The pathophysiology of migraine remains unclear. To incriminate a comorbid factor is always hypothetical, even if suppression of this factor appears to prevent the migrainous attacks. In our patient, treatment of coeliac disease coincided with total disappearance of severe migraine attacks. Moreover, the coeliac disease was first revealed during the evaluation of a migraine with aura.Key words: migraine attacks, coeliac disease, gluten-free diet (Headache 1998;38:627-628) We report the course of a patient who had suffered from typical migraine attacks since childhood. Coeliac disease was diagnosed. A gluten-free diet improved the migraine attacks which subsequently ceased. CASE HISTORYA 45year-old man, who had suffered from migraine since childhood, experienced recurrent attacks about twice a week. The headaches were associated with visual disturbances but without neurological complications.The patient played tennis and cycled in sports competitions. There was no family history of ophthalmic migraine. When he was a child he had undergone a starvation ketosis attack without subsequent disturbances; he had undergone an appendectomy. He was a former smoker.He was suffering from periodic, disabling, left then right hemicranias with visual auras. The attacks were becoming more and more frequent and were not improved by treatment: a prophylactic program with beta-blockers did not have any effect on the attack frequency. Bowel biopsy showed total villous atrophy grade I\! A CT scan of the brain was normal; in particular, there was no brain calcification. An EEG was normal.In summary, these clinical and biological data suggested a malabsorption syndrome with gluten intolerance.He correctly followed a gluten-free diet. Endoscopic biopsy performed within 3 months showed regrowth of villi.627

We report a case of acute hepatitis E occurring in a 51-year-old French woman, revealed by an abrupt onset of polyarthritis involving the ankles and knees followed by the wrists and fingers. Polyarthritis lasted up to 3 months without recurrence. Our case was characterised by a 9-month prolonged viraemia with persistence of specific IgM in the serum. The hepatitis E virus belonged to genotype 3 and may have been contracted in France or during travel to hyperendemic areas. Our case shows that acute polyarthritis could be another systemic manifestation of hepatitis E virus infection.

BackgroundChronic canaliculitis is often misdiagnosed as conjunctivitis, delaying proper documentation and management. Aggregatibacter aphrophillus has not been implicated in chronic canaliculitis.Case presentationWe report a case of unilateral chronic epiphora associated with chronic lacrimal canaliculitis resistant to prolonged topical antibiotic treatment in a 65-year-old woman without notable medical history. Canaculotomy, curettage with removal of concretions and tubing with silicone stent for six weeks resolved this chronic infection. Culturing lacrimal secretions and concretions yielded Aggregatibacter aphrophilus in pure culture. Histological analyses showed elongated seed clusters surrounded by neutrophils. Fluorescence in Situ Hybridization confirmed the presence of bacteria in two distinctive concretions.ConclusionThis first documented case of A. aphrophilus chronic lacrimal canaliculitis illustrates that optimal surgical management of chronic lacrimal canaliculitis allows for both accurate microbiological diagnosis and treatment.

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