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Grandière L, Gille T, Brillet PY, Didier M, Freynet O, Vicaire H, Clero D, Martinod E, Mathian A, Uzunhan Y. [Tracheobronchial involvement in relapsing polychondritis and differential diagnoses]. Rev Mal Respir 2024; 41:421-438. [PMID: 38762394 DOI: 10.1016/j.rmr.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/22/2024] [Indexed: 05/20/2024]
Abstract
Relapsing polychondritis is a systemic auto-immune disease that mainly affects cartilage structures, progressing through inflammatory flare-ups between phases of remission and ultimately leading to deformation of the cartilages involved. In addition to characteristic damage of auricular or nasal cartilage, tracheobronchial and cardiac involvement are particularly severe, and can seriously alter the prognosis. Tracheobronchial lesions are assessed by means of a multimodal approach, including dynamic thoracic imaging, measurement of pulmonary function (with recent emphasis on pulse oscillometry), and mapping of tracheal lesions through flexible bronchoscopy. Diagnosis can be difficult in the absence of specific diagnostic tools, especially as there may exist a large number of differential diagnoses, particularly as regards inflammatory diseases. The prognosis has improved, due largely to upgraded interventional bronchoscopy techniques and the development of immunosuppressant drugs and targeted therapies, offering patients a number of treatment options.
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Affiliation(s)
- L Grandière
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France
| | - T Gille
- Service de physiologie-explorations fonctionnelles, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France; Inserm UMR 1272 hypoxie et poumon, UFR SMBH Léonard de Vinci, université Sorbonne Paris Nord, 125, rue de Stalingrad, 93000 Bobigny, France
| | - P-Y Brillet
- Service de radiologie, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France
| | - M Didier
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France
| | - O Freynet
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France
| | - H Vicaire
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France
| | - D Clero
- Service d'oto-rhino-laryngologie, hôpital de la Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris - Sorbonne université, Paris 13(e), France
| | - E Martinod
- Service de chirurgie thoracique et vasculaire, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France; Inserm UMR 1272 hypoxie et poumon, UFR SMBH Léonard de Vinci, université Sorbonne Paris Nord, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A Mathian
- Centre de référence pour le lupus, le syndrome des anti-phospholipides et autres maladies auto-immunes rares, service de médecine interne 2, Institut E3M, Assistance publique-Hôpitaux de Paris (AP-HP), groupement hospitalier Pitié-Salpêtrière, Paris, France
| | - Y Uzunhan
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France; Inserm UMR 1272 hypoxie et poumon, UFR SMBH Léonard de Vinci, université Sorbonne Paris Nord, 125, rue de Stalingrad, 93000 Bobigny, France.
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Jamilloux Y, Bernard C, Lortholary O, Kerever S, Lelièvre L, Gerfaud-Valentin M, Broussolle C, Valeyre D, Sève P. [Opportunistic infections and sarcoidosis]. Rev Med Interne 2016; 38:320-327. [PMID: 27639910 DOI: 10.1016/j.revmed.2016.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/14/2016] [Accepted: 08/09/2016] [Indexed: 11/17/2022]
Abstract
Opportunistic infections (OI) are uncommon in sarcoidosis (1 to 10%) and mostly occur in patients with previously diagnosed disease or can rarely be the presenting manifestation. The most common OIs are, in descending order: aspergillosis, cryptococcosis, and mycobacterial infections. Treatment with corticosteroids is the most frequent risk factor for OI occurrence during sarcoidosis but immunosuppressive drugs and therapy with anti-TNFα are also risk factors. Overall, clinical presentation, treatment, and outcome are identical to that occur in other conditions complicated with the occurrence of OIs. However, some atypical presentations of OIs can mimic sarcoidosis exacerbation and misdiagnosis may lead clinicians to increase immunosuppression, causing worsening of the OI. The meticulous collection of patient's history along with factors differentiating OI from sarcoidosis exacerbation is key factor to optimally manage these patients.
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Affiliation(s)
- Y Jamilloux
- Service de médecine interne, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard-Lyon 1, 69004 Lyon, France; International research center on infectiology (CIRI), Inserm U1111, 69007 Lyon, France.
| | - C Bernard
- Service de médecine interne, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard-Lyon 1, 69004 Lyon, France
| | - O Lortholary
- Necker Pasteur center for infectious diseases and tropical medicine, Necker enfants malades, IHU Imagine, AP-HP, 75743 Paris, France; Institut Pasteur, centre national de référence des mycoses invasives, des antifongiques, et de mycologie moléculaire, 75743 Paris, France; CNRS URA3012, 75743 Paris, France
| | - S Kerever
- ECSTRA, épidémiologie et biostatistiques, UMR 1153, Inserm, 75004 Paris, France
| | - L Lelièvre
- Service de médecine interne, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard-Lyon 1, 69004 Lyon, France
| | - M Gerfaud-Valentin
- Service de médecine interne, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard-Lyon 1, 69004 Lyon, France
| | - C Broussolle
- Service de médecine interne, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard-Lyon 1, 69004 Lyon, France
| | - D Valeyre
- COMUE Sorbonne Paris Cité, hôpital Avicenne et université Paris 13, Assistance publique-Hôpitaux de Paris, 93000 Bobigny, France
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard-Lyon 1, 69004 Lyon, France
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