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Peyre M, Sicre de Fontbrune F, Berceanu A, Benjemia L, Castelle M, D'Aveni M, Marçais A, Kaphan E, Bulabois CE, Sirvent A, Rohrlich PS, Coiteux V, Chantepie S, Nguyen-Quoc S, Peffault de Latour R, Coppo P. Efficacy of eculizumab in transplantation-associated thrombotic microangiopathy: results of the French nationwide study on behalf of the SFGM-TC and the CNR-MAT. Bone Marrow Transplant 2024:10.1038/s41409-024-02279-2. [PMID: 38605146 DOI: 10.1038/s41409-024-02279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/14/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Marion Peyre
- Hematology Department, Saint-Antoine Hospital, APHP, Paris, France
| | - Flore Sicre de Fontbrune
- Hematology Transplant Unit - French Reference Center for Aplastic Anemia, Saint Louis Hospital, APHP, Paris, France.
| | - Ana Berceanu
- Hematology Department, Besançon University Hospital, Besançon, France
| | - Lise Benjemia
- Hematology Department, Besançon University Hospital, Besançon, France
| | - Martin Castelle
- Pediatric Hematology-Immunology and Rheumatology Unit, Necker Hospital, APHP, Paris, France
| | - Maud D'Aveni
- Hematology Department, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | | | - Eleonore Kaphan
- Hematology Department, Grenoble University Hospital, Grenoble, France
| | | | - Anne Sirvent
- Hematology Department, Montpellier University Hospital, Montpellier, France
| | | | - Valerie Coiteux
- Hematology Department, Lille University Hospital, Lille, France
| | | | | | - Régis Peffault de Latour
- Hematology Transplant Unit - French Reference Center for Aplastic Anemia, Saint Louis Hospital, APHP, Paris, France
| | - Paul Coppo
- Hematology Department, Saint-Antoine Hospital, APHP, Paris, France.
- French Reference Center for Thrombotic Microangiopathies, Paris, France.
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France.
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2
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Carvelli J, Bourenne J, Boucraut J, Kaphan E, Delteil C. Fulminant acute disseminated encephalomyelitis (ADEM). A difficult diagnosis and yet an absolute emergency. Rev Neurol (Paris) 2023; 179:923-924. [PMID: 37482490 DOI: 10.1016/j.neurol.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 07/25/2023]
Affiliation(s)
- J Carvelli
- Assistance publique-Hôpitaux de Marseille, Hôpital de la Timone, Réanimation des Urgences, Marseille, France; Aix-Marseille Université, Marseille, France.
| | - J Bourenne
- Assistance publique-Hôpitaux de Marseille, Hôpital de la Timone, Réanimation des Urgences, Marseille, France; Aix-Marseille Université, Marseille, France
| | - J Boucraut
- Aix-Marseille Université, Marseille, France; Assistance publique-Hôpitaux de Marseille, Hôpital de la Timone, Biogénopôle, Inserm, INS, Institut de Neurosciences, Marseille, France
| | - E Kaphan
- Assistance publique-Hôpitaux de Marseille, Hôpital de la Conception, Médecine Interne et Immunologie clinique, Marseille, France
| | - C Delteil
- Aix-Marseille Université, Marseille, France; Assistance publique-Hôpitaux de Marseille, Département de médecine légale, Hôpital de la Timone, Marseille, France
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3
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Kaphan E, Bettega F, Forcade E, Labussière-Wallet H, Fegueux N, Robin M, De Latour RP, Huynh A, Lapierre L, Berceanu A, Marcais A, Debureaux PE, Vanlangendonck N, Bulabois CE, Magro L, Daniel A, Galtier J, Lioure B, Chevallier P, Antier C, Loschi M, Guillerm G, Mear JB, Chantepie S, Cornillon J, Rey G, Poire X, Bazarbachi A, Rubio MT, Contentin N, Orvain C, Dulery R, Bay JO, Croizier C, Beguin Y, Charbonnier A, Skrzypczak C, Desmier D, Villate A, Carré M, Thiebaut-Bertrand A. Late relapse after hematopoietic stem cell transplantation for acute leukemia: a retrospective study by SFGM-TC. Transplant Cell Ther 2023:S2666-6367(23)01129-6. [PMID: 36849078 DOI: 10.1016/j.jtct.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
Late relapse (LR) after allogeneic hematopoietic stem cell transplantation (AHSCT) for acute leukemia is a rare event (nearly 4.5%) and raises the questions of prognosis and outcome after salvage therapy. We performed a retrospective multicentric study between January 1, 2010, and December 31, 2016, using data from the French national retrospective register ProMISe provided by the SFGM-TC (French Society for Bone Marrow Transplantation and Cellular Therapy). We included patients presenting with LR, defined as a relapse occurring at least 2 years after AHSCT. We used the Cox model to identify prognosis factors associated with LR. During the study period, a total of 7582 AHSCTs were performed in 29 centers, and 33.8% of patients relapsed. Among them, 319 (12.4%) were considered to have LR, representing an incidence of 4.2% for the entire cohort. The full dataset was available for 290 patients, including 250 (86.2%) with acute myeloid leukemia and 40 (13.8%) with acute lymphoid leukemia. The median interval from AHSCT to LR was 38.2 months (interquartile range [IQR], 29.2 to 49.7 months), and 27.2% of the patients had extramedullary involvement at LR (17.2% exclusively and 10% associated with medullary involvement). One-third of the patients had persistent full donor chimerism at LR. Median overall survival (OS) after LR was 19.9 months (IQR, 5.6 to 46.4 months). The most common salvage therapy was induction regimen (55.5%), with complete remission (CR) obtained in 50.7% of cases. Ninety-four patients (38.5%) underwent a second AHSCT, with a median OS of 20.4 months (IQR, 7.1 to 49.1 months). Nonrelapse mortality after second AHSCT was 18.2%. The Cox model identified the following factors as associated with delay of LR: disease status not in first CR at first HSCT (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.04 to 1.64; P = .02) and the use of post-transplantation cyclophosphamide (OR, 2.23; 95% CI, 1.21 to 4.14; P = .01). Chronic GVHD appeared to be a protective factor (OR, .64; 95% CI, .42 to .96; P = .04). The prognosis of LR is better than in early relapse, with a median OS after LR of 19.9 months. Salvage therapy associated with a second AHSCT improves outcome and is feasible, without creating excess toxicity.
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Affiliation(s)
- E Kaphan
- Department of Hematology-Transplantation, CHU Grenoble, Grenoble, France.
| | - F Bettega
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - E Forcade
- Department of Hematology-Transplantation, Hôpital de Bordeaux, Bordeaux, France
| | - H Labussière-Wallet
- Department of Hematology-Transplantation, CHU Lyon Sud, Pierre-Bénite, France
| | - N Fegueux
- Department of Hematology, CHU Montpellier, Montpellier, France
| | - M Robin
- Department of Hematology-Transplantation, Hôpital Saint-Louis, APHP, Université de Paris, Paris, France
| | - R Peffault De Latour
- Department of Hematology-Transplantation, Hôpital Saint-Louis, APHP, Université de Paris, Paris, France
| | - A Huynh
- Department of Hematology, Transplantation, and Cellular Therapy, IUCT Oncopole, Toulouse, France
| | - L Lapierre
- Department of Hematology, Transplantation, and Cellular Therapy, IUCT Oncopole, Toulouse, France
| | - A Berceanu
- Department of Intensive Care and Transplantation, CHU Jean Minjoz, Besançon, France
| | - A Marcais
- Department of Hematology, Hôpital Necker, Paris, France
| | - P E Debureaux
- Department of Hematology-Transplantation, Hôpital Saint-Louis, APHP, Université de Paris, Paris, France
| | - N Vanlangendonck
- Department of Hematology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - C-E Bulabois
- Department of Hematology-Transplantation, CHU Grenoble, Grenoble, France
| | - L Magro
- Department of Hematology-Transplantation, CHRU Lille, Lille, France
| | - A Daniel
- Department of Hematology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - J Galtier
- Department of Hematology-Transplantation, Hôpital de Bordeaux, Bordeaux, France
| | - B Lioure
- Department of Hematology, CHRU Strasbourg, Strasbourg, France
| | - P Chevallier
- Department of Hematology, CHU Nantes, Nantes, France
| | - C Antier
- Department of Hematology, CHU Nantes, Nantes, France
| | - M Loschi
- Department of Hematology-Transplantation, CHU Nice, Nice, France
| | - G Guillerm
- Department of Hematology, CHRU Brest, Brest, France
| | - J B Mear
- Department of Hematology-Transplantation, Hôpital de Rennes, Rennes, France
| | - S Chantepie
- Basse-Normandie Hematology Institute, CHU Caen, Caen, France
| | - J Cornillon
- Department of Clincial Hematology and Cellular Therapy, CHU Saint-Étienne, Saint-Priest-en-Jarez, France
| | - G Rey
- Department of Clincial Hematology and Cellular Therapy, CHU Saint-Étienne, Saint-Priest-en-Jarez, France
| | - X Poire
- Department of Hematology, CHU Saint-Luc, Brussels, Belgium
| | - A Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - M T Rubio
- Department of Hematology, CHU Nancy, Nancy, France
| | - N Contentin
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | - C Orvain
- Department of Hematology-Transplantation, CHU Angers, Angers, France
| | - R Dulery
- Department of Clinical Hematology, CHU St Antoine, APHP, Paris, France
| | - J O Bay
- Department of Clinical Hematology and Cellular Therapy, CHU Estaing, Clermont-Ferrand, France
| | - C Croizier
- Department of Clinical Hematology and Cellular Therapy, CHU Estaing, Clermont-Ferrand, France
| | - Y Beguin
- CU of Liège and University of Liège, Liège, Belgium
| | - A Charbonnier
- Department of Hematology-Transplantation, CHU Amiens, Amiens, France
| | - C Skrzypczak
- Department of Hematology-Transplantation, CHU Amiens, Amiens, France
| | - D Desmier
- Department of Hematology, CHU Poitiers, Poitiers, France
| | - A Villate
- Department of Hematology, CHRU Tours, Tours, France
| | - M Carré
- Department of Hematology-Transplantation, CHU Grenoble, Grenoble, France
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4
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Daniel A, Ghez D, Ravaiau C, Cavalieri D, Tournilhac O, Herbaux C, Roriz M, Wemeau M, Guillet S, Bossard JB, Hélène D, Kaphan E, Caroline R, Florence L, Pierache A, Michel M, Godeau B, Terriou L. Ibrutinib as a treatment of hematologic autoimmune disorders in patients with indolent B-cell lymphoma. Eur J Haematol 2022; 109:719-727. [PMID: 36048142 PMCID: PMC9826375 DOI: 10.1111/ejh.13858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Autoimmune conditions in B-cell lymphomas are frequent. Steroids are standard of care, but many patients require other immunosuppressive agents. Ibrutinib is a Bruton Tyrosine Kinase inhibitor that is approved for B-cell indolent lymphoma treatment. We evaluated the use of ibrutinib in previously treated hematologic immune manifestations associated with B-cell lymphomas. RESULTS We conducted a retrospective multicentric observational study. Patients presenting with active, relapsed/refractory B-cell lymphoma associated hematological immune manifestation (autoimmune cytopenia, acquired immune-mediated bleeding disorders) were included. Twenty-five patients were identified. Median age at ibrutinib introduction was 69 years (range 44-84) and median number of previous treatment lines before ibrutinib was 2 (1-7). Twenty-two patients (88%) were on concomitant stable treatment at inclusion. Within a median exposure of 8 months (2-35), overall response rate to ibrutinib on immune manifestations was 76% (95% CI, 54.9-90.6); complete response rate 44%. Fourteen patients (63%) were able to be weaned from concomitant treatments. Fourteen patients (56%) presented treatment-related adverse events, mostly Grade 1 or 2. CONCLUSIONS Ibrutinib in this setting provides good efficacy and safety profile. Clinical trials are needed to define subgroups of patients who will benefit from this strategy and establish its place in the therapeutic arsenal.
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Affiliation(s)
- Adrien Daniel
- Department of HematologyClaude Huriez University HospitalLilleFrance
| | - David Ghez
- Department of Hematology and INSERM UMR1030Gustave RoussyVillejuifFrance
| | - Camille Ravaiau
- Department of Internal MedicineAngers University HospitalAngersFrance
| | - Doriane Cavalieri
- Department of HematologyEstaing University HospitalClermont‐FerrandFrance
| | - Olivier Tournilhac
- Department of HematologyEstaing University HospitalClermont‐FerrandFrance
| | - Charles Herbaux
- Department of HematologySt Eloi University HospitalMontpellierFrance
| | - Mélanie Roriz
- Department of Internal MedicineAgen‐Nérac HospitalAgenFrance
| | - Mathieu Wemeau
- Department of HematologyVictor Provo HospitalRoubaixFrance
| | - Stéphanie Guillet
- Department of Internal MedicineHenri‐Mondor University Hospital, Assistance Publique des Hôpitaux de ParisParisFrance
| | | | | | - Eleonore Kaphan
- Department of HematologyGrenoble‐Alpes University HospitalGrenobleFrance
| | - Regny Caroline
- Department of HematologyPierre Oudot HospitalBourgoin‐JallieuFrance
| | | | - Adeline Pierache
- Univ.Lille, CHU Lille, ULR 2694—METRICS: évaluation des technologies de santé et des pratiques médicalesLilleFrance
| | - Marc Michel
- Department of Internal MedicineHenri‐Mondor University Hospital, Assistance Publique des Hôpitaux de ParisParisFrance
| | - Bertrand Godeau
- Department of Internal MedicineHenri‐Mondor University Hospital, Assistance Publique des Hôpitaux de ParisParisFrance
| | - Louis Terriou
- Department of Internal Medicine and Clinical ImmunologyUniversity of LilleLilleFrance
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Longval T, Galimard JE, Leprêtre AC, Suarez F, Amiranoff D, Cazaux M, Kaphan E, Michonneau D, Dhedin N, Coman T, Nguyen Quoc S, Peffault de Latour R, Resche-Rigon M, Sicre de Fontbrune F. Treatment for pure red cell aplasia after major ABO-incompatible allogeneic stem cell transplantation: a multicentre study. Br J Haematol 2021; 193:814-826. [PMID: 33844842 DOI: 10.1111/bjh.17463] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
Pure red cell aplasia (PRCA) following allogeneic haematopoietic stem cell transplantation (aHSCT) with major ABO incompatibility is responsible for transfusion dependent anaemia, impaired quality of life and iron overload. We conducted a retrospective study, over a 10-year period, which included all consecutive patients who received a major ABO mismatched aHSCT, to assess the impact of specific treatment on PRCA. We did not observe any PRCA in the 57 aHSCT issued from cord blood. Among the remaining 631 patients, cumulative incidence of PRCA was 10·5% [range 8·2-13.0]. The median duration of resolved PRCA was 171 days [IQR 116; 261]. Pre-transplant high isohaemagglutinins titre was associated with an increased risk of PRCA (P < 10-4 ). PRCA did not affect overall survival (P = 0·95). Twenty-two patients (33·3%) received at least one specific treatment. The most commonly used treatments were rituximab (17 patients) and donor lymphocyte infusion (DLI; seven patients). Regarding PRCA resolution, we did not observe a significant difference between treated or untreated subjects (HR = 0·93, 95% confidence interval (CI) 0·48- 1·80; P = 0·82). Similar results were observed with erythropoietin treatment (22 patients, HR = 0·86 95% CI: [0·47-1·57] P = 0·62). Our data do not support the use of erythropoietin, rituximab or DLI for the treatment of PRCA.
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Affiliation(s)
- Thomas Longval
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Jacques-Emmanuel Galimard
- Centre of Research in Epidemiology and Statistics, Sorbonne Paris Cité, INSERM, UMR-1153, ECSTRRA Team, Paris, France
| | | | - Felipe Suarez
- Adult Haematology Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Denise Amiranoff
- Établissement Français du Sang (EFS), Necker-Enfants Malades Hospital, Paris, France
| | - Marine Cazaux
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Eleonore Kaphan
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - David Michonneau
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Nathalie Dhedin
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Tereza Coman
- Haematology Department, Gustave-Roussy, Villejuif, France
| | | | - Régis Peffault de Latour
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Matthieu Resche-Rigon
- Centre of Research in Epidemiology and Statistics, Sorbonne Paris Cité, INSERM, UMR-1153, ECSTRRA Team, Paris, France.,Biostatistics Unit, SBIM, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Flore Sicre de Fontbrune
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
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6
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Guedj E, Campion JY, Dudouet P, Kaphan E, Bregeon F, Tissot-Dupont H, Guis S, Barthelemy F, Habert P, Ceccaldi M, Million M, Raoult D, Cammilleri S, Eldin C. 18F-FDG brain PET hypometabolism in patients with long COVID. Eur J Nucl Med Mol Imaging 2021; 48:2823-2833. [PMID: 33501506 PMCID: PMC7837643 DOI: 10.1007/s00259-021-05215-4] [Citation(s) in RCA: 232] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/19/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE In the context of the worldwide outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), some patients report functional complaints after apparent recovery from COVID-19. This clinical presentation has been referred as "long COVID." We here present a retrospective analysis of 18F-FDG brain PET of long COVID patients from the same center with a biologically confirmed diagnosis of SARS-CoV-2 infection and persistent functional complaints at least 3 weeks after the initial infection. METHODS PET scans of 35 patients with long COVID were compared using whole-brain voxel-based analysis to a local database of 44 healthy subjects controlled for age and sex to characterize cerebral hypometabolism. The individual relevance of this metabolic profile was evaluated to classify patients and healthy subjects. Finally, the PET abnormalities were exploratory compared with the patients' characteristics and functional complaints. RESULTS In comparison to healthy subjects, patients with long COVID exhibited bilateral hypometabolism in the bilateral rectal/orbital gyrus, including the olfactory gyrus; the right temporal lobe, including the amygdala and the hippocampus, extending to the right thalamus; the bilateral pons/medulla brainstem; the bilateral cerebellum (p-voxel < 0.001 uncorrected, p-cluster < 0.05 FWE-corrected). These metabolic clusters were highly discriminant to distinguish patients and healthy subjects (100% correct classification). These clusters of hypometabolism were significantly associated with more numerous functional complaints (brainstem and cerebellar clusters), and all associated with the occurrence of certain symptoms (hyposmia/anosmia, memory/cognitive impairment, pain and insomnia) (p < 0.05). In a more preliminary analysis, the metabolism of the frontal cluster which included the olfactory gyrus was worse in the 7 patients treated by ACE drugs for high blood pressure (p = 0.032), and better in the 3 patients that had used nasal decongestant spray at the infectious stage (p < 0.001). CONCLUSION This study demonstrates a profile of brain PET hypometabolism in long COVID patients with biologically confirmed SARS-CoV-2 and persistent functional complaints more than 3 weeks after the initial infection symptoms, involving the olfactory gyrus and connected limbic/paralimbic regions, extended to the brainstem and the cerebellum. These hypometabolisms are associated with patients' symptoms, with a biomarker value to identify and potentially follow these patients. The hypometabolism of the frontal cluster, which included the olfactory gyrus, seems to be linked to ACE drugs in patients with high blood pressure, with also a better metabolism of this olfactory region in patients using nasal decongestant spray, suggesting a possible role of ACE receptors as an olfactory gateway for this neurotropism.
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Affiliation(s)
- E Guedj
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix-Marseille University, Marseille, France.
| | - J Y Campion
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix-Marseille University, Marseille, France
| | - P Dudouet
- IHU-Méditerranée Infection, Marseille, France.,IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France
| | - E Kaphan
- APHM, Service de Neurologie, Hôpital de la Timone, Marseille, France
| | - F Bregeon
- IHU-Méditerranée Infection, Marseille, France.,IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France.,Service des Explorations Fonctionnelles Respiratoires, CHU Nord, APHM, Marseille, France
| | | | - S Guis
- Service de Rhumatologie, Hôpital de Sainte Marguerite, AP-HM, CNRS, CRMBM-CEMEREM, UMR CNRS 7339, Aix-Marseille Université, Marseille, France
| | - F Barthelemy
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix-Marseille University, Marseille, France
| | - P Habert
- Radiology Department, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13005, Marseille 05, France.,LIIE, Aix-Marseille University, Marseille, France
| | - M Ceccaldi
- INSERM, Inst Neurosci Syst, & APHM, Service de Neurologie et de Neuropsychologie, CHU Timone, Aix-Marseille University, Marseille, France
| | - M Million
- IHU-Méditerranée Infection, Marseille, France.,IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France
| | - D Raoult
- IHU-Méditerranée Infection, Marseille, France.,IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France
| | - S Cammilleri
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix-Marseille University, Marseille, France
| | - C Eldin
- IHU-Méditerranée Infection, Marseille, France.,IRD, AP-HM, SSA, VITROME, Aix-Marseille University, Marseille, France
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7
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Meunier B, Seguier J, Briantais A, Coulon A, De Sainte Marie B, Ebbo M, Faucher B, Kaphan E, Aurran-Schleinitz T, Harlé J, Barlogis V, Schleinitz N. Leucoencéphalopathie multifocale progressive : complication tardive d’un déficit monogénique de type XIAP ? Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Bouroumeau A, Kaphan E, Legrand C, Raskovalova T, Szymanski G, Vettier C, Lefebvre C, Jacob MC, McLeer A, Peuchmaur M, Gressin R, Sartelet H. Transformation of a low-grade follicular lymphoma into a composite lymphoma combining a high-grade B-cell lymphoma and a lymphoblastic neoplasm expressing Terminal deoxynucleotidyl Transferase: a case report. J Med Case Rep 2020; 14:117. [PMID: 32713346 PMCID: PMC7384216 DOI: 10.1186/s13256-020-02433-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/04/2020] [Indexed: 12/11/2022] Open
Abstract
Background High-grade B-cell lymphoma with rearrangements of MYC and BCL2 and/or BCL6 is an aggressive mature B-cell neoplasm, whereas B-lymphoblastic lymphoma is immature cell proliferation, with a frequent positivity for terminal deoxynucleotidyl transferase. The transformation of a low-grade follicular lymphoma into a lymphoblastic neoplasm expressing terminal deoxynucleotidyl transferase is a very rare event. Case presentation A 55-year-old Caucasian man was followed for a grade 1–2 follicular lymphoma carrying a t(14;18) IGH/BCL2+ and was initially treated with R-CHOP. The follicular lymphoma presented two relapses. In the third relapse, the patient had multiple lymphadenopathy and ascites, which motivated a retroperitoneal biopsy and an ascitic tap. These samples were analyzed by histological, cytological, flow cytometric, cytogenetic, and molecular assessments. The patient died of a multiple organ dysfunction syndrome 2 weeks after his third relapse. The biopsy revealed a diffuse proliferation made up of two types of tumor cells: centroblasts (Bcl-6-positive) and immature cells (terminal deoxynucleotidyl transferase-positive). Flow cytometric analysis confirmed the immature phenotype, with an expression of terminal deoxynucleotidyl transferase, combined with a loss of membrane immunoglobulins. The cytogenetic analysis performed on the ascites revealed a clonal evolution characterized by a t(8;22)(q24;q11) MYC+ translocation not previously detected in follicular lymphoma. Fluorescence in situ hybridization confirmed the double rearrangement of the BCL2 and MYC genes. Polymerase chain reactions and sequencing were used to study the clonal relationship between follicular lymphoma and the secondary tumors. The IGVH gene rearrangement revealed a unique clonal rearrangement involving an IGVH4–59 subset in all three specimens. Conclusion These findings suggest a clonal relationship between the two types of lymphoma cells. Furthermore, they support the transformation of an acute follicular lymphoma into a composite lymphoma combining a high-grade B-cell lymphoma and a lymphoblastic neoplasm expressing terminal deoxynucleotidyl transferase. This case report highlights the possible transformation of follicular lymphoma into a highly aggressive and immature proliferation.
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Affiliation(s)
| | | | - Clémentine Legrand
- Laboratory of Hematology and Oncohematology, CHU de Grenoble, Grenoble, France
| | - Tatiana Raskovalova
- Laboratory of Hematology and Oncohematology, CHU de Grenoble, Grenoble, France
| | - Gautier Szymanski
- Laboratory of Hematology and Oncohematology, CHU de Grenoble, Grenoble, France
| | - Claire Vettier
- Laboratory of Hematology and Oncohematology, CHU de Grenoble, Grenoble, France
| | - Christine Lefebvre
- Laboratory of Hematology and Oncohematology, CHU de Grenoble, Grenoble, France
| | | | - Anne McLeer
- Department of Pathology, CHU de Grenoble, Grenoble, France
| | | | - Rémy Gressin
- Department of Hematology, CHU de Grenoble, Grenoble, France
| | - Hervé Sartelet
- Department of Pathology, CHU de Grenoble, Grenoble, France.
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Kaphan E, Germi R, Carré M, Bulabois C, Bailly S, Cahn J, Thiebaut-Bertrand A. Facteurs de risque de cystites à BK virus post allogreffe de cellules souches hématopoïétiques. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Melenotte C, Ebbo M, Régent A, Tieulie N, Mekinian A, Closs-Prophette F, Kaphan E, Hamidou M, Feyeux D, Audoin B, Harlé J, Schleinitz N. Présentation clinique, biologique et radiologique des pachyméningites associées aux IgG4. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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11
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Ete M, Cally R, Patient M, Poullin P, Boucraut J, Bernit E, Ebbo M, Harlé J, Kaphan E, Schleinitz N. Amélioration spectaculaire d’une encéphalite limbique à anti-contactin-associated protein-like 2 (CASPR2) par des échanges plasmatiques. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Le Dault E, Lagarde S, Guedj E, Dufournet B, Rey C, Kaphan E, Tanguy G, Bregigeon M, Sagui E, Brosset C. [Unexplicated neuropsychiatric disorders: Do not ignore dysimmune encephalitis. A case report of a dysimmune encephalitis with anti-leucine rich glioma inactivated 1 (LGI-1) antibodies]. Rev Med Interne 2015; 37:127-30. [PMID: 26164401 DOI: 10.1016/j.revmed.2015.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/22/2015] [Accepted: 06/05/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Anti-leucine rich glioma inactivated 1 encephalitis is a common and a treatable etiology of autoimmune encephalitis. Its diagnosis is a challenge because the initial diagnostic work-up is often normal. CASE REPORT A 48-year-old man experienced cognitive and behavioral troubles, facio-brachial dystonic seizures and a syndrome of inappropriate antidiuretic hormone secretion. First line tests excluded infectious, neoplastic, systemic inflammatory, endrocrine or toxic etiologies. Cerebral (18)Fluoro-desoxy-glucose (FDG) position emission tomography and research of specific antibodies in cerebro-spinal fluid and serum led to diagnose an anti-leucine rich glioma inactivated 1 encephalitis. Intravenous immunoglobulins and corticosteroids were partially effective. Cyclophosphamid permitted a good recovery. CONCLUSION In the presence of acute neuropsychiatric disorders with a negative etiologic research, physician should think about dysimmune encephalitis. Facio-brachial dystonic seizures and syndrome of inappropriate antidiuretic hormone secretion are highly evocative of anti-leucine rich glioma inactivated 1 encephalitis. The diagnosis needs specific diagnostic tests (cerebral (18)FDG position emission tomography and antibodies research in cerebro-spinal fluid and in serum), after the exclusion of alternative diagnoses. Extensive and repeated diagnostic work-up for neoplasia is required. Immunosupressive therapies are effective in most cases.
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Affiliation(s)
- E Le Dault
- Service de pathologie infectieuse et tropicale, hôpital d'instruction des armées Laveran, 34, boulevard Alphonse-Laveran, 13014 Marseille, France.
| | - S Lagarde
- Service de neurologie, hôpital d'instruction des armées Laveran, 34, boulevard Alphonse-Laveran, 13014 Marseille, France
| | - E Guedj
- Service de médecine nucléaire, CHU La Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - B Dufournet
- Service de neurologie, CHU La Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - C Rey
- Service de neurologie, CHU La Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - E Kaphan
- Service de neurologie, CHU La Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - G Tanguy
- Service de neurologie, hôpital d'instruction des armées Laveran, 34, boulevard Alphonse-Laveran, 13014 Marseille, France
| | - M Bregigeon
- Service de neurologie, hôpital d'instruction des armées Laveran, 34, boulevard Alphonse-Laveran, 13014 Marseille, France
| | - E Sagui
- Service de neurologie, hôpital d'instruction des armées Laveran, 34, boulevard Alphonse-Laveran, 13014 Marseille, France
| | - C Brosset
- Service de neurologie, hôpital d'instruction des armées Laveran, 34, boulevard Alphonse-Laveran, 13014 Marseille, France
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Marlinge M, Crespy L, Zandotti C, Piorkowski G, Kaphan E, Charrel RN, Ninove L. Afebrile meningoencephalitis with transient central facial paralysis due to Toscana virus infection, southeastern France, 2014 [corrected]. ACTA ACUST UNITED AC 2014; 19:20974. [PMID: 25496570 DOI: 10.2807/1560-7917.es2014.19.48.20974] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We report a case of meningoencephalitis caused by Toscana virus (TOSV) with central facial paralysis lasting over two days acquired in south-eastern France. The patient was not febrile either before or during the course of the disease. The diagnosis was established by both real-time RT-PCR and virus isolation with complete genome sequencing. This case emphasises the need to consider TOSV in non-febrile neurological syndromes in people living in or having travelled to the Mediterranean area.
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Affiliation(s)
- Mc Marlinge
- IHU Mediterranee Infection, APHM Public Hospitals of Marseille, Marseille, France
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Bigot A, Lavigne C, Kaminsky P, Odent S, Kaphan E, Thauvin C, Caramella JP, Hosseini H, Broué P, Brunault P, Maillot F. Révélation psychiatrique des déficits du cycle l’urée chez l’adolescent et l’adulte. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Lagarde S, Kaphan E, Lagier J, Charrel R, Nougairede A, Pelletier J. Encéphalite japonaise du voyageur au Népal. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Thomas G, Guedj E, Savini H, Chapon F, Barlesi F, Kaphan E, Durand JM, Harle JR, Didelot A, Chiche L. Intérêt du PET-scan cérébral dans le diagnostic des syndromes paranéoplasiques neurologiques : à propos d’un cas. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Galanaud D, Haik S, Linguraru MG, Ranjeva JP, Faucheux B, Kaphan E, Ayache N, Chiras J, Cozzone P, Dormont D, Brandel JP. Combined diffusion imaging and MR spectroscopy in the diagnosis of human prion diseases. AJNR Am J Neuroradiol 2010; 31:1311-8. [PMID: 20430851 DOI: 10.3174/ajnr.a2069] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The physiopathologic bases underlying the signal intensity changes and reduced diffusibility observed in prion diseases (TSEs) are still poorly understood. We evaluated the interest of MRS combined with DWI both as a diagnostic tool and a way to understand the mechanism underlying signal intensity and ADC changes in this setting. MATERIALS AND METHODS We designed a prospective study of multimodal MR imaging in patients with suspected TSEs. Forty-five patients with a suspicion of TSE and 11 age-matched healthy volunteers were included. The MR imaging protocol included T1, FLAIR, and DWI sequences. MRS was performed on the cerebellum, pulvinar, right lenticular nucleus, and frontal cortex. MR images were assessed visually, and ADC values were calculated. RESULTS Among the 45 suspected cases, 31 fulfilled the criteria for probable or definite TSEs (19 sCJDs, 3 iCJDs, 2 vCJDs, and 7 genetic TSEs); and 14 were classified as AltDs. High signals in the cortex and/or basal ganglia were observed in 26/31 patients with TSEs on FLAIR and 29/31 patients on DWI. In the basal ganglia, high DWI signals corresponded to a decreased ADC. Metabolic alterations, increased mIns, and decreased NAA were observed in all patients with TSEs. ADC values and metabolic changes were not correlated; this finding suggests that neuronal stress (vacuolization), neuronal loss, and astrogliosis do not alone explain the decrease of ADC. CONCLUSIONS MRS combined with other MR imaging is of interest in the diagnosis of TSE and provides useful information for understanding physiopathologic processes underlying prion diseases.
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Affiliation(s)
- Damien Galanaud
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
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Kaphan E, Pellissier JF, Rey M, Robert D, Auphan M, Ali Chérif A. [Esophageal achalasia, sleep disorders and chorea in a tauopathy without ophthalmoplegia, parkinsonian syndrome, nor dementia (progressive supranuclear palsy?): clinicopathological study]. Rev Neurol (Paris) 2008; 164:377-83. [PMID: 18439931 DOI: 10.1016/j.neurol.2007.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 08/15/2007] [Accepted: 09/26/2007] [Indexed: 12/12/2022]
Abstract
CONTEXT Progressive supranuclear palsy (PSP) is classically characterized by supranuclear ophthalmoplegia, paroxysmal imbalance with backward falling, axial dystonia, rigidity, pseudobulbar palsy and cognitive dysfunction. However, incomplete or atypical clinical presentation has been previously reported, but in all these cases, the patients had at least one of the main clinical features of the disease (ophthalmoplegia, parkinsonian syndrome or cognitive dysfunction). CASE REPORT A 60-year-old woman presented with nocturnal agitation and choreiform movements. A few months later she developed severe swallowing disorders, caused by achalasia of the upper esophageal sphincter, and responsible for recurrent acute respiratory distress and pneumonia, prevailing to tracheotomy and gastrostomy. She died suddenly two years after the onset of the symptoms. RESULTS Postmortem examination of brain revealed a tauopathy, with deposition of abnormal phosphorylated tau in threads and in coiled-shaped as well as globose tangles in the brainstem, subthalamic nuclei and hippocampus. Nuclei of the medulla, including the vagus/solitarius complex and the region of the nucleus ambiguous were especially rich in tau positive inclusions. Ultrastructural analysis of globoid-shaped tangles in the brainstem revealed the presence of straight and paired helicoidal filaments compatible with a PSP. CONCLUSIONS This case contributes to improve knowledge of the clinical phenotypic range of PSP. In this case, the neuropathological lesions accounted for most of the symptoms. However, the early death of the patient was probably related to the particular distribution of the neuropathological lesions. This case suggests that the initial neuropathological changes in PSP is located in the dorsal brainstem.
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Affiliation(s)
- E Kaphan
- Pôle de neurosciences cliniques, Assistance publique-Hôpitaux de Marseille, université de la Méditerranée, CHU Timone, 264, Rue St-Pierre, 13005 Marseille, France.
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Abstract
Nonmotor fluctuations (NMF) in Parkinson's disease are nonmotor symptoms that occur in coincidence with motor fluctuations or independently. Long under-assessed, NMF are now recognized as frequent and sometimes involving a greater degree of disability than motor fluctuations. They can be classified in three categories: dysautonomic, cognitive/psychiatric and sensory/pain. Recognition of these nonmotor fluctuations as part of Parkinson's disease has important implications. Some symptoms such as dyspnea, chest pain, or abdominal pains can mimic cardiac or gastrointestinal emergencies. The underlying pathogenic mechanisms of NMF are not well known. The dopaminergic system is probably involved via modulation of other systems (serotoninergic, adrenergic) since NMF usually respond to dopaminergic treatment. Subthalamic nucleus deep brain stimulation alleviates NMF-- particularly sensory, dysautonomic and cognitive fluctuations--while psychic fluctuations respond less consistently to this treatment. The development of new instruments that enable a comprehensive and precocious assessment of NMF is important for optimized management of advanced Parkinson's disease.
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Affiliation(s)
- T Witjas
- Pôle de Neurosciences cliniques, CHU Timone, service de neurologie et pathologie du mouvement, 264 rue Saint-Pierre, 13385 Marseille cedex 05.
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Laksiri N, Kaphan E, Pellissier JF, Ali Chérif A. Nécrose laminaire corticale : aspects en imagerie par résonance magnétique et étude anatomoclinique. Rev Neurol (Paris) 2007; 163:365-8. [PMID: 17404525 DOI: 10.1016/s0035-3787(07)90410-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The most frequent acute and sub-acute complications of chronic alcoholism are delirium tremens, hepatic encephalopathy and Gayet-Wernicke encephalopathy. Morel laminar sclerosis is a rare and less known complication, often reported with Marchiafava-Bignami disease. CASE REPORT A 57-year-old alcoholic man presented delirium after surgery. Anterograde and retrograde amnesia as well as wrong recognitions appeared progressively and one generalized seizure occurred. He then developed mutism and became bedridden. Magnetic resonance imaging (MRI) showed high-intensity bilateral temporoparietal signals from white matter on T2-weighted images and high-intensity signals from the parietal cortex on T1-weighted images. The patient died four months after the onset of the delirium. Post-mortem examination of the brain showed cortical laminar necrosis with Alzheimer Type II gliosis but without demyelinisation of the corpus callosum. CONCLUSION Cortical laminar necrosis with chronic ethylism is usually called Morel's laminar sclerosis. Nevertheless, histology is not typical of this diagnosis, because of necrosis especially of the second (and not the third) layer of the cortex, and because of the absence of lesion of the corpus callosum. MRI data are of interest here because they were rarely reported in cases of Morel's laminar sclerosis.
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Affiliation(s)
- N Laksiri
- Service de Neurologie, Hôpital de la Timone, Marseille, France
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21
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Feuillet L, Milandre L, Kaphan E, Ali Cherif A. [Acute tetraparesis of cerebral origin]. Rev Neurol (Paris) 2005; 161:853-6. [PMID: 16244571 DOI: 10.1016/s0035-3787(05)85149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Thrombolytic treatment in the early stage of ischemic cerebral attacks requires rapid confirmation of the diagnosis and topographic localization. Unusual clinical features can lead to misdiagnosis with the risk of delaying optimal therapeutic management. OBSERVATION We report the cases of two patients who experienced acute tetraparesis without any associated encephalic sign, consistent with the diagnosis of spinal cord injury. Cervical magnetic resonance imaging (MRI) was normal. Conversely, cerebral MRI displayed in both cases bilateral hemispheric infarction. Two ischemic lesions were revealed in the territory of both anterior cerebral arteries in the first patient, while the second patient had a bilateral infarction in the posterior arms of both internal capsules. CONCLUSION In case of tetraparesis, emergency spinal cord MRI should be performed to rule out neurosurgical etiologies and ischemia. If negative, cerebral MRI should be performed at the same time to look for early cerebral infarction in both hemispheres and determine the indication for thrombolysis.
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Affiliation(s)
- L Feuillet
- Service de Neurologie, Faculté de Médecine de Marseille, Université de la Méditerranée, AP-HM, Hôpital de la Timone, Marseille.
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22
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Kaphan E, Witjas T, Feuillet L, Malikova I, Laksiri N, Pelletier J, Ali Chérif A. Accidents vasculaires cérébraux multiples et primo-infection varicelleuse chez un adulte. Rev Neurol (Paris) 2005; 161:840-3. [PMID: 16244568 DOI: 10.1016/s0035-3787(05)85145-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Chickenpox is considered as a high risk factor for developing stroke in childhood, but descriptions in adult are exceptional (only three cases reported, to our knowledge). CASE REPORT A 37-year-old man presented with a chickenpox eruption, followed by a right parietal and a left occipital infarcts, associated with multiple lacunae. There was no coagulation disorder, no hypertension or cardiovascular disorder. Cerebral angiography showed an irregular narrowing of the right internal parietal artery and vascular defects in right parietal and left occipital areas. The diagnosis of VZV-related vasculitis was evoked. White cell count, serology and VZV PCR were negative in the cerebrospinal fluid. Clinical improvement was observed after treatment by corticosteroids and aciclovir. CONCLUSION Chickenpox is a rare cause of cerebral vasculitis. Involvement of both medium and small vessels was present here, contrary to other adult case reports in the literature. Hematogenous dissemination of the virus responsible for cerebral vasculitis seems to be the most probable pathophysiological mechanism.
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Affiliation(s)
- E Kaphan
- Faculté de Médecine de Marseille, Université de la Méditerranée, Service de Neurologie, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Timone, Marseille, France.
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Casseron W, Azulay JP, Broglin D, Kaphan E, Genton P, Le Ber I, Gastaut JL. Phenotype variability in a caucasian family with dentatorubral-pallidoluysian atrophy. Eur Neurol 2004; 52:175-6. [PMID: 15528920 DOI: 10.1159/000081859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- W Casseron
- Centre St. Paul, Hôpital Henri-Gastaut, Marseille, France.
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Granel B, Cantiniaux S, Kaphan E, Veit V, Witjas T, Morange P, Harlé JR, Weiller PJ, Ali Cherif A. Une anémie chez un parkinsonien. Rev Med Interne 2004; 25 Suppl 2:S257-8. [PMID: 15460469 DOI: 10.1016/s0248-8663(04)80022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- B Granel
- Service de médecine Interne, hôpital Nord, 13915 Marseille, France
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Kaphan E, Eusebio A, Witjas T, Donnet A, Vacher-Coponat H, Figarella-Branger D, Ali Chérif A. [Primary leiomyosarcoma of the cavernous sinus associated with Epstein-Barr virus in a kidney graft]. Rev Neurol (Paris) 2003; 159:1055-9. [PMID: 14710028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Immunodeficient patients have an increased incidence of neoplasms, whether the immunodeficiency is due to genetic disorder, the acquired immunodeficiency syndrome (AIDS), or immunosuppressive therapy. Leiomyosarcoma (LMS) is a rare neoplasm, even if its incidence has increased because of AIDS. Less than fifteen cases were described after organ transplantation. An intracranial localization is exceptional (five cases in the literature) and was never described after organ transplantation, to our knowledge. Our present report focuses on a 45-year-old immunocompromised patient, who received immunosuppressive therapy for renal transplantation. He suffered from atypical peri-orbital headaches six months after transplantation and a mass involving the cavernous sinus was identified. Surgical biopsy was performed. Histologic examination revealed a LMS. Epstein-Barr virus was identified by quantitative polymerase chain reaction in the LMS. Immunosuppression was reduced, the patient received adriamycin and protontherapy was realized. He died two years after the transplantation because of tumor progression and kidney failure.
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Affiliation(s)
- E Kaphan
- Service de Neurologie, Hôpital de la Timone, Marseille
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Kaphan E, Eusebio A, Donnet A, Witjas T, Ali Chérif A. Shortlasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome) and tumour of the cavernous sinus. Cephalalgia 2003; 23:395-7. [PMID: 12780771 DOI: 10.1046/j.1468-2982.2003.00535.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Feuillet L, Kaphan E, Audoin B, Witjas T, Pelletier J, Pellissier JF, Ali Cherif A. [Melanocytic meningitis and large congenital melanocytic naevus: neurocutaneous melanosis]. Rev Neurol (Paris) 2003; 159:435-9. [PMID: 12773873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Neurological symptoms in a patient with large congenital melanocytic naevus are highly suggestive of cerebromeningeal melanoma metastasis. The presence of melanocytic cells in cerebrospinal fluid confirms this diagnosis If their malignant nature is shared with cutaneous naevocytic cells. Conversely, neurocutaneous melanosis is diagnosed when benign melanocytosis meningitis is found in patients with multiple and/or large congenital melanocytic naevus, whether cutaneous naevus cells are benign or not, or when cerebrospinal fluid cells are malignant with benign cutaneous melanocytic naevus. We report the case of a young man aged 19 presenting with multiple and large congenital melanocytic naevus who experienced transcient neurological signs and increased intracranial pressure. Cerebral neuroimaging evoked meningeal infiltration which benign melanocytic nature was supposed on CSF analysis and confirmed by necropsy findings, only 3 month after neurological onset, leading to neurocutaneous melanosis diagnosis. This rare neuroectodermal dysembryoplasia finds expression in various neurological signs, depending on patient's age and leptomeningeal and/or cerebral proliferation localization. Lumbar puncture, cerebral scanography and MRI may help diagnosis, but only histological examination can prove neurocutaneous melanosis, more often by necropsy because of poor prognosis.
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Affiliation(s)
- L Feuillet
- Service de Neurologie, CHU La Timone, Marseille
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Witjas T, Kaphan E, Azulay JP, Blin O, Ceccaldi M, Pouget J, Poncet M, Chérif AA. Nonmotor fluctuations in Parkinson's disease: frequent and disabling. Neurology 2002; 59:408-13. [PMID: 12177375 DOI: 10.1212/wnl.59.3.408] [Citation(s) in RCA: 425] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the frequency and disability caused by nonmotor fluctuations (NMF) in PD. METHODS A structured questionnaire was administered to 50 patients with PD with motor fluctuations (MF), focused on 54 nonmotor symptoms classified in three subgroups: 26 dysautonomic, 21 cognitive and psychiatric, and seven pain/sensory NMF. The link between each NMF and the motor state was determined. Patients were asked to grade their disability from 0 (no disability) to 4 (maximum discomfort) and to specify which kind of fluctuation subgroup (motor or nonmotor) was the most incapacitating. A statistical analysis was performed to determine the frequency of each NMF and to determine whether the level of disability resulting from NMF could be correlated to the main characteristics of the population. RESULTS All patients had had at least one type of NMF, most of which were associated with the "off" state. Anxiety (66%), drenching sweats (64%), slowness of thinking (58%), fatigue (56%), and akathisia (54%) were the most frequent NMF. Some symptoms such as anxiety or dyspnea correlated with a greater level of disability. The total number of NMF was found to be correlated with the motor disability. Incapacity resulting from the dysautonomic fluctuations was also significantly correlated with levodopa treatment. Surprisingly, 28% of the patients stated that NMF involved a greater degree of disability than MF. CONCLUSION Nonmotor fluctuations are frequent and debilitating in PD.
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Affiliation(s)
- Tatiana Witjas
- Department of Neurology, CHU Timone, 264 rue Saint Pierre, 13385 Marseille cedex 05, France.
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Papazian L, Bregeon F, Gaillat F, Kaphan E, Thirion X, Saux P, Badier M, Gregoire R, Gouin F, Jammes Y, Auffray JP. Does norepinephrine modify the effects of inhaled nitric oxide in septic patients with acute respiratory distress syndrome? Anesthesiology 1998; 89:1089-98. [PMID: 9821996 DOI: 10.1097/00000542-199811000-00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Hypoxia-related pulmonary vasoconstriction enhanced by norepinephrine could be deleterious in patients with the acute respiratory distress syndrome (ARDS) and sepsis. A prospective study compared the effects of nitric oxide on cardiorespiratory parameters, including the evaluation of right ventricular function in patients with ARDS and sepsis who were receiving or not receiving norepinephrine. METHODS During a 15-month period, 27 patients with ARDS and sepsis were prospectively investigated (group 1: 15 patients not receiving norepinephrine; group 2: 12 patients receiving norepinephrine). Right ventricular ejection fraction was measured by thermodilution. After baseline measurements, nitric oxide was administered at increasing inspiratory concentrations. RESULTS The ratio of oxygen tension in arterial blood to the fractional concentration of oxygen in inspired gas increased in the two groups. After logarithmic transformation of the data, an analysis of variance was performed that did not show any difference between the two groups. A dose-dependent decrease in mean pulmonary arterial pressure was observed in the two groups. This decrease and the increase in right ventricular ejection fraction induced by inhaled nitric oxide were more marked when patients received norepinephrine (P < 0.0001). CONCLUSION Norepinephrine did not influence the beneficial effects of inhaled nitric oxide administered to patients with ARDS and sepsis on oxygenation.
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Affiliation(s)
- L Papazian
- Service de Réanimation Polyvalente, Hôpital Sainte-Marguerite, Marseille, France.
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