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3.
Rev Med Interne ; 40(12): 785-790, 2019 Dec.
Article in French | MEDLINE | ID: mdl-31668883

ABSTRACT

INTRODUCTION: Hodgkin's lymphoma (HL) is less common than non-Hodgkin lymphoma and is rarely associated with autoimmune cytopenia. METHOD: We report a consecutive, monocentric and retrospective series of HL patients diagnosed with concomitant or subsequent autoimmune cytopenia over a period of 8 years. RESULTS: We report 4 out of 84 HL patients (4.8%) diagnosed with autoimmune cytopenia (4 immune thrombocytopenia including 2 Evans' syndromes). They were 4 males (average age 24 years for the 3 youngest, and one over 60 years old). Autoimmune cytopenia revealed lymphoma in 2 patients and occurred after HL treatment in the two other patients (5 and 36 months from the end of chemotherapy) without HL relapse. All cytopenias were resistant to conventional treatments (glucocorticoids, intravenous immune globulin, rituximab) and sensitive to chemotherapy when indicated for HL treatment. CONCLUSION: In our series, the predominance of males, a higher frequency of immune thrombocytopenia than autoimmune hemolytic anemia, the resistance to usual treatments and the efficacy of specific chemotherapy were consistent with the literature. Unexpectedly, patients were young and with nodular sclerosis morphology (vs. mixed cellularity) in 3 of 4 cases.


Subject(s)
Anemia, Hemolytic, Autoimmune/complications , Anemia, Hemolytic, Autoimmune/diagnosis , Hodgkin Disease/complications , Hodgkin Disease/diagnosis , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Adolescent , Adult , Aged , Humans , Male , Retrospective Studies , Thrombocytopenia/complications , Thrombocytopenia/diagnosis , Young Adult
4.
J Med Vasc ; 44(4): 285-290, 2019 Jun.
Article in French | MEDLINE | ID: mdl-31213301

ABSTRACT

Glomous tumors are rare and benign, generally affecting the fingers. Other localizations have nevertheless been described. We report the case of a patient who presented a supra-patellar glomous tumor provoking a pain-induced limp. Magnetic resonance imaging confirmed the diagnosis. The patient underwent complete surgical resection of the tumor followed by total resolution of the pain. Glomous tumors in an atypical localization may go unnoticed, with the risk of late or erroneous diagnosis. Symptoms are easily resolved with simple resection.


Subject(s)
Glomus Tumor/pathology , Soft Tissue Neoplasms/pathology , Biopsy , Glomus Tumor/diagnostic imaging , Glomus Tumor/surgery , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Soft Tissue Neoplasms/diagnostic imaging , Soft Tissue Neoplasms/surgery , Treatment Outcome , Ultrasonography, Doppler, Color
5.
Aliment Pharmacol Ther ; 46(11-12): 1070-1076, 2017 12.
Article in English | MEDLINE | ID: mdl-29023905

ABSTRACT

BACKGROUND: The outcome of cholangiopathy developing in intensive care unit (ICU) is not known in patients surviving their ICU stay. AIM: To perform a survey in liver units, in order to clarify the course of cholangiopathy after surviving ICU stay. METHODS: The files of the liver units affiliated to the French network for vascular liver disease were screened for cases of ICU cholangiopathy developing in patients with normal liver function tests on ICU admission, and no prior history of liver disease. RESULTS: Between 2005 and 2015, 16 cases were retrieved. Extensive burns were the cause for admission to ICU in 11 patients. Serum alkaline phosphatase levels increased from day 11 (2-46) to a peak of 15 (4-32) × ULN on day 81 (12-511). Magnetic resonance cholangiography showed irregularities or frank stenosis of the intrahepatic ducts, and proximal extrahepatic ducts contrasting with a normal aspect of the distal common bile duct. Follow-up duration was 20.6 (4.7-71.8) months. Three patients were lost to follow-up; 2 patients died from liver failure and no patient was transplanted. One patient had worsening strictures of the intrahepatic bile ducts with jaundice. Nine patients had persistent but minor strictures of the intrahepatic bile ducts on MR cholangiography, and persistent cholestasis without jaundice. One patient had normal liver function tests. CONCLUSIONS: In patients surviving their ICU stay, ICU cholangiopathy is not uniformly fatal in the short term or clinically symptomatic in the medium term. Preservation of the distal common bile duct appears to be a finding differentiating ICU cholangiopathy from other diffuse cholangiopathies.


Subject(s)
Bile Duct Diseases/mortality , Critical Illness/mortality , Intensive Care Units/statistics & numerical data , Liver Diseases/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Bile Ducts, Intrahepatic , Cholangiography , Critical Care , Female , Humans , Liver Function Tests , Male , Middle Aged , Retrospective Studies , Surveys and Questionnaires , Young Adult
6.
Med Sante Trop ; 26(3): 283-286, 2016 Aug 01.
Article in English | MEDLINE | ID: mdl-27694085

ABSTRACT

BACKGROUND: As part of French assistance for the outbreak of Ebola virus disease in west Africa, a military treatment center for infected healthcare workers was deployed in Conakry, Guinea. Although some cases of bradycardia have been reported since the first Ebola outbreak, they have never been documented to our knowledge. We studied heart rhythm in patients with Ebola virus disease to analyze inappropriate bradycardia and discuss its mechanism. METHODS: Nine patients who tested positive for Ebola were admitted in March 2015. Baseline clinical data were noted at admission and twice a day during follow-up, and laboratory analyses (with troponin testing) were performed. RESULTS: At admission, patients had no or moderate tachycardia (pulse = 82 ± 27 bpm). Among them, a 32-year-old midwife admitted on her fourth day of symptoms had marked bradycardia: 43 bpm. ECG showed sinus bradycardia with no conduction disturbances or repolarization anomalies; findings were similar for the three other patients with bradycardia (< 60 bpm). During follow-up, her pulse gradually increased, as it did for the other three; all four recovered. DISCUSSION: Despite several factors likely to promote tachycardia, we observed no or only moderate tachycardia in all patients with Ebola. In our study, ECG recorded sinus rhythm, without significant node dysfunction or atrioventricular block. In the absence of any evidence of myocarditis, we discuss the possibility of a central nervous system cause, associated with encephalitis. CONCLUSION: We observed relative or marked bradycardia in our patients infected with Ebola. We hypothesize that its causal mechanism was encephalitis.


Subject(s)
Bradycardia/etiology , Hemorrhagic Fever, Ebola/complications , Adult , Encephalitis/complications , Female , Humans , Male , Middle Aged
14.
Clin Rheumatol ; 30(5): 685-9, 2011 May.
Article in English | MEDLINE | ID: mdl-21221683

ABSTRACT

Increased free light chain (FLC) levels have been reported as useful in various autoimmune conditions. We investigated how FLC concentrations change upon B cell targeted therapy in systemic lupus erythematosus (SLE) patients and if they correlate with disease activity. We retrospectively studied 11 SLE patients without renal failure, whom were treated with rituximab. Quantitative determination of IgG, IgA, IgM, and serum FLC was performed before and after rituximab. At baseline, 70% had abnormal serum FLC levels, including increased kappa and lambda levels, while the kappa/lambda ratio was normal for all. A strong correlation was observed between complement C3 fraction and kappa levels (r = -0.929, P < 0.001) or lambda levels (r = -0.854, P = 0.003), but not with IgG, IgA, or IgM levels. After rituximab treatment, kappa and lambda FLC concentrations decreased significantly whilst total concentrations of IgG, IgA, and IgM also decreased but remained within the normal range. There was a strong correlation only between kappa FLC levels and complement C3 fraction consumption (r = -0.543, P = 0.003). In SLE patients without renal failure, increased FLC levels (mainly kappa) with normal kappa/lambda ratios are a common feature, and in contrast to total IgG levels, FLC concentrations correlate with biological disease activity.


Subject(s)
Antibodies, Monoclonal, Murine-Derived/therapeutic use , Immunoglobulin Light Chains/blood , Lupus Erythematosus, Systemic/drug therapy , Adult , Autoimmunity , Complement C3/biosynthesis , Female , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Immunoglobulin M/blood , Immunologic Factors/therapeutic use , Male , Middle Aged , Retrospective Studies , Rituximab , Treatment Outcome
15.
Rev Med Interne ; 32(5): e66-8, 2011 May.
Article in French | MEDLINE | ID: mdl-20633965

ABSTRACT

We report a 49-year-old man suffering from chronic hypereosinophilia whose biological tests revealed a gene rearrangement between FIP1L1 and PDGFRA as well as a T-cell clonality. After 1 year of therapy with imatinib mesylate (100 mg daily), the patient was clinically asymptomatic, the fusion transcript was undetectable using RTQ-PCR and no lymphoproliferative disorders occurred. This unique combination raises the question of the physiopathology of such a grey zone hypereosinophilia and their management.


Subject(s)
Hypereosinophilic Syndrome/genetics , Hypereosinophilic Syndrome/pathology , Mutation/genetics , Oncogene Proteins, Fusion/genetics , Receptor, Platelet-Derived Growth Factor alpha/genetics , T-Lymphocytes/pathology , mRNA Cleavage and Polyadenylation Factors/genetics , Antineoplastic Agents/therapeutic use , Benzamides , Chronic Disease , Gene Rearrangement, T-Lymphocyte/genetics , Genetic Testing , Humans , Hypereosinophilic Syndrome/drug therapy , Imatinib Mesylate , Male , Middle Aged , Piperazines/therapeutic use , Pyrimidines/therapeutic use , Treatment Outcome
16.
Rev Med Interne ; 32(2): e15-7, 2011 Feb.
Article in French | MEDLINE | ID: mdl-20627476

ABSTRACT

Macrophage activation syndrome (MAS) is a rare immunological disorder, rapidly life-threatening in the absence of specific treatment. Malignant lymphoma is common cause of MAS, but Hodgkin's lymphoma has been rarely associated with MAS. We report a 79-year-old man who presented a MAS as the presenting feature of Hodgkin's lymphoma, with a rapidly fatal outcome. We discuss the usefulness of sCD25 and interleukine 18 assays when diagnosis is difficult to obtain. We also review the literature data related to Hodgkin's lymphoma-associated MAS.


Subject(s)
Hodgkin Disease/diagnosis , Macrophage Activation Syndrome/etiology , Aged , Fatal Outcome , Humans , Male
18.
Rev Med Interne ; 30(12): 1067-79, 2009 Dec.
Article in French | MEDLINE | ID: mdl-19833415

ABSTRACT

Over the past 10 years, the management of rheumatoid arthritis has been revolutionized. Early diagnosis is essential and should allow an early initiation of disease modifying anti-rheumatic drugs (DMARD), if possible within the first 3 three months after disease onset, aiming at disease remission and the best long-term prognosis. Recommendations for the prescription of synthetic and biologic DMARD (mainly anti-TNFalpha agents) are available since September 2007 [6] by HAS in France. The great efficacy of these drugs has been established from many clinical trials including tens of thousands of patients. However, severe adverse side effects may occur (allergy, tuberculosis, opportunistic infections, demyelination) and rheumatologists should remain vigilant. Global care of the patient includes prescription of pharmacologic and non-pharmacologic treatments (education, physical treatment, ergotherapy, psychotherapy, surgery). A good coordination between all specialists is required. Screening and treatment of extra-articular manifestations, prevention of infections, osteoporosis and cardiovascular complications are essential to allow a better long-term prognosis, and reduce disability and mortality of rheumatoid arthritis.


Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Glucocorticoids/therapeutic use , Immunosuppressive Agents/therapeutic use , Arthritis, Rheumatoid/therapy , Clinical Trials as Topic , Drug Therapy, Combination , Early Diagnosis , Humans , Physical Therapy Modalities , Practice Guidelines as Topic , Prognosis , Quality of Life , Severity of Illness Index , Treatment Outcome
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