[Cardiac sarcoidosis: a diagnostic and therapeutic challenge]

The diagnosis of cardiac sarcoidosis, particularly in its isolated cardiac form, represents a major challenge due to non-specific symptoms and the limited sensitivity and specificity of basic cardiac investigations. MRI and metabolic PET-CT are important elements in the diagnostic process. Corticosteroids remain the cornerstone for the treatment of the inflammatory phase, in association with biological agents and steroid-sparing therapies. The goal is to limit the progression of fibrosis, which is a source of malignant arrhythmias and heart failure. The indication for implantation of a cardiac defibrillator must be carefully evaluated to reduce the risk of sudden death. Multidisciplinary collaboration is essential for optimal care.

Renal involvement in systemic sclerosis

Systemic sclerosis is a rare autoimmune vasculopathy associated with dysregulated innate and adaptive immunity that leads to generalized systemic fibrosis. Renal involvement occurs in a significant proportion of systemic sclerosis patients, and is associated with worse outcome. Scleroderma renal crisis (SRC) is the most studied and feared renal complication described in systemic sclerosis. However, with the emergence of ACE inhibitors and better management, the mortality rate of SRC has significantly decreased. Renal disease in systemic sclerosis offers a wide array of differential diagnoses that may be challenging for the clinician. The spectrum of renal manifestations in systemic sclerosis ranges from an isolated decrease in glomerular filtration rate, increased intrarenal arterial stiffness, and isolated proteinuria due to SRC to more rare manifestations such as association with antiphospholipid antibody nephropathy and ANCA-associated vasculitis. The changes observed in the kidneys in systemic sclerosis are thought to be due to a complex interplay of various factors, including renal vasculopathy, as well as the involvement of the complement system, vasoactive mediators such as endothelin-1, autoimmunity, prothrombotic and profibrotic cytokines, among others. This literature review aims to provide an overview of the main renal manifestations in systemic sclerosis by discussing the most recent epidemiological and pathophysiological data available and the challenges for clinicians in making a diagnosis of renal disease in patients with systemic sclerosis.

[Acute hepatitis as an inaugural presentation of systemic lupus erythematosus]

Systemic lupus erythematosus (SLE) is a complex multiorgan autoimmune disease with varied clinical and laboratory manifestations. Although common in lupus disease, liver test disturbance is rarely seen as a primary manifestation at diagnosis. In this case report, we describe acute hepatitis as the initial presentation of SLE in a young woman.

[Idiopathic recurrent pericarditis: review of the literature and the Geneva experience]

The notion of idiopathic recurrent pericarditis (IRP) appeared in the scientific literature in the 1930s. In 1955, W. Dressler published a case series of IRP in which treatment of cortisone and salicylates (i.e. Aspirin) was effective. About 30 years later, De La Serna et al. in 1987 and Guindo et al. in 1990, reported a beneficial effect of colchicine. In recent years, several clinical studies have helped to i mprove the management of this disease. In this present literature review of IRP, we will focus on the definition, differential diagnoses, pathophysiological hypotheses and available treatments. We will also discuss the clinical experience at the division of clinical immunology at the University Hospitals of Geneva.

[New onset atrial fibrillation in patients hospitalized with sepsis : is there an indication for anticoagulation ?]

Atrial fibrillation (AF) is the most common cardiac arrhythmia in the general population and in patients with sepsis hospitalized in intensive care. The indication for long-term anticoagulation is based on expert recommendations that take into account data from the general population and thus recommend therapeutic anticoagulation for AF longer than 48 hours. However, a majority of new onset AF in intensive care seem to last less than 48 hours and additional risk factors such as the type of sepsis, the drugs administered as well as the presence of a central venous catheters, are involved. Moreover, the increased of minor and major hemorrhage renders it difficult to apply the usual recommendations. In this literature review, we will focus on the various risk factors, prognosis, and indication of long-term anticoagulation in the new onset AF in this population.

[Fever in a returning traveler from Tuscany]

Arbovirus infections are emerging pathogens leading sometimes to severe disease. This virus is transmitted by sandflies in the Mediterranean countries during the summer season. The disease is often asymptomatic but can also cause an influenza-like illness and aseptic meningitis or encephalitis. The treatment is supportive and preventive measures should be taken in order to avoid an infection when travelling to the affected areas. The differential diagnosis of fever in the returning traveler from southern European countries should include Toscana virus.