IgG4-related pleural disease in a patient with a history of unknown origin acute pancreatitis: a case report and review of the literature.

Immunoglobulin G4-related disease is a rare autoimmune systemic disease with the capability of involving every organ. The disease is microscopically defined by a diffuse tissular inflammation with an infiltration of IgG4 positive plasma cells in the affected organs. IgG4 disease has an increasing incidence in the last few years with a growing interest in its pathophysiology still misunderstood to date. Despite the growing recognition of this pathology, the literature still does not allow to propose a simple diagnostic algorithm. In this article, we present a case of a 56-year-old man with a history of unknown etiology acute pancreatitis and a unilateral pleural effusion.

An atypical presentation of an acute gastric Helicobacter felis infection.

Helicobacter pylori is a Gram negative bacterium that has been associated with a wide variety of gastric pathologies in humans. Besides this well studied gastric pathogen, other Helicobacter spp. have been detected in a minority of patients with gastric disease. These species, also referred to as "H. heilmanii sensu lato" or "non Helicobacter pylori Helicobacter spp. (NHPH)", have a very fastidious nature which makes their in vitro isolation difficult. This group compromises several different Helicobacter species which naturally colonize the stomach of animals. In this article we present a case of a patient with severe gastritis in which H. felis was identified. The necrotic lesions observed at gastroscopy differ from the less active and less severe lesions generally associated with NHPH infections in human patients. The patient was successfully treated with a combination of amoxicillin, clarithromycin and pantoprazole. Infections with NHPH should be included in the differential diagnosis of gastritis when anatomopathological findings show an atypically shaped helicobacter.

[Acute respiratory distress revealing antisynthetase syndrome]. / Détresse respiratoire aiguë révélatrice d'un syndrome des antisynthétases.

Antisynthetase syndrome is a clinical entity characterized by specific anti-aminoacyl-tRNA-synthetase antibodies usually associated with inflammatory myopathy and interstitial lung disease. The classic presentation of the pathology is the pulmonary interstitium involvment, wich commonly determines the global prognosis. The subsequent diagnosis of antisynthetase syndrome in patients with acute respiratory distress syndrome (ARDS) is unusual, even more so when a veino-veinous (VV) extracorporeal membrane oxygenation (ECMO) is required. This article presents a clinical case of antisynthetase syndrome with severe ARDS successfully treated with immunosuppressive agents and ECMO.

Le syndrome des antisynthétases (SAS) est une pathologie multi-systémique auto-immune rare caractérisée par un trépied diagnostique associant la présence d'auto-anticorps anti-aminoacyl-ARNt synthétase, une myopathie inflammatoire et une pneumopathie interstitielle diffuse. L'atteinte pulmonaire parenchymateuse est la plus fréquemment rencontrée et détermine, de manière presque systématique, le pronostic global de la pathologie. L'identification d'un syndrome des antisynthétases dans le décours d'un syndrome de détresse respiratoire aigüe (SDRA) est rare, d'autant plus lorsque la mise en place d'un système d'oxygénation par membrane extracorporelle (ECMO) veino-veineuse (VV) est requise. Cet article présente un cas de SAS avec SDRA sévère, traité avec succès par immunosuppresseurs et ECMO.