[Active WHO class IV lupus nephritis in a patient treated with etanercept for a psoriasic arthritis]. / Néphropathie lupique stade IV chez une patiente traitée par étanercept pour un rhumatisme psoriasique.

INTRODUCTION: Drug-induced lupus nephritis in patients treated with TNF α inhibitor is a rare adverse effect. Anti-TNF α therapies are commonly associated with the induction of auto-antibodies, whereas anti-TNF α-induced lupus is rare, most frequently involving arthritis and cutaneous lesions. However, several renal involvement has been reported. OBSERVATION: A 26-year old woman with a history of psoriasic arthritis treated with TNF α inhibitor (etanercept) presented with a biopsy-proved class IV lupus nephritis. The diagnosis of drug-induced lupus nephritis was probable and anti-TNF α therapy was discontinued. Standard lupus nephritis therapy was then started with prednisolone pulses and mycophenolate mofetil (MMF). Two weeks later, a septic shock following a leg cellulitis was caused by Pseudomonas aeruginosa and had a fatal evolution despite MMF withdrawal, adapted antibiotherapy and large wound excision. DISCUSSION: Our therapy was not different than for other class IV lupus nephritis. Our observation highlights two points: first the attributability to etanercept in lupic manifestations in our patient and second the therapeutic strategy in this particular case of drug-induced lupus. CONCLUSION: We reported a possible first case of IV lupus nephritis induced by anti-TNF α with a fatal evolution.

A "true" polymicrobial endocarditis: Candida tropicalis and Staphylococcus aureus--to a drug user. Case presentation and literature review.

Polymicrobial endocarditis is more frequent in intravenous drug user (IVDU). Combined therapy--medical and surgical--represents the standard of care, but long-term suppressive therapy duration in fungal endocarditis is still debated. The polymicrobial endocarditis is rare: 1-3%. It is being observed with increasing frequency among drug users; a predominance of tricuspid valve involvement exists. We report a case of dual etiology infective endocarditis (IE) - Candida tropicalis and Staphylococcus aureus - in a IVDU; the treatment was combined, medical and surgical, and was followed by a suppressive antifungal therapy. We review the other published Candida tropicalis endocarditis cases and discuss their optimal management.

Aortic prosthetic endocarditis with Neisseria elongata subspecies nitroreducens.

A case of Neisseria elongata subsp. nitroreducens endocarditis with a favourable course is presented. Dental foci were involved as the infective origin. Only conservative therapy was performed for 6 weeks; no complications were registered in 3 months of follow-up. The other 12 cases with similar aetiology communicated in the past 30 y were reviewed.