[Severe hepatitis with hypogammaglobulinaemia IgA of non-alcoholic origin]. / Le cas clinique du mois - Hépatite sévère avec hypergamma-globulinémie à IgA d'origine non alcoolique.

This clinical case describes a severe liver insufficiency associated with an IgA hypergammaglobulinaemia. The search for an etiology excluded all classical causes of hepatopathy and led to the diagnosis of celiac disease. Liver impairment improved with a gluten-free diet. This observation emphasizes the need for a careful etiological diagnosis of any hepatopathy; this may result in the discovery of a potentially reversible cause amenable to a simple therapeutic strategy.

Ce cas clinique décrit une hépatopathie sévère avec présence d'une hypergammaglobulinémie à IgA. La recherche étiologique a exclu les causes classiques d'hépatopathie et abouti au diagnostic de maladie coeliaque. L'atteinte hépatique a régressé avec le respect d'un régime alimentaire sans gluten. Ce cas illustre l'importance d'une recherche étiologique minutieuse face à une hépatopathie; elle peut parfois aboutir à une solution thérapeutique simple et efficace.

Increased frequency of bronchial hyperresponsiveness in patients with inflammatory bowel disease.

Although bronchopulmonary manifestations are rare in inflammatory bowel disease (IBD), subclinical abnormalities have been described in up to 50% of cases. The pathophysiology of these abnormalities remains unknown. However, a latent inflammation of the bronchial mucosa secondary to the inflammation of the intestinal mucosa has been suggested. This subclinical inflammation may lead to increased bronchial responsiveness. We studied the bronchial responsiveness in 38 inflammatory bowel disease (IBD) patients, using the methacholine test. Bronchial hyperresponsiveness was defined by a PC20M < 16 mg/ml. Twenty-four healthy controls were also studied. There was no significant difference in baseline FEV1 between IBD patients and controls. However, there was a significantly greater fall in FEV1 in the IBD patients at the concentrations of methacholine tested. The frequency of bronchial hyperresponsiveness was significantly higher in the IBD population (45%) than in controls (17%; P < 0.03). Atopy, defined by skin test, was more common in IBD patients (42%) than in controls (21%). Even when only nonatopic subjects were considered, the frequency of bronchial hyperresponsiveness was significantly higher in IBD patients (41%) than in controls (5%; P < 0.02). Thus, subclinical bronchial hyperresponsiveness is common in IBD, and may be considered a further extraintestinal manifestation.