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Marzouk S, Garbaa S, Cherif Y, Jallouli M, Bahri F, Bahloul Z. Entérite lupique récidivante améliorée par Azathioprine. Pan Afr Med J 2015; 20:215. [PMID: 26113946 PMCID: PMC4470445 DOI: 10.11604/pamj.2015.20.215.5757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/13/2015] [Indexed: 11/13/2022] Open
Abstract
Les manifestations gastro-intestinales observées au cours du lupus érythémateux systémique sont fréquentes et peuvent intéresser n'importe quel segment du tractus digestif. L'entérite lupique constitue l'une des manifestations responsable de douleurs abdominales. Son traitement est basé essentiellement sur les corticoïdes. Le recours aux immunosuppresseurs est réservé aux formes récidivantes ou en cas d’échec des corticoïdes. Nous rapportons une nouvelle observation d'entérite lupique récidivante améliorée par azathioprine. Il s'agissait d'une femme âgée de 30 ans chez laquelle le diagnostic du lupus a été retenu en 2004. Un an après, elle a présenté des douleurs abdominales, des vomissements et des diarrhées. Les explorations ont conclu à une entérite lupique après élimination de toute autre cause notamment infectieuse. Elle a été traitée par des corticoïdes à forte dose. Cependant à chaque tentative de dégression, elle présentait la même symptomatologie. En 2010 l'azathioprine a été associé permettant de juguler la maladie et de diminuer la corticothérapie.
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Cherif Y, Jallouli M, Hriz H, Gouiaa R, Marzouk S, Snoussi M, Frikha F, Masmoudi H, Bahloul Z. Late-onset primary antiphospholipid syndrome in the elderly: a report of seven cases. Int J Rheum Dis 2014; 18:103-7. [PMID: 25530096 DOI: 10.1111/1756-185x.12494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM We describe the clinical profile of elderly with primary antiphospholipid syndrome (APS). METHODS Charts of seven elderly patients diagnosed with APS between 1996 and 2012 were retrospectively assessed. RESULTS The mean age at diagnosis was 77 ± 6 years (67-84 years). Two patients had experienced frequent miscarriages. Five patients presented with deep venous thrombosis of the lower limb, one had venous thrombosis of the upper limb and brachiocephalic vein and another had a cerebral ischemic stroke. The antiphospholipid antibodies tests revealed the presence of significant amounts of anticardiolipin antibodies, 12 weeks apart, twice in four patients. The antibodies to β2-glycoprotein 1 were positive twice in two patients and lupus anticoagulant in one of these. All patients were treated with heparin and long-term anti-vitamin K and thrombosis was cleared in all cases. Two patients presented with bleeding complications: hematuria and hematoma of the buttock in one patient and rectal bleeding in another case. Two elderly developed a colon cancer and lymphoma 1 year later. CONCLUSION In this report, we report on primary APS in the elderly, to discuss its prevalence and the clinical significance of positive antiphospholipid antibodies in subjects over the age of 65 years.
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Loukil H, Snoussi M, Frikha F, Ben Salah R, Jallouli M, Chérif Y, Elaoud S, Garbaa S, Damak C, Marzouk S, Bahloul Z. Atteinte digestive au cours du purpura rhumatoïde de l’adulte : une série de 12 cas. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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79
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Damak C, Ben Salah R, Frikha F, Cherif Y, Garbaa S, Fatma T, Hanen L, Elaoud S, Snoussi M, Jallouli M, Marzouk S, Bahloul Z. Hémorragie intra-alvéolaire d’origine immunitaire : à propos de 11 cas. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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80
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Cherif Y, Ben Salah R, Frikha F, Jallouli M, Dammak C, Garbaa S, Snoussi M, Elaoud S, Fatma T, Loukil H, Marzouk S, Bahloul Z. Défaillances viscérales au cours de la sclérodermie systémique. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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81
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Cherif Y, Jallouli M, Mseddi M, Turki H, Bahloul Z. Acute generalized exanthematous pustulosis induced by piroxicam: a case report. Indian J Pharmacol 2014; 46:232-3. [PMID: 24741202 PMCID: PMC3987199 DOI: 10.4103/0253-7613.129332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 07/30/2013] [Accepted: 01/21/2014] [Indexed: 01/05/2023] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a severe adverse cutaneous reaction characterized by an acute episode of sterile pustules over erythematous-edematous skin. The main triggering drugs are antibiotics, mainly beta-lactam and macrolides. Non-steroid anti-inflammatory drugs may rarely be responsible. We describe a case of a woman with AGEP, who presented with generalized pustulosis lesions after the use of piroxicam for renal colic. The diagnosis was confirmed by the clinical and histological correlations and the dermatosis resolved after withdrawal of the drug.
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Cherif Y, Ben Salah R, Frikha F, Dammak C, Jallouli M, Snoussi M, Garbaa S, Elaoud S, Loukil H, Marzouk S, Bahloul Z. Sclérodermie systémique : à propos de 77 cas. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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83
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Cherif Y, Ben Salah R, Frikha F, Dammak C, Jallouli M, Snoussi M, Garbaa S, Loukil H, Elaoud S, Marzouk S, Bahloul Z. Syndrome auto-immun multiple : à propos de 17 observations. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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84
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Zouari M, Ben Dhaou M, Kchaou R, Jallouli M, Mhiri R. Unusual sites of cystic lymphangioma in children. Arch Pediatr 2014; 22:676-7. [PMID: 25282458 DOI: 10.1016/j.arcped.2014.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/20/2014] [Accepted: 09/01/2014] [Indexed: 01/11/2023]
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Schoindre Y, Jallouli M, Tanguy ML, Ghillani P, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Kahn JE, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Leroux G, Cohen-Bittan J, Hulot JS, Lechat P, Musset L, Piette JC, Amoura Z, Souberbielle JC, Costedoat-Chalumeau N. Lower vitamin D levels are associated with higher systemic lupus erythematosus activity, but not predictive of disease flare-up. Lupus Sci Med 2014; 1:e000027. [PMID: 25379192 PMCID: PMC4213833 DOI: 10.1136/lupus-2014-000027] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/03/2014] [Accepted: 05/08/2014] [Indexed: 01/11/2023]
Abstract
Objectives Growing evidence suggests that vitamin D plays a key role in the pathogenesis and progression of autoimmune diseases, including systemic lupus erythematosus (SLE). Recent studies have found an association between lower serum 25-hydroxyvitamin D (25(OH)D) levels and higher SLE activity. We studied the relationship between 25(OH)D levels and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, and we assessed for the first time the role of vitamin D in predicting SLE flare-ups. Methods Serum 25(OH)D levels were measured in 170 patients with SLE who were prospectively followed up for 6 months (Plaquenil LUpus Systemic study, ClinicalTrials.gov number NCT00413361). Results The mean SLEDAI score was 2.03±2.43 and 12.3% patients had active disease (SLEDAI ≥6). The mean 25(OH)D level was 20.6±9.8 ng/mL. Deficiency (25(OH)D <10 ng/mL) was observed in 27 (15.9%), insufficiency (10≤25(OH)D<30) in 112 (65.9%) and optimal vitamin D status (25(OH)D≥30) in 31 (18.2%) patients. In multivariate analysis, female gender (p=0.018), absence of defined antiphospholipid syndrome (p=0.002) and higher creatinine clearance (p=0.004) were predictive of lower 25(OH)D levels. In multivariate analysis, lower 25(OH)D levels were associated with high SLE activity (p=0.02). Relapse-free survival rate was not statistically different according to the vitamin D status during the 6-month follow-up (p=0.22). Conclusions We found a low vitamin D status in the majority of patients with SLE, and a modest association between lower 25(OH)D levels and high disease activity. There was no association between baseline 25(OH)D levels and relapse-free survival rate.
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Jallouli M, Hriz H, Cherif Y, Marzouk S, Snoussi M, Frikha F, Ben Salah R, Masmoudi H, Bahloul Z. Causes and outcome of hospitalisations in Tunisian patients with systemic lupus erythematosus. Lupus Sci Med 2014; 1:e000017. [PMID: 25396063 PMCID: PMC4225742 DOI: 10.1136/lupus-2014-000017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/22/2014] [Accepted: 05/08/2014] [Indexed: 12/01/2022]
Abstract
Objective To describe the most common reasons of admission of Tunisian patients with systemic lupus erythematosus (SLE) and the outcomes of these hospitalisations. Method The charts of patients with SLE who were hospitalised at our Department of Internal Medicine during a 2-year period from January 2011 to December 2012 were retrospectively reviewed, and the demographic characteristics, clinical and laboratory features, as well as all comorbidities, were collected. Results There were 128 episodes of hospitalisation of 87 patients with SLE. 25 patients (28.7%) were admitted twice or more. The median length of stay for all admissions was 11 days (2–76). The total number of days of hospitalisation was 1896 days, which represent 10.7% of the total number of days of hospitalisation in our department. The most common overall reason for hospitalisation was active SLE (55 events, 43%). In 29 patients, SLE was newly diagnosed during hospitalisation. Other causes of hospitalisation included assessment of the disease, infections (9.4%) and associated autoimmune disease (6.25%). Adverse drug reaction (3.1%) and thromboembolic events (1.25%) were uncommon causes of hospitalisations. There was a significant difference in length of stay between patients admitted with SLE flare and those admitted for non-SLE flare reasons (p<0.01). Four hospitalisations (3%) resulted in death. The principal cause of death was active SLE. Conclusions Hospitalisation of patients with SLE is common in our department. Our study of this North African SLE population confirms the findings of previous studies suggesting that active SLE and infection remain the most common causes of hospitalisation of patients with SLE.
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Loukil H, Snoussi M, Frikha F, Ben Salah R, Jallouli M, Cherif Y, Damak C, Garbaa S, Mesrati H, Marzouk S, Bahloul Z. Atteinte oculaire au cours de la maladie de Behçet dans le sud tunisien : à propos de 40 cas. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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88
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Loukil H, Snoussi M, Frikha F, Jallouli M, Ben Salah R, Cherif Y, Garbaa S, Damak C, Mesrati H, Marzouk S, Bahloul Z. À propos d’une association rare : vascularite urticarienne hypocomplémentémique de MacDuffie, une anémie hémolytique auto-immune et une cirrhose biliaire primitive. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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89
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Jolly M, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Boutin D, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Jallouli M, Leroux G, Cohen-Bittan J, Tanguy ML, Hulot JS, Musset L, Amoura Z, Piette JC, Costedoat-Chalumeau N. FRI0434 Blood Hydroxychloroquine (HCQ) Levels do not PREDICT Quality of Life in Systemic Lupus Erythematosus (SLE). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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90
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Chérif Y, Ben Salah R, Frikha F, Snoussi M, Jallouli M, Baccouche N, Loukil H, Marzouk S, Bahloul Z. Myosite localisée au cours du diabète : à propos de 2 observations de pseudophlébite. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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91
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Ben Dhaou M, Jallouli M, Zitouni H, Mefteh S, Mesbehi S, Mhiri R. SFCP P-020 - Cause rare d’occlusion intestinale néonatale : Le diaphragme rectal. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71736-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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92
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Ben Dhaou M, Jallouli M, Mesbehi S, Zitouni H, Kotti A, Mefteh S, Mhiri R. SFCP P-097 - Un nouveau concept pédiatrique pour la chirurgie laparoscopique à travers un site unique. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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93
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Ben Dhaou M, Jallouli M, Kchaou R, Chtourou R, Fourati H, Hentati Y, Mnif Z, Mhiri R. SFCP P-013 - Les localisations inhabituelles des lymphongiomes kystiques chez l’enfant : Etude de 6 cas. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71729-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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94
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Safi F, Hsairi M, Gargouri L, Maalej B, Ben Dhaou M, Mejdoub I, Jallouli M, Mhiri R, Mahfoudh A. SFP P-149 – Malformations broncho-pulmonaires chez l’enfant À propos de 7 cas. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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95
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Ben Dhaou M, Jallouli M, Ammar S, Mefteh S, Zitouni H, Kotti A, Mhiri R. SFCP P-012 - Hamartome du foie chez l’enfant. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71728-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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96
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Boukesra T, Zitouni H, Mefteh S, Ben Dhaou M, Jallouli M, Mhiri R. Preoperative clinical diagnosis of an amyand's hernia. LA TUNISIE MEDICALE 2014; 92:231-232. [PMID: 24955973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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97
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Ben Salah R, Frikha F, Kaddour N, Saidi N, Snoussi M, Marzouk S, Jallouli M, Frigui M, Bahloul Z. [Risk factor for deep venous thrombosis in internal medicine: A retrospective study of 318 cases]. Ann Cardiol Angeiol (Paris) 2014; 63:11-16. [PMID: 24035260 DOI: 10.1016/j.ancard.2013.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 06/28/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Venous thromboembolic disease is a common condition. Deep vein thrombosis (DVT) and pulmonary embolism are the most common manifestation but other locations may also occur. The objectives of the study were to estimate the incidence and determine the epidemiologic, topographic and associated conditions of venous thromboembolic disease in a department of internal medicine. METHODS A retrospective study of a series of 318 cases of DVT was conducted in Internal Medicine CHU Hedi Chaker, Sfax, during a period of 15 years (1996-2010). RESULTS DVT of the lower limbs was the most common location (87%). Other sites of DVT was noted in 16.35% of cases including upper limbs (19 cases), vena cava (16 cases), cerebral veins (10 cases), portal vein (10 cases) and hepatic vein (3 cases). A risk factor of VTE was found in 274 patients (86.1%). A state of thrombophilia was retained in 203 patients (63.5%). It was a hereditary thrombophilia (22.6%), an antiphospholipids syndrome (19.1%), Behçet's disease (16.4%) and neoplasia (7.2%). The study of the distribution of venous thrombosis as the seat and etiology showed that: the antiphospholipid syndrome was the most associated conditions with the upper extremity DVT (31.7%) whereas Behçet's disease was the most frequent etiology of vena cava thrombosis (7 cases) and the cerebral vein thrombosis especially in young males.
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Chérif Y, Jallouli M, Marzouk S, Snoussi M, Ben Salah R, Frikha F, Loukil H, Elaoud S, Triki S, Marrekchi G, Bahloul Z. Vascularites rétiniennes au cours de la maladie de Behçet : à propos de 24 cas. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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99
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Chérif Y, Jallouli M, Marzouk S, Snoussi M, Ben Salah R, Loukil H, Elaoud S, Marrekchi G, Triki S, Frikha F, Bahloul Z. Profil épidémiologique, clinique, étiologique, thérapeutique et évolutif des vascularites rétiniennes : à propos de 72 cas. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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100
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Jallouli M, Francès C, Piette JC, Huong DLT, Moguelet P, Factor C, Zahr N, Miyara M, Saadoun D, Mathian A, Haroche J, De Gennes C, Leroux G, Chapelon C, Wechsler B, Cacoub P, Amoura Z, Costedoat-Chalumeau N. Hydroxychloroquine-induced pigmentation in patients with systemic lupus erythematosus: a case-control study. JAMA Dermatol 2013; 149:935-40. [PMID: 23824340 DOI: 10.1001/jamadermatol.2013.709] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Hydroxychloroquine-induced pigmentation is not a rare adverse effect. Our data support the hypothesis that hydroxychloroquine-induced pigmentation is secondary to ecchymosis or bruising. OBJECTIVE To describe the clinical features and outcome of hydroxychloroquine (HCQ)-induced pigmentation in patients with systemic lupus erythematosus (SLE). DESIGN, SETTING, AND PARTICIPANTS In a case-control study conducted at a French referral center for SLE and antiphospholipid syndrome, 24 patients with SLE, with a diagnosis of HCQ-induced pigmentation, were compared with 517 SLE controls treated with HCQ. MAIN OUTCOMES AND MEASURES The primary outcome was the clinical features of HCQ-induced pigmentation. Skin biopsies were performed on 5 patients, both in healthy skin and in the pigmented lesions. The statistical associations of HCQ-induced pigmentation with several variables were calculated using univariate and multivariate analyses. RESULTS Among the 24 patients, skin pigmentation appeared after a median HCQ treatment duration of 6.1 years (range, 3 months-22 years). Twenty-two patients (92%) reported that the appearance of pigmented lesions was preceded by the occurrence of ecchymotic areas, which gave way to a localized blue-gray or brown pigmentation that persisted. Twenty-three patients (96%) had at least 1 condition predisposing them to easy bruising. Results from skin biopsies performed on 5 patients showed that the median concentration of iron was significantly higher in biopsy specimens of pigmented lesions compared with normal skin (4115 vs 413 nmol/g; P < .001). Using multivariate logistic regression, we found that HCQ-induced pigmentation was independently associated with previous treatment with oral anticoagulants and/or antiplatelet agents and with higher blood HCQ concentration. CONCLUSIONS AND RELEVANCE Hydroxychloroquine-induced pigmentation is not a rare adverse effect of HCQ. Our data support the hypothesis that HCQ-induced pigmentation is secondary to ecchymosis or bruising.
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