Crowned dens syndrome is due to a microcrystalline infringement (hydroxyapatite or calcium pyrophosphate) of the retro-odontoidal ligament of atlas, often leading to the erroneous diagnosis of meningitis or spondylitis. We report on three new cases diagnosed from 1996 to 1999.The patients complained of cervicalgies, headaches or fever. The initially evoked diagnoses were meningitis, spondylodiscitis or endocarditis. Clinical exam found meningism and an inflammatory syndrome in all patients. Analysis of the cerebro-spinal fluid realised in two cases was normal. The diagnosis of crowned dens syndrome was assessed in two cases by cervical CT scan of C1/C2. In the third case, chondrocalcinosis of a wrist allowed this diagnosis. We report a probably non fortuitous case of crowned dens syndrome associated with genetic hemochromatosis. A non steroidal anti-inflammatory treatment allowed a dramatic regression of clinical symptoms.This entity should be better known; it can mimick numerous diagnosis and be responsible for fever in the long course.

Introduction. - Crowned dens syndrome is due to a microcrystalline infringement (hydroxyapatite or calcium pyrophosphate) of the retro-odontoidal ligament of atlas, often leading to the erroneous diagnosis of meningitis or spondylitis. We report on three new cases diagnosed from 1996 to 1999.Exegesis. - The patients complained of cervicalgies, headaches or fever. The initially evoked diagnoses were meningitis, spondylodiscitis or endocarditis. Clinical exam found meningism and an inflammatory syndrome in all patients. Analysis of the cerebro-spinal fluid realised in two cases was normal. The diagnosis of crowned dens syndrome was assessed in two cases by cervical CT scan of C1/C2. In the third case, chondrocalcinosis of a wrist allowed this diagnosis. We report a probably non fortuitous case of crowned dens syndrome associated with genetic hemochromatosis. A non steroidal anti-inflammatory treatment allowed a dramatic regression of clinical symptoms.Conclusion. - This entity should be better known; it can mimick numerous diagnosis and be responsible for fever in the long course. (C) 2003 Editions scientifiques et medicales Elsevier SAS. All rights reserved.

We retrospectively studied the epidemiological, clinical, histological and evolutive aspects of vertebral tuberculosis diagnosed in all consecutive patients recruited in 2 Parisian hospitals between January 1990 and July 1997, The diagnosis relied on a vertebral involvement associated with evidence of tuberculosis (culture of local ponction yielded Mycobacterium tuberculosis) or presumption of tuberculosis (evidence of other tuberculous focus, histological data, good outcome under specific treatment), Sixteen patients (mean age: 41 years; sex ratio: 1,29) have been included; thirteen were migrants. The main symptoms, which appeared within a mean period of 3 months were vertebral pain (13/16) and alteration of patient's general conditions(8/16). RMN imaging showed spondylitis (10/16), spondylodiscitis (4/16) and involvement of posterior arch (8/16), Inflammatory syndrom was present in 14 cases. The diagnosis of vertebral tuberculosis was confirmed in 12 cases according to the results of culture and/or histological grounds of local ponction, The diagnosis of vertebral tuberculosis was presumed in the 4 other cases according to the isolation of M. tuberculosis from an other site (2 cases), the characteristic histological pattern of a lymphadenopathy (1 case), and a favorable outcome upon specific treatment (1 case). All the patients were cured without complications with the exception of one patient who developed a spinal cord compression.

We retrospectively studied the epidemiological, clinical, histological and evolutive aspects of vertebral tuberculosis diagnosed in all consecutive patients recruited in 2 Parisian hospitals between January 1990 and July 1997. The diagnosis relied on a vertebral involvement associated with evidence of tuberculosis (culture of local puncture yielded Mycobacterium tuberculosis) or presumption of tuberculosis (evidence of other tuberculous focus, histological data, good outcome under specific treatment). Sixteen patients (mean age: 41 years; sex ratio: 1.29) have been included; thirteen were migrants. The main symptoms, which appeared within a mean period of 3 months were vertebral pain (13/16) and alteration of patient's general conditions (8/16). RMN imaging showed spondylitis (10/16), spondylodiscitis (4/16) and involvement of posterior arch (8/16). Inflammatory syndrome was present in 14 cases. The diagnosis of vertebral tuberculosis was confirmed in 12 cases according to the results of culture and/or histological grounds of local puncture. The diagnosis of vertebral tuberculosis was presumed in the 4 other cases according to the isolation of M. tuberculosis from an other site (2 cases), the characteristic histological pattern of a lymphadenopathy (1 case), and a favorable outcome upon specific treatment (1 case). All the patients were cured without complications with the exception of one patient who developed a spinal cord compression.

We report four cases of the side effects of minocylcine seen during the last two years in our department. There was one case of drug-related lupus and three cases of hypersensitivity reactions, including one eosinophilic pnemopathy with pericarditis, one nephropathy and one severe, pseudo-infectious episode of high fever, rash, lympadenopathy, hepatitis and eosinophilia.Minocycline is a tetracycline agent widely used for acne therapy iii France and all over the world. During the last few years, there has been an increasing number of reports concerning systemic adverse reactions to minocycline, with on the one hand auto-immune disorders (lupus, autoimmune hepatitis, vascularitis with ANCA), occurring after a prolonged course of therapy and reported recently in the last few gears, and on the other hand, hypersensitivity reactions (eosinophilic pneumopathies, hepatitis, nephropathies, myocarditis, serum sickness or pseudoinfectious reactions), occurring precociously in the course of therapy and potentially severe.Although these side effects are uncommon bl the context of the high number of patients who have been prescribed the drug, the first-line antibiotic therapy in acne must probably be reconsidered (C) 1999 Editions scientifiques et medicales Elsevier SAS.

Objectives of this study were to examine the cytokine and perforin mRNA expression in minor salivary glands from patients with primary Sjögren's syndrome (pSS), searching for possible correlation with clinical parameters and to identify the dominant cytokine pattern in the different groups. Oral mucosa biopsy samples from 42 pSS patients were studied. Total RNA was analysed by normalized RT-PCR using oligo-dT as the RT primer and IL-2, IFN-γ, IL-12, IL-18, IL-4, IL-10, TGF-β, TNF-α and perforin-specific primers for amplification. Results were analysed taking into account: (1) biopsy grade I to IV (Chisholm's classification); (2) diagnosis of either definite pSS (n=30) or probable pSS (n=12), following the European classification criteria (ECC), and (3) length of disease evolution from the beginning of symptoms to the time of biopsy, using an arbitrary cut-off point of 12 months. This studied showed that Th1-related cytokines (IL-2, IFN-γ, IL-12, IL-18, TNF-α) and perforin were present in most samples. IL-4 (Th2) was totally absent but other Th2 and regulatory cytokines (IL-10, TGF-β) were detected in the majority of samples. No significant differences were found between definite and probable pSS nor between grades II, III, IV and fibrous tissue biopsies. A statistically significant increase of IL-2 (P=0.012) and IFN-γ (P=0.019) was observed in samples from patients with longer disease evolution, whereas the two Th1-inducer cytokines IL-12 and IL-18 were equally and highly expressed in all samples. In conclusion, a predominant Th1 pattern of cytokines was observed in all pSS samples, irrespective of biopsy classification. In addition, a significant increase of Th1 cytokine expression frequency was associated with longer disease evolution.

We report four cases of the side effects of minocycline seen during the last rwo years in our department. There was one case of drug-related lupus and three cases of hypersensitivity reactions, including one eosinophilic pneumopathy with pericarditis, one nephropathy and one severe, pseudo-infectious episode of high fever, rash, lympadenopathy, hepatitis and eosinophilia.