological conditions including hematologic disorders. We report the case of a 24-year-old patient admitted for haemorrhagic syndrome caused by immunological thrombocytopenic purpura. The diagnosis was acquired amegakaryocytosis after the failure of corticotherapy and the performance of myelography. The patient was treated with ciclosporin with rapid progression to acute myeloblastic leukemia. The progression of acquired amegakaryocytosis to acute leukemia is reported but it is generally not so rapid and above all it is preceded by myelodysplastic syndrome or medullary aplasia. This study highlights the importance of a close follow-up of these pathologies with a benign-like appearance.

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Primarye systemic AL amyloidosis is a rare hematologic disorder. The majority of the therapeutic guidelines are based on phase II studies or on retrospective comparisons and case series. Our study aimed to describe all the cases of primary AL amyloidosis reported in 2 military hospitals and to make a comparison between standard melphalan-dexamethasone protocol and new agents in first-line treatment of patients with this disease. We conducted a retrospective, descriptive and multicentric study of all patients with AL amyloidosis whose data were collected during the period July 2009-June 2016. Twenty five patients were enrolled in the study (12 patients treated with melphalan-dexamethasone and 13 with bortezomib-based protocol or lenalidomide-based protocol). There was no significant difference in the epidemiological, clinical and prognostic features between the 2 groups. After a median follow up of 40 months, median overall survival was 54 months in the melphalan-dexamethasone-treated group and 60 months in the new therapies-treated group (P = 0.98). Progression-free survival was 18 months in the standard treatment group vs 11 months in the 2nd group (p = 0.08). In our small case series we haven't found a superiority of the new therapies compared to the standard protocol. This result should be confirmed by a true prospective study, mainly because of the cost of these new molecules that are not always accessible, especially in developing countries.

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L'anémie constitue un problème majeur de la santé publique à travers le monde malgré l'amélioration remarquable des conditions de vie. Elle est classée par l'OMS comme l'un des dix problèmes les plus sérieux du monde. Notre objectif est de décrire les profils épidémiologique et étiologique des cas d'anémies prises en charge dans notre formation. Il s'agit d'une étude rétrospective menée durant 5 ans, allant de Janvier 2011 à décembre 2015 et portant sur 150 patients. L'âge moyen de nos patients est de 48,8ans et les femmes sont les plus touchées avec un sex-ratio de 1,78. Le taux moyen de l'hémoglobine est de 8 g/dl avec des extrêmes allant de 3,4 à 11,4 g/dl. L'anémie ferriprive est le diagnostic étiologique dominant étant retrouvée dans 60% des cas, suivie par l'anémie mégaloblastique observée chez 21% des patients puis les anémies hémolytiques dans 7,33% des cas. La survenue d'une anémie chez l'adulte peut représenter un véritable défit diagnostique pour l'interniste et cela parfois dans un contexte d'urgence. Le recours à des examens spécialisés peut s'imposer

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Lower back pain is due to multiple etiologies that make diagnosis difficult. Primitive spinal lymphoma is rare and its diagnosis often requires ultrasound-guided biopsy. A 30-year old man hospitalized for inflammatory lumbago evolving within the context of an impaired general condition. Phisical examination revealed pain on palpation of the L2-L3 vertebral apophysis without peripheral tumor syndrome. Laboratory tests showed an inflammatory syndrome. Morphological assessment was in favour of a spondylodiscitis. The first biopsy showed granulomatous osteitis.Clinical and radiological worsening during antibacillary treatment led to reconsider the original diagnosis and a second biopsy confirmed the diagnosis of lymphoma. The diagnosis of skeletal tuberculosis in particular spinal tuberculosis requires bacteriological or histological confirmation in order not to overlook a primitive bone lymphoma.

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Anti TNF alpha treatments are wide spectrum therapies. Multiple side effects have been reported in recent years, particularly peripheral neuropathies. We report a case of axonal neuropathy occurring three months after starting treatment with Infliximab. Our study focused on a 60-year old female patient treated for therapy-resistant hemorrhagic rectocolitis, requiring treatment with infliximab. Three months later, the patient had sensory axonal neuropathy. Etiologic assessment remained negative and dose reduction was accompanied by an improvement in symptoms. The time between initiation of treatment with Infliximab and the onset of clinical manifestations as well as improvement after dose reduction advocate the responsibility of infliximab in the occurrence of sensory neuropathy. Its management is not standardized and should be discussed case by case.

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