AFRICAN HISTOPLASMA TENOSYNOVITIS ASSOCIATED WITH OVERLAP SYNDROME: RHEUMATOID ARTHRITIS AND SCLERODERMA

S. Mahfoud-Filali , S. El Hassani , A. Faik , F. Allali , L. Sekkat , N. Hajjaj-Hassouni Rheumatology B, Rheumatology A, El Ayachi Hospital, salé, MoroccoObjectives: African histoplasmosis is rarely localized on synovial. Polyarthritis can be the articular manifestation. We report one case.Methods: Ms B.F. is a 43 year old woman. she had surgical treatment 12 years ago for parotide non hodgkinian lymphoma. She has presented an overlap syndrome (Rheumatoid arthritis and Scleroderma) for 10 years. Symptomatic treatment (corticotherapy: 10 mg/day) with DMARD treatment (D penicillamine) didn't give neither clinical nor biological improuvement. Clinical exam found polysynovitis on hands and knees, right ankle tenosynovitis (peroneus brevis and tibialis posterior), third and right distal interphalangeal joint. Biological exam showed inflammatory syndrome (ESR= 105 mm, Protein C Reactiv= 64 mg/l) and positive rheumatoid factor. No osseous lesion was found in ankle radiographs and computed tomography. Tenosynovitis fluid color was green. Histological study of ankle tenosynovitis showed necrosis and histiocyte cell PAS positive in favour of histoplasmosis with small squall. Patient received amphotericine B treatment. Evolution was favourable. Relapse occurred after the treatment was stopped.Results: Histoplasmosis is rare in our country. However it occurrence on a weakned rheumatic patient is understandable as all kinds of infections may be diagnosed in such patholgies.Citation: , volume , supplement , year 2002, page Session: Infection related rheumatic diseases 2