Abstract Background: Cogan’s syndrome is a rare autoimmune vasculitis (less than 300 cases described in the literature) characterized in its typical form by cochleovestibular involvement, interstitial keratitis, and an inflammatory involvement of large vessels. It is frequently accompanied by general signs and cardio-vascular, rheumatologic, and digestive complications. Its management is essentially based on the use of corticosteroids and immunosuppressants. The outcome of the treatment, even if rapid, does not always avoid functional com plications. This disease is probably under-diagnosed in Africa. Objective: The objective of this study was to report a case of Cogan syndrome in sub-Saharan Africa. Case report: A 78 year old black African female patient presented with arthritis of the left knee without fever. The examination also revealed a bilateral deafness of rapidly progressive onset. The patient was known to be diabetic and hypertensive, and was regularly monitored. The biology revealed an inflammatory syndrome and an inflammatory joint puncture fluid. Pure tone audiometry confirmed a 77% hearing loss. The ophthalmological exami nation revealed stromaloedema and hypertensive retinopathy of Kendall stage III. The rheumatological evolution was good under ethylprednisolone and methotrexate, but the deafness persisted. The occurrence of a fever on day 12 of treatment required further investigations (blood culture, PCR-Covid 19 test, cytobacteriological examination of sputum, thoracic CT). The evolution was unfavourable with the death of the patient. Conclusion: Cogan’s disease is a rare inflammatory disease. Its diagnosis and management are multidisciplinary. The treatment can be disappointing.

Abstract Objectives: To determine the frequency, the clinical and radiological features of lumbar spondylolisthesis in a rheumatological practice in Lomé. Patients and methods: This was a cross-sectional study conducted in therheumatology department of the Sylvanus Olympio Teaching Hospital in Lomé between January 1997 and December 2019. Medical records of patients with symptomatic spondylolisthesis with radiographic confirmation were reviewed. The Meyerding classification system was used for grading. Results: Of the 350 patients contacted, 118 consented to participate in the study, making a response rate of 33.71%. Of the 118, 104 (88.1%) were females. 109 (92.4%) presented with radicular pain and 9 (7.6%) presented low back pain. The mean age of the patients was 54.24 ± 11.19 years. The average duration of the pain was 4.56 ± 1.32 years. The spondylolisthesis level most involved was the L4 - L5 (92/118), followed by L5 - S1 (23/118). 106 (89.8%) patients had anterolis thesis only, seven (5.9%) combination anterolisthesis and retrolisthesis. The spondylolisthesis was associated with spondylosis in 110 (93.2%) patients. Spondylosis was found at level L4 - L5 in 38.98% patients, followed by L5 - S1 (24.58%), L3 - L4 (18.64%). Grade I slip was found in 108 (91.53%) patients and Grade II slips 10 (8.47%). Isthmic lysis was found in 40 (33.9%) patients and it was located at L4 in 30 (75.0%). Conclusion: Lumbar spondylolisthesis appears to be expected in Lomé patients with nonspecific back pain and mainly affects females.

Abstract Introduction: Cutaneous manifestations of systemic sclerosis (SSc) include skin ulceration; 4% - 12% of patients with SSc develop lower extremity ulcers of various etiologies. Limited data, significant morbidity, and substantial cost of wound care led us to undertake this study to describe and identify risk factors. Methods: After Institutional Review Board approval, we identified 30 patients with SSc and lower extremity ulcers over a 10-year period at a single center with an SSc clinic, which were included in a descriptive analysis. Results: Median age of onset of lower extremity ulcers was 59.5 years (range 20 -84). Ninety percent of patients were female, 60% were Caucasian, 63% had limited SSc, 13% diffuse SSc and 23% an overlap syndrome. Immunomodulators or steroids were prescribed in 53%; hypercoagulable state identified in 16%. Ulcers were attributed to venous stasis (27%), SSc (20%), trauma (20%), arterial disease (17%), and multifactorial/unknown (17%). In patients with ulcers attributed to SSc, age at onset was lower (45.5 vs 59.5 years). Biopsies generally did not contribute to management. Multidisciplinary treatment was routine; 20% required amputation, 10% endovascular intervention, 20% frequent surgical debridement, 10% hyperbaric oxygen, 26% local treatment and antibiotics and 13% received immunosuppression for wound treatment. Conclusion: Lower extremity ulcers are a serious clinical problem in patients with SSc. The clinical exam, venous dopplers, ankle-brachial indices and assessment of vascular risk factors helped define causality. In younger patients, ulcers were more frequently attributed to SSc and these patients were more likely to be on immunosuppressants/DMARDS, possibly indicating severe phenotype of SSc.

Abstract This report describes clinical findings of a 28-year old female patient presented with non-healing digit ulcer and Raynaud’s phenomenon. Upon investigation was found to have high eosinophil count alongside hypocomplementemia. This patient was diagnosed with diffuse cutaneous systemic sclerosis and was started on therapy; her other laboratory findings were attributed to a coinciding helminthic infection. This case suggests the possibility of having two different diagnoses presenting at once causing a clinical dilemma.

Abstract Introduction: Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic disease. It is a systemic disease with extra-articular manifestations that can be life-threatening. In sub-Saharan Africa, there is little published information on cardiovascular manifestations in RA. Objective:The objective is to determine the asymptomatic cardiac manifestations during rheumatoid arthritis in Conakry. Patients and Methods: This was a crosssectional study lasting 6 months from January 1, 2020 to June 30, 2020 in the rheumatology and cardiology departments of the Ignace Deen National Hospital. Patients with RA diagnosed according to the 2010 ACR/EULAR criteria, asymptomatic at the cardiovascular level, which had an ECG and echocardiography, were included in the study. Left ventricular diastolic dysfunction was considered in any patient with an E/A ratio < 1, an E/E’ ratio > 10, and an LVEF = 50%, assessed by the Simpson biplane method and classified according to Redfield. Epidemiological, clinical and paraclinical data were analyzed using SPSS statistics 21.0 software. Results: Seventeen cases of rheumatoid arthritis (5.9%) were collected. There was a predominance of women with 14 cases (82.4%). The mean age of patients was 48.2 ± 11.9 years. The average duration of RA was 7.2 ± 4.2 years. Cardiovascular risk factors were dominated by overweight and obesity (58.8%) and sedentary lifestyle (35.3%). RA was predominantly high activity (DAS 28 ≥ 5.1) in 82.4% of patients. Anti-CCP antibodies were positive in 76.9% of cases. Fourteen patients (82.4%) had abnormal cardiac results. The electrocardiogram showed left atrial hypertrophy in 29.4% of cases, left ventricular hypertrophy (11.8%) and ventricular extrasystole (11.8%). The cardiac Doppler scan showed diastolic dysfunction of the left ventricle (47.1%) and moderate pericardial effusion in 11.8% of cases. Conclusion: The study found asymptomatic cardiac manifestations of rheumatoid arthritis. They were dominated by ventricular hypertrophy on electrocardiogram and left ventricular diastolic dysfunction on cardiac Doppler ultrasound. Systematic examination of patients with RA is necessary to detect them early and avoid complications.