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Lévesque H, Viallard JF, Houivet E, Bonnotte B, Voisin S, Le Cam-Duchez V, Maillot F, Lambert M, Liozon E, Hervier B, Fain O, Guillet B, Schmidt J, Luca LE, Ebbo M, Ferreira-Maldent N, Babuty A, Sailler L, Duffau P, Barbay V, Audia S, Benichou J, Graveleau J, Benhamou Y. Cyclophosphamide vs rituximab for eradicating inhibitors in acquired hemophilia A: A randomized trial in 108 patients. Thromb Res 2024; 237:79-87. [PMID: 38555718 DOI: 10.1016/j.thromres.2024.03.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Acquired hemophilia A (AHA) is a rare autoimmune disorder due to autoantibodies against Factor VIII, with a high mortality risk. Treatments aim to control bleeding and eradicate antibodies by immunosuppression. International recommendations rely on registers and international expert panels. METHODS CREHA, an open-label randomized trial, compared the efficacy and safety of cyclophosphamide and rituximab in association with steroids in patients with newly diagnosed AHA. Participants were treated with 1 mg/kg prednisone daily and randomly assigned to receive either 1.5-2 mg/kg/day cyclophosphamide orally for 6 weeks, or 375 mg/m2 rituximab once weekly for 4 weeks. The primary endpoint was complete remission over 18 months. Secondary endpoints included time to achieve complete remission, relapse occurrence, mortality, infections and bleeding, and severe adverse events. RESULTS Recruitment was interrupted because of new treatment recommendations after 108 patients included (58 cyclophosphamide, 50 rituximab). After 18 months, 39 cyclophosphamide patients (67.2 %) and 31 rituximab patients (62.0 %) were in complete remission (OR 1.26; 95 % CI, 0.57 to 2.78). In the poor prognosis group (FVIII < 1 IU/dL, inhibitor titer > 20 BU mL-1), significantly more remissions were observed with cyclophosphamide (22 patients, 78.6 %) than with rituximab (12 patients, 48.0 %; p = 0.02). Relapse rates, deaths, severe infections, and bleeding were similar in the 2 groups. In patients with severe infection, cumulative doses of steroids were significantly higher than in patients without infection (p = 0.03). CONCLUSION Cyclophosphamide and rituximab showed similar efficacy and safety. As first line, cyclophosphamide seems preferable, especially in poor prognosis patients, as administered orally and less expensive. FUNDING French Ministry of Health. CLINICALTRIALS gov number: NCT01808911.
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Affiliation(s)
- H Lévesque
- Normandie Univ, UNIROUEN, U 1096, CHU Rouen, Department of Internal Medicine, F-76000 Rouen, France.
| | - J F Viallard
- Service de Médecine Interne et Maladies Infectieuses Hôpital Haut-Lévêque, CHU Bordeaux, 5 avenue de Magellan, 33604 Pessac, France
| | - E Houivet
- Department of Biostatistics, CHU Rouen, F-76031 Rouen, France
| | - B Bonnotte
- Service de médecine interne et immunologie clinique, CHU Dijon-Bourgogne, Université de Dijon, F-21079 Dijon, France
| | - S Voisin
- Department of Internal Medicine, CHU Toulouse, F-31059 Toulouse. France
| | - V Le Cam-Duchez
- Normandie Univ, UNIROUEN, Hématologie biologique, F-76031 Rouen, France
| | - F Maillot
- Département de Médecine Interne et immunologie clinique, CHRU Tours, Université de Tours, F-37044 Tours, France
| | - M Lambert
- CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reerence Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), F-59000 Lille, France
| | - E Liozon
- Department of Internal Medicine, Dupuytren Hospital, F-87000 Limoges, France
| | - B Hervier
- Service de Médecine Interne, Hôpital Saint-Louis, APHP, 75010 Paris & INSERM UMR-S 976, Human Immunology, Pathophysiology, Immunotherapy, Saint-Louis Research Institute, F-75000 Paris, France
| | - O Fain
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris F-75000, France
| | - B Guillet
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR-S 1085, F-35000 Rennes, France
| | - J Schmidt
- Department of Internal Medicine, Amiens University Hospital, F-80000 Amiens, France
| | - L E Luca
- Department of Internal Medicine, Poitiers University Hospital, F-86000 Poitiers, France
| | - M Ebbo
- Service de Médecine Interne, Hôpital La Timone, CHU Marseille, Aix-Marseille Université, F-13000 Marseille, France
| | - N Ferreira-Maldent
- Département de Médecine Interne et immunologie clinique, CHRU Tours, Université de Tours, F-37044 Tours, France
| | - A Babuty
- Service d'Hématologie Biologique, CRC-MHC, CHU de Nantes, Nantes Cedex 1, France
| | - L Sailler
- Department of Internal Medicine, CHU Toulouse, F-31059 Toulouse. France
| | - P Duffau
- Service de Médecine Interne-Immunologie Clinique Hôpital Saint-André, CHU Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux, France
| | - V Barbay
- Normandie Univ, UNIROUEN, Hématologie biologique, F-76031 Rouen, France
| | - S Audia
- Service de médecine interne et immunologie clinique, CHU Dijon-Bourgogne, Université de Dijon, F-21079 Dijon, France
| | - J Benichou
- Department of Biostatistics, CHU Rouen and CESP UMR 1018, University of Rouen and University Paris-Saclay, F-76031 Rouen, France
| | - J Graveleau
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes, France
| | - Y Benhamou
- Normandie Univ, UNIROUEN, U 1096, CHU Rouen, Department of Internal Medicine, F-76000 Rouen, France
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Chaigne B, Chevalier K, Boucly A, Agard C, Baudet A, Bourdin A, Chabanne C, Cottin V, Fesler P, Goupil F, Jego P, Launay D, Lévesque H, Maurac A, Mohamed S, Tromeur C, Rottat L, Sitbon O, Humbert M, Mouthon L. In-depth characterization of pulmonary arterial hypertension in mixed connective tissue disease: a French national multicentre study. Rheumatology (Oxford) 2023; 62:3261-3267. [PMID: 36727465 DOI: 10.1093/rheumatology/kead055] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) is a leading cause of death in MCTD. We aimed to describe PAH in well-characterized MCTD patients. METHODS MCTD patients enrolled in the French Pulmonary Hypertension Registry with a PAH diagnosis confirmed by right heart catheterization were included in the study and compared with matched controls: MCTD patients without PAH, SLE patients with PAH and SSc patients with PAH. Survival rates were estimated by the Kaplan-Meier method and risk factors for PAH in MCTD patients and risk factors for mortality in MCTD-PAH were sought using multivariate analyses. RESULTS Thirty-six patients with MCTD-PAH were included in the study. Comparison with MCTD patients without PAH and multivariate analysis revealed that pericarditis, polyarthritis, thrombocytopenia, interstitial lung disease (ILD) and anti-Sm antibodies were independent predictive factors of PAH/PH in MCTD. Estimated survival rates at 1, 5 and 10 years following PAH diagnosis were 83%, 67% and 56%, respectively. MCTD-PAH presentation and survival did not differ from SLE-PAH and SSc-PAH. Multivariate analysis revealed that tobacco exposure was an independent factor predictive of mortality in MCTD-PAH. CONCLUSION PAH is a rare and severe complication of MCTD associated with a 56% 10-year survival. We identified ILD, pericarditis, thrombocytopenia and anti-Sm antibodies as risk factors for PAH in MCTD and tobacco exposure as a predictor of mortality in MCTD-PAH.
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Affiliation(s)
- Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- APHP-CUP, Hôpital Cochin, Université Paris Cité, Paris, France
| | - Kevin Chevalier
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- APHP-CUP, Hôpital Cochin, Université Paris Cité, Paris, France
| | - Athenaïs Boucly
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Christian Agard
- Service de Médecine Interne, Nantes Université, CHU Nantes, Nantes, France
| | - Antoine Baudet
- Department of Internal Medicine, Centre de Compétence Maladies Auto-Immunes Systémiques Rares Annecy, CHR Annecy-Genevois, Annecy, France
| | - Arnaud Bourdin
- Physiologie et Médecine Expérimentale du Cœur et des Muscles, Université de Montpellier, Centre National de la Recherche Scientifique, INSERM, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Céline Chabanne
- Service de Cardiologie et Maladies Vasculaires, Centre Hospitalier Universitaire de Rennes, Université de Rennes-Institut National de la Santé et de la Recherche Médicale, Rennes, France
| | - Vincent Cottin
- Unité Mixte de Recherche 754: Infections Virales et Pathologie Comparée, Hospices Civils de Lyon, Université Lyon 1-Institut National de la Recherche Agronomique-Centre National de Référence des Maladies Pulmonaires Rares, Lyon, France
| | - Pierre Fesler
- Service de Médecine Interne, Hôpital Lapeyronie, Montpellier, France
| | | | - Patrick Jego
- Internal Medicine and Clinical Immunology Unit, CHU Rennes, Rennes, France
| | - David Launay
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France, Université of Lille, Inserm, CHU Lille, U1286 - Institute for Translational Research in Inflammation, Lille, France
| | - Hervé Lévesque
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
- INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen University Hospital, Rouen, France
| | - Arnaud Maurac
- Département de Pneumologie, Hôpital Haut Lévèque, CHU de Bordeaux, Pessac, France
| | - Shirine Mohamed
- Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, Centre Hospitalier Universitaire Nancy, Nancy, France
| | - Cécile Tromeur
- Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France
- INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale, University Brest, Brest, France
- F-CRIN INNOVTE, Saint-Etienne, France
| | - Laurence Rottat
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- APHP-CUP, Hôpital Cochin, Université Paris Cité, Paris, France
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Bou-Jaoudeh M, Delignat S, Daventure V, Astermark J, Lévesque H, Dimitrov JD, Deligne C, Proulle V, Lacroix-Desmazes S. The IgG-degrading enzyme, Imlifidase, restores the therapeutic activity of FVIII in inhibitor-positive hemophilia A mice. Haematologica 2023; 108:1322-1334. [PMID: 36655430 PMCID: PMC10153532 DOI: 10.3324/haematol.2022.281895] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Indexed: 01/20/2023] Open
Abstract
Neutralizing anti-factor VIII (FVIII) antibodies, known as FVIII inhibitors, represent a major drawback of replacement therapy in persons with congenital hemophilia A (PwHA), rendering further infusions of FVIII ineffective. FVIII inhibitors can also appear in nonhemophilic individuals causing acquired hemophilia A (AHA). The use of non-FVIII bypassing agents in cases of bleeds or surgery in inhibitor-positive patients is complicated by the lack of reliable biological monitoring and increased thrombotic risk. Imlifidase (IdeS) is an endopeptidase that degrades human IgG; it was recently approved for hyperimmune patients undergoing renal transplants. Here we investigated the ability of IdeS to eliminate FVIII inhibitors in vitro and in a model of inhibitor-positive HA mice. IdeS cleaved anti-FVIII plasma IgG from PwHA and AHA patients, and hydrolyzed recombinant human anti-FVIII IgG independently from their subclass or specificity for the A2, A3, C1 or C2 domains of FVIII. In HA mice passively immunized with recombinant human anti-FVIII IgG, IdeS restored the hemostatic efficacy of FVIII, as evidenced by the correction of the bleeding tendency. Our results provide the proof of concept for the transient removal of FVIII inhibitors by IdeS, thereby opening a therapeutic window for efficient FVIII replacement therapy in inhibitor-positive patients.
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Affiliation(s)
- Melissa Bou-Jaoudeh
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris
| | - Sandrine Delignat
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris
| | - Victoria Daventure
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris
| | - Jan Astermark
- Department for Translational Medicine, Skane University Hospital, Lund University, Malmö
| | - Hervé Lévesque
- Service de médecine interne, Normandie Université, UNIROUEN, 76031 Rouen
| | - Jordan D Dimitrov
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris
| | - Claire Deligne
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris
| | - Valérie Proulle
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France; Service d'Hématologie Biologique et Unité Fonctionnelle d'Hémostase, Hôpital Cochin, APHP. Centre, Université Paris Cité, Paris.
| | - Sébastien Lacroix-Desmazes
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris.
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Rottenberg P, Brevet P, Leclercq M, Jouen F, Marie I, Lévesque H, Lequerré T, Vittecoq O. Potential Benefit of Rituximab in Rhupus Patients From a Single-Center: A Series of 16 Cases. J Clin Rheumatol 2022; 28:e699-e702. [PMID: 35293888 DOI: 10.1097/rhu.0000000000001837] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/26/2022]
Abstract
BACKGROUND Rhupus syndrome is better characterized, but uncertainties remain, and therapeutic management must be defined. The objective was to analyze therapeutic procedures with a focus on biologic disease-modifying antirheumatic drugs (bDMARDs). METHODS This 10-year medical records review was based on diagnosis codes (rheumatoid arthritis [RA] and systemic lupus erythematosus [SLE]) and biological data (anti-CCP testing, anti-dsDNA, and anti-RNP antibodies). Patients fulfilling 2010 ACR/EULAR and 2012 SLICC and/or 2019 ACR/EULAR classification criteria for RA and SLE, respectively, were included. RESULTS Sixteen patients were identified. Rheumatoid arthritis most often preceded rhupus, with predominant articular pattern; 11 of them had erosive arthropathy. Skin involvement was the most frequent associated manifestation (n = 12). Serious events were reported, including active glomerulonephritis (n = 3), ischemic stroke (n = 1), and myocardial infarction (n = 1). Immunological profiles showed positivity for antinuclear (n = 16), anti-dsDNA (n = 9), and anti-CCP (n = 9). Ten patients required bDMARDs. All types of RA-approved bDMARDs were used. Abatacept was considered effective in 3 of the 4 patients, with 1 primary failure, 1 secondary escape, and 2 therapeutic maintenances, whereas primary or secondary failure was observed under tocilizimub and TNF-blocking agents. Rituximab was the most prescribed (n = 9) and the most effective with a sustained response in 6 patients. CONCLUSIONS In rhupus refractory to conventional treatment, T or B lymphocytes targeted therapies, and particularly rituximab, seem to be a relevant therapeutic option unlike anticytokine biologics.
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Affiliation(s)
| | | | | | - Fabienne Jouen
- Rouen University Hospital, Clinical Immunology Laboratory, Rouen University Hospital, Rouen, France
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Lévesque H, Guillet B, Benhamou Y. [Acquired hemophilia and pregnancy: A necessarily multidisciplinary approach]. Rev Med Interne 2022; 43:494-497. [PMID: 35637030 DOI: 10.1016/j.revmed.2022.04.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/22/2022] [Accepted: 04/02/2022] [Indexed: 11/19/2022]
Abstract
The occurrence of acquired hemophilia during pregnancy or postpartum is rare (2 to 10 % in series). It is generally suspected in the presence of haemorrhagic manifestations (especially subcutataneous or mucosal bleeding) associated with an isolated prolongation of the activated partial thromboplastin time (APTT). The diagnosis is confirmed by the association of a low level of factor VIII (FVIII) and the presence of an anti-FVIII inhibitor. Postpartum management is similar to that of other acquired haemophilias: correction of a severe haemorrhagic syndrome by "bypassing" agents, eradication of the inhibitor by corticosteroids alone or in combination with another immunosuppressive agent depending on the residual level of FVIII and the titer of the inhibitor. Management of the forms occurring during pregnancy is based on rare experiences or expert opinions. The management of childbirth is particularly delicate in terms of haemorrhage, especially if the anti-FVIII inhibitor is still present, and must be prepared in a multidisciplinary manner. Finally, as with any acquired hemophilia, a relapse is possible, especially in the year following remission. During a subsequent pregnancy, the risk of recurrence is possible but should not be a contraindication to a new pregnancy.
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Affiliation(s)
- H Lévesque
- Service de médecine interne, Normandie université, UNIROUEN, Interne, 76031 Rouen, France.
| | - B Guillet
- Centre de traitement des maladies hémorragiques, CHU de Rennes, Rennes, France; Inserm, EHESP, IRSET (institut de recherche en santé, environnement et travail) - UMR_S 1085, Université Rennes, CHU de Rennes, 35000 Rennes, France
| | - Y Benhamou
- Service de médecine interne, Normandie université, UNIROUEN, Interne, 76031 Rouen, France
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Guillet B, Aouba A, Borel-Derlon A, Borg JY, Schved JF, Schneid H, Lévesque H. Adaptation of recombinant activated factor VII in the treatment of acquired haemophilia A: Results from a prospective study (ACQUI-7) in France. Thrombosis Update 2021. [DOI: 10.1016/j.tru.2020.100021] [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] Open
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Membrey B, Miranda S, Lévesque H, Cailleux N, Benhamou Y, Armengol G. Artérite gigantocellulaire : apport de l’écho-doppler. Rev Med Interne 2020; 41:106-110. [DOI: 10.1016/j.revmed.2019.10.337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/04/2019] [Accepted: 10/21/2019] [Indexed: 01/22/2023]
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Miranda S, Billoir P, Le Besnerais M, Joannides R, Richard V, Lévesque H, Armengol G, Bellien J, Benhamou Y. New insights into antiphospholipid-related endothelial dysfunction by assessment of vascular glycocalyx layer: results from a preliminary cross-sectional study. Lupus 2020; 29:157-164. [DOI: 10.1177/0961203319897958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction Antiphospholipid syndrome (APS) is associated with greater atherothrombotic risk and endothelial dysfunction, suggesting that endothelial glycocalyx is impaired in this disease. Objectives The aim was to investigate the endothelial glycocalyx and the relationship between glycocalyx markers, endothelial dysfunction parameters and atherosclerotic markers in APS. Methods A total of 15 primary arterial APS patients and healthy controls were included in the study. Glycocalyx was assessed in both groups by sublingual sidestream dark field imaging and syndecan-1 plasma level. Endothelial function was evaluated by brachial artery flow-mediated dilatation (FMD) and early atherosclerosis by carotid intima media thickness (IMT). Thrombotic profile was also performed by measuring the plasma level of the tissue factor (TF). Results APS patients had significantly increased syndecan-1 plasma level 38.6 ± 5.0 pg/ml vs. 19.1 ± 3.5 pg/ml; p < 0.01 and a reduced glycocalyx thickness 0.26 ± 0.03 µm vs. 0.75 ± 0.07 µm; p < 0.01 compared with control. FMD was impaired in APS patients compared with control, 5.68% ± 0.42 vs. 8.29 ± 0.30, p < 0.01, respectively. IMT was significantly increased in APS patients compared with control, 0.52 ± 0.13 mm vs. 0.40 ± 0.06 mm, p < 0.01, respectively. Soluble TF, thiobarbituric acid-reactive substances levels were increased in the sera from APS patients compared with control. Conclusions This preliminary study supports, for the first time, that in APS patients endothelial glycocalyx is impaired, which could lead to thrombosis, endothelial dysfunction and early atherosclerosis.
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Affiliation(s)
- S Miranda
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
| | - P Billoir
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
- Department of Vascular Haemostasis, Rouen University Hospital, Rouen, France
| | - M Le Besnerais
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
| | - R Joannides
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
- Department of Pharmacology, Rouen University Hospital, Rouen, France
- Centre d'Investigation Clinique (CIC)-INSERM 1404, Rouen University Hospital, Rouen, France
| | - V Richard
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
| | - H Lévesque
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
| | - G Armengol
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
| | - J Bellien
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
- Department of Pharmacology, Rouen University Hospital, Rouen, France
- Centre d'Investigation Clinique (CIC)-INSERM 1404, Rouen University Hospital, Rouen, France
| | - Y Benhamou
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
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Noël N, Le Roy A, Hot A, Saadoun D, Lazaro E, Lévesque H, Le Gouellec N, Meaux-Ruault N, Nguyen T, Costedoat-Chalumeau N, Amieux B, Fontana A, De Gennes C, Fulpin J, Thomas PA, Bluthgen MV, Besse B, Lambotte O. Systemic lupus erythematosus associated with thymoma: A fifteen-year observational study in France. Autoimmun Rev 2020; 19:102464. [PMID: 31917264 DOI: 10.1016/j.autrev.2020.102464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe the clinical, biological and pathological characteristics of patients with the association of SLE and thymic epithelial tumors (TET) in a retrospective multicenter series. METHODS Cases diagnosed in France between 2000 and 2015 were collected after a call for observations from the French network for thymic epithelial tumors (RYTHMIC database) and the French National Society of Internal Medicine (SNFMI). RESULTS Fourteen patients were identified, the majority were women (93%). The median age at diagnosis of lupus was 43.5 [range: 30-66] years and 43.5 [range: 26-73] years at diagnosis of thymoma. TET required chemotherapy and/or radiotherapy complementary to surgery in >90% cases. Lupus was diagnosed before, simultaneously, or after diagnosis of thymoma in 6, 3 and 5 cases, respectively. Among the lupus manifestations, joint involvement was predominant (78.6%), followed by autoimmune cytopenia (35.7%), cutaneous affections (28.6%), serositis (28.6%) and renal involvement (21.4%). SLE was associated with one or more AID in 5/14 patients. These characteristics were compared with those from 17 patients identified in the literature. Among them, joint and skin involvement as well as pleural/pericardial effusions occurred in >50%. SLE was controlled by prednisone and hydroxychloroquine in the majority of cases, but 7 out of 31 patients had an immunosuppressant. CONCLUSION The association of SLE and TET is rare, and its clinical profile seems to be distinguished by the frequency of cytopenias. The management of these patients is complicated by the need to treat cancer, lupus and/or associated autoimmune diseases.
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Affiliation(s)
- Nicolas Noël
- Assistance Publique - Hôpitaux de Paris, Hopital Bicêtre, Service de Médecine Interne et Immunologie Clinique, F-94275 Le Kremlin-Bicêtre, France; Université Paris Sud, UMR 1184, F-94276 Le Kremlin-Bicêtre, France; INSERM, U1184, Immunologie des Maladies Virales et Autoimmunes, F-94276 Le Kremlin-Bicêtre, France; CEA, DSV/iMETI, Département d'Immunovirologie, IDMIT, F-92265 Fontenay-aux-Roses, France
| | - Audrey Le Roy
- Assistance Publique - Hôpitaux de Paris, Hopital Bicêtre, Service de Médecine Interne et Immunologie Clinique, F-94275 Le Kremlin-Bicêtre, France; Ecole du Val de Grâce, 1 place Alphonse Laveran, F-75005 Paris, France
| | - Arnaud Hot
- Service de Médecine Interne, Hopital Edouard Herriot, F-69003 Lyon, France
| | - David Saadoun
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005 Paris, France; INSERM, UMR_S 959, F-75013 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013 Paris, France; CNRS, FRE3632, F-75005 Paris, France; Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose, France
| | - Estibaliz Lazaro
- Service de Médecine Interne, Hopitaux Universitaires de Bordeaux, Hopital Haut-Lévêque, F-33604 Pessac, France
| | - Hervé Lévesque
- Normandie univ, UNIROUEN, U1096, Service de Médecine Interne, F-76000 Rouen, France
| | - Noémie Le Gouellec
- Service de Médecine Interne, Hopital de Valenciennes, F-59300 Valenciennes, France
| | - Nadine Meaux-Ruault
- Service de Médecine Interne, CHU de Besançon, Hopital Jean Minjoz, 3 boulevard Fleming, F-25030 Besançon, France
| | - Thierry Nguyen
- Service de Cancérologie, CHU de Besançon, Hopital Jean Minjoz, 3 boulevard Fleming, F-25030 Besançon, France
| | | | | | - Aurélie Fontana
- Service de Rhumatologie, Pavillon F, CHU Édouard Herriot, F-69003 Lyon, France
| | - Christian De Gennes
- APHP, Service de Médecine Interne, Hôpital Pitié-Salpétrière, F-75013 Paris, France
| | | | | | | | - Benjamin Besse
- Université Paris Sud, UMR 1184, F-94276 Le Kremlin-Bicêtre, France; Cancer Medicine Department, Gustave Roussy, F-94800 Villejuif, France
| | - Olivier Lambotte
- Assistance Publique - Hôpitaux de Paris, Hopital Bicêtre, Service de Médecine Interne et Immunologie Clinique, F-94275 Le Kremlin-Bicêtre, France; Université Paris Sud, UMR 1184, F-94276 Le Kremlin-Bicêtre, France; INSERM, U1184, Immunologie des Maladies Virales et Autoimmunes, F-94276 Le Kremlin-Bicêtre, France; CEA, DSV/iMETI, Département d'Immunovirologie, IDMIT, F-92265 Fontenay-aux-Roses, France.
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Quentric P, Michelin P, Lévesque H, Miranda S. Une cause inhabituelle d’œdème du membre supérieur. Rev Med Interne 2019; 40:769-770. [DOI: 10.1016/j.revmed.2019.02.002] [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] [Received: 01/23/2019] [Accepted: 02/10/2019] [Indexed: 11/27/2022]
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Simon D, Cailleux-Talbot N, Armengol G, Benhamou Y, Lévesque H, Monnot A, Miranda S. [A neck mass]. Rev Med Interne 2019; 41:348-349. [PMID: 31662231 DOI: 10.1016/j.revmed.2019.09.004] [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: 07/11/2019] [Revised: 09/19/2019] [Accepted: 09/26/2019] [Indexed: 11/18/2022]
Affiliation(s)
- D Simon
- UNIROUEN, service de médecine interne, Normandie université, 76000 Rouen, France.
| | - N Cailleux-Talbot
- UNIROUEN, service de médecine interne, Normandie université, 76000 Rouen, France
| | - G Armengol
- UNIROUEN, service de médecine interne, Normandie université, 76000 Rouen, France
| | - Y Benhamou
- UNIROUEN, service de médecine interne, Normandie université, 76000 Rouen, France; UNIROUEN, U1096, service de médecine interne, Normandie université, 76000 Rouen, France
| | - H Lévesque
- UNIROUEN, service de médecine interne, Normandie université, 76000 Rouen, France; UNIROUEN, U1096, service de médecine interne, Normandie université, 76000 Rouen, France
| | - A Monnot
- UNIROUEN, service de chirurgie vasculaire, Normandie université, 76000 Rouen, France
| | - S Miranda
- UNIROUEN, service de médecine interne, Normandie université, 76000 Rouen, France; UNIROUEN, U1096, service de médecine interne, Normandie université, 76000 Rouen, France
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Lévesque H, Grall M, Bréant N, Idrissi Kassimy I, Arbid TD, Boujedaini R, Clamageran C, Joly LM, Tanguy L, Marpeau L, Benhamou Y, Gricourt C. [Pre-hospitalization unit: A simple organization and a place for internists to improve the non-scheduled hospitalization stream from emergencies]. Rev Med Interne 2019; 40:707-713. [PMID: 31409518 DOI: 10.1016/j.revmed.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/02/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The adult emergency department at Rouen University hospital (CHU) welcomes over 100.000 patients per year. In order to streamline unscheduled hospital admissions from the emergency room (ER), a 20-bed pre-hospitalization unit and a centralized bed management system (bed manager, bed manager software, dedicated beds) have been put into place. PATIENTS AND METHODS Emergency admissions have increased by (+3.5% between 2017 and 2018) with 20% direct hospitalization from the ER to other conventional units (2/3 in medicine, 1/3 in surgery). In 2018, 3450 patients, of which 54% aged over 75 years have been admitted in the pre-hospitalization unit with an average length of stay of 1.3±1.4 days: 35.4% stayed less than 24hours and 34.8% more than 48hours of which 5.2% stated more than 4 days, 132 patients (3.8%) died, 805 patients (23.3%) were discharged at home, 220 (6.4%) transferred to another facility, and 2287 (66.3%) were secondarily hospitalized in another hospital unit: more than 9 times out of 10 in a medicine unit (internal medicine 30%, geriatrics 27.9%, respiratory medicine 12.2%). This unscheduled emergency hospitalization allowed a daily hospitalization of 50 short stay inpatients beds. It has to be noted that the number of available inpatient beds clearly decreases during the week-ends. The main pathologies were respiratory infections (14.2%), heart diseases (9.7%), metabolic disorders (3.9%), and urinary tract infections (13.6%). CONCLUSION This pre-hospitalization unit associated with a centralized bed management system has clearly improved the unscheduled hospital admissions, in particular concerning the emergency medical sector. The lack of inpatient beds at the week-end and the management of epidemic periods still remain a challenge that has to be taken up.
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Affiliation(s)
- H Lévesque
- Service de médecine interne, Normandie université, UniRouen, U1096, 76000 Rouen, France.
| | - M Grall
- Service de médecine interne, Normandie université, UniRouen, U1096, 76000 Rouen, France
| | - N Bréant
- Cadre gestionnaire du pôle médecine, CHU Rouen, 76000 Rouen, France
| | - I Idrissi Kassimy
- Unité d'attente d'hospitalisation, CHU Rouen, 76000 Rouen, France; Cadre gestionnaire du pôle médecine, CHU Rouen, 76000 Rouen, France; Service d'accueil et des urgences, 76000 Rouen, France
| | - T D Arbid
- Unité d'attente d'hospitalisation, CHU Rouen, 76000 Rouen, France; Cadre gestionnaire du pôle médecine, CHU Rouen, 76000 Rouen, France; Service d'accueil et des urgences, 76000 Rouen, France
| | - R Boujedaini
- Unité d'attente d'hospitalisation, CHU Rouen, 76000 Rouen, France; Cadre gestionnaire du pôle médecine, CHU Rouen, 76000 Rouen, France; Service d'accueil et des urgences, 76000 Rouen, France
| | - C Clamageran
- Unité d'attente d'hospitalisation, CHU Rouen, 76000 Rouen, France; Cadre gestionnaire du pôle médecine, CHU Rouen, 76000 Rouen, France; Service d'accueil et des urgences, 76000 Rouen, France
| | - L M Joly
- Service d'accueil et des urgences, 76000 Rouen, France
| | - L Tanguy
- Département d'informatique médicale, Normandie université, UniRouen, 76000 Rouen, France
| | - L Marpeau
- Service de gynécologie-obstétrique, Commission Médicale d'Établissement, CHU Rouen, 76000 Rouen, France
| | - Y Benhamou
- Service de médecine interne, Normandie université, UniRouen, U1096, 76000 Rouen, France
| | - C Gricourt
- Unité d'attente d'hospitalisation, CHU Rouen, 76000 Rouen, France; Cadre gestionnaire du pôle médecine, CHU Rouen, 76000 Rouen, France; Service d'accueil et des urgences, 76000 Rouen, France
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13
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Avenel M, Miranda S, Benhamou Y, Michelin P, Boyer J, Lévesque H, Armengol G. Canal carpien aigu : penser à la thrombose de l’artère persistante du nerf médian ! Rev Med Interne 2019; 40:453-456. [DOI: 10.1016/j.revmed.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/23/2019] [Accepted: 04/10/2019] [Indexed: 11/27/2022]
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Borg JY, Lévesque H, Cailleux N, Franc C, Hellot MF, Courtois H. Rapid Quantitative D-dimer Assay and Clinical Evaluation for the Diagnosis of Clinically Suspected Deep Vein Thrombosis. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1656013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J Y Borg
- The Unité fonctionnelle d’hémostase, CHU Rouen, France
| | - H Lévesque
- Département de Médecine Interne, CHU Rouen-Boisguillaume, Rouen, France
| | - N Cailleux
- Département de Médecine Interne, CHU Rouen-Boisguillaume, Rouen, France
| | - C Franc
- The Unité fonctionnelle d’hémostase, CHU Rouen, France
| | - M F Hellot
- Département de Médecine Interne, CHU Rouen-Boisguillaume, Rouen, France
| | - H Courtois
- Département de Médecine Interne, CHU Rouen-Boisguillaume, Rouen, France
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Le Besnerais M, Arnaud L, Boutémy J, Bienvenu B, Lévesque H, Amoura Z, Marie I. Aortic involvement in relapsing polychondritis. Joint Bone Spine 2018; 85:345-351. [DOI: 10.1016/j.jbspin.2017.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/03/2017] [Indexed: 11/15/2022]
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Adham S, Miranda S, Doucet J, Lévesque H, Benhamou Y. [Statins in primary prevention of cardiovascular disease]. Rev Med Interne 2017; 39:42-49. [PMID: 28866432 DOI: 10.1016/j.revmed.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/17/2017] [Revised: 07/31/2017] [Accepted: 08/07/2017] [Indexed: 12/12/2022]
Abstract
Cardiovascular events are the second leading cause of death in France. The assessment of overall cardiovascular risk using a personalized assessment with weighting risk factors can predict the risk of cardiovascular events in ten years. The validated treatments to reduce cardiovascular mortality in primary prevention are few. The use of statins in primary prevention is discussed. We report in this review the updated conclusions from clinical trials regarding the treatment with statins in primary prevention.
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Affiliation(s)
- S Adham
- Centre de référence des maladies vasculaires rares, service de génétique, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
| | - S Miranda
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - J Doucet
- Service de médecine interne, gériatrie et thérapeutique, hôpital de Saint-Julien, CHU de Rouen, rue Guillaume-Lecointe, 76140 Le Petit-Quevilly, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Unité inserm U1096, UFR de médecine et de pharmacie de Rouen, 22, boulevard Gambetta, 76000 Rouen, France
| | - Y Benhamou
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Unité inserm U1096, UFR de médecine et de pharmacie de Rouen, 22, boulevard Gambetta, 76000 Rouen, France
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Langlois V, Bedat Millet AL, Lebesnerais M, Miranda S, Marguet F, Benhamou Y, Marcorelles P, Lévesque H. [Small fiber neuropathy]. Rev Med Interne 2017; 39:99-106. [PMID: 28410768 DOI: 10.1016/j.revmed.2017.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/29/2017] [Accepted: 03/11/2017] [Indexed: 12/15/2022]
Abstract
Small fiber neuropathy (SFN) is still unknown. Characterised by neuropathic pain, it typically begins by burning feet, but could take many other expression. SFN affects the thinly myelinated Aδ and unmyelinated C-fibers, by an inherited or acquired mechanism, which could lead to paresthesia, thermoalgic disorder or autonomic dysfunction. Recent studies suggest the preponderant role of ion channels such as Nav1.7. Furthermore, erythromelalgia or burning mouth syndrome are now recognized as real SFN. Various aetiologies of SFN are described. It could be isolated or associated with diabetes, impaired glucose metabolism, vitamin deficiency, alcohol, auto-immune disease, sarcoidosis etc. Several mutations have recently been identified, like Nav1.7 channel leading to channelopathies. Diagnostic management is based primarily on clinical examination and demonstration of small fiber dysfunction. Laser evoked potentials, Sudoscan®, cutaneous biopsy are the main test, but had a difficult access. Treatment is based on multidisciplinary management, combining symptomatic treatment, psychological management and treatment of an associated etiology.
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Affiliation(s)
- V Langlois
- Service de médecine interne et maladies infectieuses, CH Le Havre, 29, avenue Pierre-Mendès, 76290 Montivilliers, France; U1096, service de médecine interne, Normandie univ, UNIROUEN, 76000 Rouen, France.
| | - A-L Bedat Millet
- Département de neurophysiologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France
| | - M Lebesnerais
- U1096, service de médecine interne, Normandie univ, UNIROUEN, 76000 Rouen, France
| | - S Miranda
- U1096, service de médecine interne, Normandie univ, UNIROUEN, 76000 Rouen, France
| | - F Marguet
- Département d'anatomie et cytologie pathologiques, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France
| | - Y Benhamou
- U1096, service de médecine interne, Normandie univ, UNIROUEN, 76000 Rouen, France
| | - P Marcorelles
- Département d'anatomie et cytologie pathologiques, hôpital Morvan, centre hospitalier régional et universitaire de Brest, 2, avenue Foch, 29609 Brest cedex, France
| | - H Lévesque
- U1096, service de médecine interne, Normandie univ, UNIROUEN, 76000 Rouen, France
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Miranda S, Le Cam-Duchez V, Benichou J, Donnadieu N, Barbay V, Le Besnerais M, Delmas FX, Cuvelier A, Lévesque H, Benhamou Y, Armengol G. Adjusted value of thromboprophylaxis in hospitalized obese patients: A comparative study of two regimens of enoxaparin: The ITOHENOX study. Thromb Res 2017; 155:1-5. [PMID: 28460259 DOI: 10.1016/j.thromres.2017.04.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 10/13/2016] [Revised: 04/03/2017] [Accepted: 04/09/2017] [Indexed: 01/14/2023]
Abstract
Thromboprophylaxis is a mainstay of hospital care in patients at high risk of thrombosis. Fixed doses of low-molecular-weight heparin (LMWH) are recommended for thromboprophylaxis in patients admitted to hospital for an acute medical condition. However, the distribution of LMWH is weight-based, and the efficacy of standard doses in obese patients may be decreased. Data for obese patients are mainly available in bariatric surgery with extremely obese patients who are at greater risk of venous thromboembolism than those hospitalized for a medical condition. We conducted a randomized control trial in medically obese inpatients (BMI≥30kg/m2) assessing two regimens of enoxaparin (40mg and 60mg SQ daily) in order to determine whether a stronger dosage would achieve higher anti-Xa level suitable for thromboprophylaxis. Between September 2013 and April 2015, 91 patients were included in the study (mean (±standard deviation) age was 70.4±10.7years, average BMI 37.8±6.4kg/m2). Main indications of thromboprophylaxis were mainly acute infection (50%), acute respiratory failure (10%), acute congestive heart failure (9%) and acute rheumatic disorders (18%). Average anti-Xa activity, measured 4h after the third administration of enoxaparin was 0.25±0.09IU/mL in group 1 (enoxaparin 40mg) and 0.35±0.13IU/mL in group 2 (enoxaparin 60mg) (P<10-3). The proportions of patients with normal anti-Xa activity (between 0.32 and 0.54IU/mL) were 31% (n=11) and 69% (n=24) in group 1 and 2 respectively (P=0.007). The proportions of anti-Xa activity measurement below the normal range were 64% and 36% in group 1 and 2 (P<10-3) respectively. Subgroup analysis focusing on high weight patients (above 100kg, n=45) showed a marked difference in the proportion of patients with normal anti-Xa activity between group 1 (9%) and 2 (44%) (P=0.009). No venous thromboembolism occurred during the study and one patient in group 1 died because of hemorrhagic shock due to a gastric ulcer. Incidence of adverse events was not different between the two groups (P=0.52). In conclusion, the ITOHENOX study shows in medically obese inpatients that thromboprophylaxis with enoxaparin 60mg provides higher control of anti-Xa activity, without more bleeding complications than the standard enoxaparin regimen. This trial is registered with ClinicalTrials.gov, number NCT01707732.
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Affiliation(s)
- Sébastien Miranda
- Department of internal medicine, vascular and thrombosis unit, Rouen University Hospital, Rouen, France; INSERM U1096, Rouen University, Rouen, France
| | - Véronique Le Cam-Duchez
- INSERM U1096, Rouen University, Rouen, France; Vascular Hemostasis Unit, Rouen University Hospital, Rouen, France
| | - Jacques Benichou
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Nathalie Donnadieu
- Pharmacy, Unit of Clinical Trials, Rouen University Hospital, Rouen, France
| | - Virginie Barbay
- Vascular Hemostasis Unit, Rouen University Hospital, Rouen, France
| | - Maelle Le Besnerais
- Department of internal medicine, vascular and thrombosis unit, Rouen University Hospital, Rouen, France
| | | | - Antoine Cuvelier
- Pulmonary & Respiratory Intensive Care Department, UPRES EA 3830, Rouen University Hospital, Rouen, France
| | - Hervé Lévesque
- Department of internal medicine, vascular and thrombosis unit, Rouen University Hospital, Rouen, France; INSERM U1096, Rouen University, Rouen, France
| | - Ygal Benhamou
- Department of internal medicine, vascular and thrombosis unit, Rouen University Hospital, Rouen, France; INSERM U1096, Rouen University, Rouen, France
| | - Guillaume Armengol
- Department of internal medicine, vascular and thrombosis unit, Rouen University Hospital, Rouen, France.
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Affiliation(s)
- S Miranda
- Normandie université, UNIROUEN, U1096, service de médecine interne, 76000 Rouen, France
| | - H Lévesque
- Normandie université, UNIROUEN, U1096, service de médecine interne, 76000 Rouen, France.
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Girszyn N, Hellouin L, Sauvêtre G, Ngo S, Lévesque H, Masseau A. Un homme, deux femmes : un trio à en perdre les cheveux ! Rev Med Interne 2017; 38:147-149. [DOI: 10.1016/j.revmed.2016.10.394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 11/30/2022]
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Roca F, Dominique S, Schmidt J, Smail A, Duhaut P, Lévesque H, Marie I. Interstitial lung disease in primary Sjögren's syndrome. Autoimmun Rev 2017; 16:48-54. [DOI: 10.1016/j.autrev.2016.09.017] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 12/21/2022]
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Damian L, Benhamou Y, Girszyn N, Lévesque H, Sauvetre G. Myosite granulomateuse inflammatoire et monocytopénie révélant un syndrome MonoMAC. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.234] [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: 11/15/2022]
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Marie I, Gehanno J, Duval-Modeste A, Joly P, Dominique S, Bravard P, Noel D, Cailleux A, Benichou J, Lévesque H, Bubenheim M, Goulle J. Exposition au métaux lourds au cours de la sclérodermie systémique. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.108] [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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Éblé V, Legallicier B, Joly P, Vittecoq O, Caron F, Jouen F, Lévesque H, Ménard J, Guerrot D, Marie I. Caractéristiques et profil évolutif des cryoglobulinémies de faible taux non associées au virus de l’hépatite C. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.286] [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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Marie I, Goulle J, Duval-Modeste A, Dominique S, Joly P, Noël D, Bravard P, Cailleux A, Bénichou J, Lévesque H. Sclérodermie systémique et exposition aux métaux lourds : enquête prospective cas témoins. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.251] [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: 11/15/2022]
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Lévesque H, Benhamou Y. Du bon usage des D-dimères au cours de la maladie thromboembolique veineuse. Rev Med Interne 2016; 37:303-6. [DOI: 10.1016/j.revmed.2015.06.009] [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] [Received: 05/23/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
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Grall M, Miranda S, Cailleux-Talbot N, Cardinael N, Contentin N, Grangé S, Girault C, Benhamou Y, Lévesque H, Armengol G. [An unusual cause of digital ischemia]. Rev Med Interne 2016; 38:282-283. [PMID: 27062099 DOI: 10.1016/j.revmed.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 01/04/2016] [Indexed: 12/28/2022]
Affiliation(s)
- M Grall
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - S Miranda
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U1096, université de Rouen, Rouen, France
| | - N Cailleux-Talbot
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - N Cardinael
- Département d'hématologie, centre Henri-Becquerel, Rouen, France
| | - N Contentin
- Département d'hématologie, centre Henri-Becquerel, Rouen, France
| | - S Grangé
- Département de réanimation médicale, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Girault
- Département de réanimation médicale, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Y Benhamou
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U1096, université de Rouen, Rouen, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U1096, université de Rouen, Rouen, France
| | - G Armengol
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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Langlois V, Nassarmadji K, Célestin S, Tuech JJ, Bernet J, Lévesque H, Grémain V, Marie I. [Thigh cutaneous lesions]. Rev Med Interne 2016; 37:782-784. [PMID: 27016278 DOI: 10.1016/j.revmed.2016.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 02/20/2016] [Indexed: 11/17/2022]
Affiliation(s)
- V Langlois
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France
| | - K Nassarmadji
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France
| | - S Célestin
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France
| | - J-J Tuech
- Service de chirurgie digestive, CHU de Rouen, Rouen, France
| | - J Bernet
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France
| | - V Grémain
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France
| | - I Marie
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France.
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Affiliation(s)
- A Lebarbier-Dumesnil
- Service de médecine interne, hôpitaux de Rouen, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - N Cailleux-Talbot
- Service de médecine interne, hôpitaux de Rouen, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Armengol
- Service de médecine interne, hôpitaux de Rouen, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - H Lévesque
- Service de médecine interne, hôpitaux de Rouen, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Y Benhamou
- Service de médecine interne, hôpitaux de Rouen, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
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Ngo S, Benhamou Y, Armengol G, Sauvêtre G, Cailleux-Talbot N, Massy N, Buchonnet G, Lévesque H. [Agranulocytosis related to fluindione: A case report]. Rev Med Interne 2015; 37:58-61. [PMID: 26096756 DOI: 10.1016/j.revmed.2015.05.013] [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: 11/13/2014] [Revised: 04/25/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION While in most countries warfarin is the preferred anti-vitamin K, fluindione, a molecule with a prolonged half-life remains largely prescribed in France. Some of its side effects, including immuno-allergic complications, remain poorly understood. CASE REPORT A 77-year-old woman presented with a febrile severe neutropenia of immunoallergic mechanism with a favourable outcome associated with fluindione, introduced 25 days earlier for the treatment of atrial fibrillation. CONCLUSION This rare side effect is a reminder of the importance of biological monitoring in the first weeks following the introduction of fluindione and key diagnostic elements and therapeutic aspects of iatrogenic agranulocytosis.
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Affiliation(s)
- S Ngo
- Département de médecine interne, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - Y Benhamou
- Département de médecine interne, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Armengol
- Département de médecine interne, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Sauvêtre
- Département de médecine interne, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - N Cailleux-Talbot
- Département de médecine interne, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - N Massy
- Pharmacovigilance, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Buchonnet
- Hématologie biologique, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - H Lévesque
- Département de médecine interne, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
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Aussy A, Girszyn N, Vandhuick T, Marie I, Vittecoq O, Lévesque H, Benhamou Y. [Psoriatic arthritis during rituximab treatment of granulomatosis with polyangiitis: a new paradoxical side effect?]. Rev Med Interne 2015; 36:491-4. [PMID: 25554400 DOI: 10.1016/j.revmed.2014.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/07/2014] [Revised: 05/10/2014] [Accepted: 09/09/2014] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Rituximab is a monoclonal antibody targeting the CD20 molecule of the B lymphocyte. Its efficacy has been recently reported in ANCA-associated vasculitis. We report a case of psoriatic arthritis that occurs during a treatment with rituximab in granulomatosis with polyangiitis. CASE REPORT A 66-year-old woman, without past history of psoriasis, presented with a relapsing granulomatosis with polyangiitis in July 2010 with sinus and lung involvement. Treatment with rituximab was started, allowing a complete remission in 6 months. Two months after the first two infusions of rituximab she developed asymmetric arthritis of 3 distal interphalangeal joints. A few months later, the clinical presentation showed asymmetrical arthritis of the hands and wrists and dactylitis. Standard radiographs and MRI showed an inflammatory impairment according with psoriatic arthritis. CONCLUSION Accountability of rituximab was retained in the development of the disease given the chronology of psoriatic arthritis development. It may be a paradoxical reaction, by analogy to those observed in anti-TNFα.
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Affiliation(s)
- A Aussy
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France.
| | - N Girszyn
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France
| | - T Vandhuick
- Inserm U905, service de rhumatologie, CIC-CRB020, CHU de Rouen, 76031 Rouen cedex, France
| | - I Marie
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France
| | - O Vittecoq
- Inserm U905, service de rhumatologie, CIC-CRB020, CHU de Rouen, 76031 Rouen cedex, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France; Inserm U 1096, CHU de Rouen, 76031 Rouen cedex, France
| | - Y Benhamou
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France; Inserm U 1096, CHU de Rouen, 76031 Rouen cedex, France
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Fiaux E, Noel D, Armengol G, Quatresous I, Cailleux-Talbot N, Lévesque H, Benhamou Y. [Usefulness of assessing hydration status in elderly patients over 70 years with suspected deep vein thrombosis]. Rev Med Interne 2015; 36:381-5. [PMID: 25554399 DOI: 10.1016/j.revmed.2014.10.005] [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: 03/03/2014] [Revised: 06/12/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Venous thromboembolism and dehydration are frequent conditions in elderly. The objective of this study was to assess the prevalence of dehydration in patients aged over 70 years suspected of deep vein thrombosis (DVT). METHODS This is a prospective observational study that included patients aged over 70 years and suspected of deep vein thrombosis. Clinical and biological dehydration was diagnosed on the presence of a skin fold, a weight loss≥5%, a thirst, a plasmatic osmolality>295 mOsm/L or blood urea nitrogen/creatinine ratio>20. RESULTS One hundred and forty-four patients (mean age 81.8±5.8 years) were included. A diagnosis of DVT was retained in 97 patients. Clinical dehydration was not more frequent in the DVT+ group (37.2% vs 35.1%). At baseline, 69.1% of DVT+ patients and 53.2% of DVT- patients had a plasma osmolality greater than 295 mosm/L (NS). BUN/creatinine ratio greater than 20 was found in 58.8% of DVT+ patients and 72.3% of DVT- patients (NS). Clinical and biological dehydration was present in 28.6% of DVT+ patients and in 33.3% of DVT- patients (NS). The positive predictive value of the Wells score≥3 was 86.5%, and negative predictive value of a Wells score≤0 was 85%. CONCLUSION The presence of dehydration does not appear predictive of the occurrence of DVT and does not influence the statistical performance of the Wells score in elderly patients.
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Affiliation(s)
- E Fiaux
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - D Noel
- Service de médecine interne, centre hospitalier Elbeuf-Louviers-Val de Reuil, Saint Aubin-lès-Elbeuf, 76503 Elbeuf, France
| | - G Armengol
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - I Quatresous
- Service de médecine interne, centre hospitalier Elbeuf-Louviers-Val de Reuil, Saint Aubin-lès-Elbeuf, 76503 Elbeuf, France
| | - N Cailleux-Talbot
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Y Benhamou
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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Bertrand E, Dumesnil C, Lahary A, Al Bagami M, Schneider P, Lévesque H, Vannier JP. [Delayed haemolytic transfusion reaction: About 3 patients with sickle cell disease]. Rev Med Interne 2014; 36:769-72. [PMID: 25529378 DOI: 10.1016/j.revmed.2014.11.015] [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: 06/10/2014] [Revised: 11/17/2014] [Accepted: 11/24/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The use of a red blood cell transfusion in a patient with major sickle cell disease is sometimes necessary. The occurrence of delayed haemolytic transfusion reaction is a rare but potentially serious complication. This event can occur at any age. It is probably under diagnosed due to the difficulty in diagnosis with few specific signs. CASE REPORTS We describe in this article the clinical, biological, and hazards of therapeutic management of three cases of delayed haemolytic transfusion reaction in sickle cell disease patients. The high performance chromatography, which evaluates the percentage of HbA1, is the biological investigation used to establish the diagnosis of this event. The pathophysiology of this event remains still poorly understood. Several treatments have been used during this event. However, the therapeutic management remains controversial. CONCLUSION Transfusion in any patient likely to suffer from delayed haemolytic transfusion reaction is not recommended because of the risk of worsening this reaction. Prevention of recurrence is essential.
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Affiliation(s)
- E Bertrand
- Service d'immuno-hémato-oncologie pédiatrique, CHU de Rouen, 76031 Rouen cedex, France.
| | - C Dumesnil
- Service d'immuno-hémato-oncologie pédiatrique, CHU de Rouen, 76031 Rouen cedex, France
| | - A Lahary
- Service d'hématologie, CHU de Rouen, 76031, Rouen, France
| | - M Al Bagami
- Service d'immuno-hémato-oncologie pédiatrique, CHU de Rouen, 76031 Rouen cedex, France
| | - P Schneider
- Service d'immuno-hémato-oncologie pédiatrique, CHU de Rouen, 76031 Rouen cedex, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 76031, Rouen, France
| | - J-P Vannier
- Service d'immuno-hémato-oncologie pédiatrique, CHU de Rouen, 76031 Rouen cedex, France
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Faisant C, Armengol G, Bouillet L, Lévesque H, Boccond-Gibod I, Villier C, Massy N, Benhamou Y. Angiœdèmes bradykiniques médicamenteux : étude rétrospective à partir de la banque nationale de pharmacovigilance française. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.100] [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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Begarin L, Beaujour A, Fainsilber P, Hermil JL, Lévesque H, Benhamou Y. Compression et ulcère veineux en pratique de ville : une étude observationnelle en médecine générale. ACTA ACUST UNITED AC 2014; 39:382-8. [DOI: 10.1016/j.jmv.2014.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/27/2014] [Indexed: 11/30/2022]
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Borg JY, Négrier C, Durieu I, Dolimier E, Masquelier AM, Lévesque H. FEIBA in the treatment of acquired haemophilia A: Results from the prospective multicentre French ‘FEIBA dans l'hémophilie A acquise’ (FEIBHAC) registry. Haemophilia 2014; 21:330-337. [DOI: 10.1111/hae.12574] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2014] [Indexed: 12/25/2022]
Affiliation(s)
- J.-Y. Borg
- Haemophilia Treatment Centre; Rouen University Hospital and INSERM CIC-CRB 0204; Rouen France
| | - C. Négrier
- Haemophilia Treatment Centre; Edouard Herriot Hospital; University Claude Bernard; Lyon France
| | - I. Durieu
- Department of Internal Medicine; Lyon-Sud Hospital; Pierre Bénite France
| | | | | | - H. Lévesque
- Department of Internal Medicine; Rouen University Hospital; INSERM U1096 and INSERM CIC-CRB 0204; Rouen France
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Abstract
Digital ischemia associated with cancer (DIAC) is increasing in frequency and recent reports have suggested the concept of paraneoplastic manifestation. The aims of this study were to characterize the clinical presentation of DIAC and identify clinical features that could lead physicians to diagnose underlying cancer.From January 2004 to December 2011, 100 patients were hospitalized in the Department of Internal Medicine at Rouen University Hospital, France for a first episode of DI. Fifteen (15%) exhibited symptomatic or asymptomatic cancer during the year preceding or following vascular episode and constituted the DIAC group. Other patients without cancer made up the digital ischemia (DI) group.Median time between diagnosis of cancer and episode of digital necrosis was 2 months [0.25-9]. Diagnosis of DI and concomitant cancer was made in 7 of the 15 patients, while DI preceded the malignant disorder in 2 cases and followed it in 6 cases. Histological types were adenocarcinoma for 7 (46.7%), squamous cell carcinoma for 4 (26.7%), and lymphoid neoplasia for 3 patients (20%). Six patients (40%) had extensive cancer. Three patients were lost to follow-up and 5 patients died <1 year after diagnosis of cancer. Cancer treatment improved vascular symptoms in 6 patients (40%). Patients with DIAC, compared to patients with DI, were significantly older (56 years [33-79] vs 46 [17-83] P =0.005), and had significantly lower hemoglobin and hematocrit levels (12.7 g/dl vs 13.9 g/dl; P =0.003 and 38% vs 42%; P =0.003, respectively). Patients with DIAC had a higher platelet rate (420 vs 300 G/L P =0.01), and 6 patients with DIAC (40%) had thrombocytosis. There was no difference between groups either in C-reactive protein level (12 mg/L vs 5 mg/L; P =0.08) or regarding cardiovascular risk factors, presence of autoimmunity, or monoclonal protein.This retrospective study suggests that DIAC may be more prevalent than previously reported. Outcomes of the 2 diseases were not strictly chronologically parallel. However, in the majority of cases, treatment of the tumor resolved vascular involvement. Our findings suggest that age >50 years and thrombocytosis should alert physicians to consider a possible occult malignancy when digital necrosis occurs.
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Affiliation(s)
- Maëlle Le Besnerais
- Department of Internal Medicine (MLB, SM, NC, NG, IM, HL, YB), Rouen University Hospital, 1 Rue de Germont and Inserm (National Institute for Health and Medical Research) U1096 (HL, YB), University of Rouen, Rouen, France
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Khetta M, Lemaître C, Lecam Duchez V, Benhamou Y, Leprêtre S, Köning E, Lévesque H, Savoye G, Goria O. [Spontaneous intrahepatic hematoma: an unexpected etiology]. Rev Med Interne 2014; 36:127-30. [PMID: 24657041 DOI: 10.1016/j.revmed.2013.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/20/2013] [Revised: 10/18/2013] [Accepted: 11/25/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Diagnosis of AL amyloidosis can be complicated by the diversity and the absence of specificity of symptoms. CASE REPORT We report a patient who presented with a non-traumatic hepatic hematoma, leading to the discovery of hepatic amyloidosis secondary to probable multiple myeloma. The originality of our report lies in the discovery of two acquired abnormalities of haemostasis: a factor X deficiency and an acquired von Willebrand syndrome, by a likely inhibitor. CONCLUSION Our case report is a reminder of the importance of haemostasis analysis in AL amyloidosis.
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Affiliation(s)
- M Khetta
- Service de médecine interne, CHU, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France
| | - C Lemaître
- Service d'hépato-gastro-entérologie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - V Lecam Duchez
- Laboratoire d'hémostase, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U 1096, CHU de Rouen, 76031 Rouen cedex, France
| | - Y Benhamou
- Service de médecine interne, CHU, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France; Inserm U 1096, CHU de Rouen, 76031 Rouen cedex, France
| | - S Leprêtre
- Centre Henri-Becquerel, rue d'Amiens, 76038 Rouen cedex, France
| | - E Köning
- Service de radiologie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - H Lévesque
- Service de médecine interne, CHU, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France; Inserm U 1096, CHU de Rouen, 76031 Rouen cedex, France
| | - G Savoye
- Service d'hépato-gastro-entérologie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U 1073, CHU de Rouen, 76031 Rouen cedex, France
| | - O Goria
- Service d'hépato-gastro-entérologie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
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Langlois V, Armengol G, Girszyn N, Lepileur L, Armengol-Debeir L, Benhamou Y, Lévesque H. [Multiple intra-abdominal nodules]. Rev Med Interne 2014; 35:840-2. [PMID: 24503384 DOI: 10.1016/j.revmed.2013.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 12/26/2013] [Indexed: 11/27/2022]
Affiliation(s)
- V Langlois
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Armengol
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - N Girszyn
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - L Lepileur
- Département d'hépato-gastroentérologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - L Armengol-Debeir
- Département d'hépato-gastroentérologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Y Benhamou
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
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Benhamou Y, Bellien J, Armengol G, Gomez E, Richard V, Lévesque H, Joannidès R. [Assessment of endothelial function in autoimmune diseases]. Rev Med Interne 2014; 35:512-23. [PMID: 24412013 DOI: 10.1016/j.revmed.2013.12.010] [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: 05/22/2013] [Revised: 11/07/2013] [Accepted: 12/02/2013] [Indexed: 11/15/2022]
Abstract
Numerous autoimmune-inflammatory rheumatic diseases have been associated with accelerated atherosclerosis or other types of vasculopathy leading to an increase in cardiovascular disease incidence. In addition to traditional cardiovascular risk factors, endothelial dysfunction is an important early event in the pathogenesis of atherosclerosis, contributing to plaque initiation and progression. Endothelial dysfunction is characterized by a shift of the actions of the endothelium toward reduced vasodilation, a proinflammatory and a proadhesive state, and prothrombic properties. Therefore, assessment of endothelial dysfunction targets this vascular phenotype using several biological markers as indicators of endothelial dysfunction. Measurements of soluble adhesion molecules (ICAM-1, VCAM-1, E-selectin), pro-thrombotic factors (thrombomodulin, von Willebrand factor, plasminogen activator inhibitor-1) and inflammatory cytokines are most often performed. Regarding the functional assessment of the endothelium, the flow-mediated dilatation of conduit arteries is a non-invasive method widely used in pathophysiological and interventional studies. In this review, we will briefly review the most relevant information upon endothelial dysfunction mechanisms and explorations. We will summarize the similarities and differences in the biological and functional assessments of the endothelium in different autoimmune diseases.
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Affiliation(s)
- Y Benhamou
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Service de pharmacologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U 1096, faculté de médecine de Rouen, 22, boulevard Gambetta, 76183 Rouen cedex, France.
| | - J Bellien
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Service de pharmacologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Armengol
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - E Gomez
- Inserm U 1096, faculté de médecine de Rouen, 22, boulevard Gambetta, 76183 Rouen cedex, France
| | - V Richard
- Inserm U 1096, faculté de médecine de Rouen, 22, boulevard Gambetta, 76183 Rouen cedex, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U 1096, faculté de médecine de Rouen, 22, boulevard Gambetta, 76183 Rouen cedex, France
| | - R Joannidès
- Service de pharmacologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U 1096, faculté de médecine de Rouen, 22, boulevard Gambetta, 76183 Rouen cedex, France
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Banse C, Vittecoq O, Benhamou Y, Gauthier-Prieur M, Lequerré T, Lévesque H. Reactive macrophage activation syndrome possibly triggered by canakinumab in a patient with adult-onset Still's disease. Joint Bone Spine 2013; 80:653-5. [DOI: 10.1016/j.jbspin.2013.04.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2013] [Indexed: 01/17/2023]
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42
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De Masson A, Bouaziz JD, Peffault de Latour R, Benhamou Y, Moluçon-Chabrot C, Bay JO, Laquerrière A, Picquenot JM, Michonneau D, Leguy-Seguin V, Bonnotte B, Jardin F, Lévesque H, Socié G, Bagot M, Rybojad M. Fasciite de Shulman et aplasie médullaire idiopathique : description de quatre cas et revue de 19 cas de la littérature. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.550] [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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43
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Lévesque H, Hanslik T. Contraception œstroprogestative et risque thrombotique : des faits cliniques aux conséquences médiatiques. Rev Med Interne 2013; 34:453-5. [DOI: 10.1016/j.revmed.2013.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 04/27/2013] [Indexed: 10/26/2022]
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44
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Jamart C, Sauvêtre G, Lévesque H, Marie I. [Brain calcifications]. Rev Med Interne 2013; 35:141-3. [PMID: 23880301 DOI: 10.1016/j.revmed.2013.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 06/04/2013] [Indexed: 11/26/2022]
Affiliation(s)
- C Jamart
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Sauvêtre
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - I Marie
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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Affiliation(s)
- A Dumesnil
- Département de médecine interne, CHU de Rouen, 1 rue de Germont, Rouen cedex, France
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46
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Proux A, Josse S, Begarin L, Assie-Chauvier C, Benhamou Y, Bernet J, Louvel JP, Lévesque H. [A muscular mass]. Rev Med Interne 2013; 34:783-4. [PMID: 23639328 DOI: 10.1016/j.revmed.2013.03.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 03/18/2013] [Indexed: 11/19/2022]
Affiliation(s)
- A Proux
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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47
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Belizna C, Ghali A, Henrion D, Hamidou M, Lévesque H, Voswinkel J, Ifrah N. P-249 Myelodysplasic syndromes and vasculitis. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70296-0] [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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48
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Borg JY, Guillet B, Le Cam-Duchez V, Goudemand J, Lévesque H. Outcome of acquired haemophilia in France: the prospective SACHA (Surveillance des Auto antiCorps au cours de l'Hémophilie Acquise) registry. Haemophilia 2013; 19:564-70. [PMID: 23574453 DOI: 10.1111/hae.12138] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2013] [Indexed: 01/24/2023]
Abstract
Although extremely rare, acquired haemophilia A (AHA) can cause severe bleeding, which may be fatal. The underlying causes of autoantibody development are not fully understood. Treatment goals are bleeding control and autoantibody eradication. At the time of our study, there was no consensus on a standard treatment strategy for AHA. Previous data were mainly retrospective or from single-centre cohorts. We conducted a prospective, controlled, registry-based study of patients with AHA in France. The prospective French registry (Surveillance des Auto antiCorps au cours de l'Hémophilie Acquise [SACHA]) collected data on prevalence, clinical course, disease associations and outcomes for haemostatic treatment and autoantibody eradication in 82 patients with a 1-year follow-up. Similar to earlier studies, the prevalence of AHA was higher in the elderly, with two thirds of patients aged >70 years. Around half of AHA cases were associated with underlying disease, most commonly autoimmune disease and cancer in younger and older patients respectively. Haemostatic treatment was initially administered to 46% of patients. Complete resolution or improvement of initial bleeding occurred in 22/27 (81%) rFVIIa-treated patients and in all six cases receiving pd-aPCC. The majority of patients (94%) received immunosuppressive therapy, with complete remission at 3 months in 61% (36/59) and in 98% (50/51) at 1 year. Overall mortality was 33%: secondary to bleeding in only three patients but to sepsis in 10. Bypassing agents were effective at controlling bleeding in patients with AHA. Immunosuppressive therapy should be used early but with caution, particularly in elderly patients.
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Affiliation(s)
- J Y Borg
- Haematology Laboratory, Rouen University Hospital and INSERM CIC-CRB 0204, Rouen, France
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49
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de Masson A, Bouaziz JD, de Latour RP, Benhamou Y, Moluçon-Chabrot C, Bay JO, Laquerrière A, Picquenot JM, Michonneau D, Leguy-Seguin V, Rybojad M, Bonnotte B, Jardin F, Lévesque H, Bagot M, Socié G. Severe aplastic anemia associated with eosinophilic fasciitis: report of 4 cases and review of the literature. Medicine (Baltimore) 2013; 92:69-81. [PMID: 23429351 PMCID: PMC4553982 DOI: 10.1097/md.0b013e3182899e78] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Diffuse eosinophilic fasciitis (Shulman disease) is a rare sclerodermiform syndrome that, in most cases, resolves spontaneously or after corticosteroid therapy. It has been associated with hematologic disorders, such as aplastic anemia. The clinical features and long-term outcomes of patients with eosinophilic fasciitis and associated aplastic anemia have been poorly described. We report the cases of 4 patients with eosinophilic fasciitis and associated severe aplastic anemia. For 3 of these patients, aplastic anemia was refractory to conventional immunosuppressive therapy with antithymocyte globulin and cyclosporine. One of the patients received rituximab as a second-line therapy with significant efficacy for both the skin and hematologic symptoms. To our knowledge, this report is the first to describe rituximab used to treat eosinophilic fasciitis with associated aplastic anemia. In a literature review, we identified 19 additional cases of eosinophilic fasciitis and aplastic anemia. Compared to patients with isolated eosinophilic fasciitis, patients with eosinophilic fasciitis and associated aplastic anemia were more likely to be men (70%) and older (mean age, 56 yr; range, 18-71 yr). Corticosteroid-containing regimens improved skin symptoms in 5 (42%) of 12 cases but were ineffective in the treatment of associated aplastic anemia in all but 1 case. Aplastic anemia was profound in 13 cases (57%) and was the cause of death in 8 cases (35%). Only 5 patients (22%) achieved long-term remission (allogeneic hematopoietic stem cell transplantation: n = 2; cyclosporine-containing regimen: n = 2; high-dose corticosteroid-based regimen: n = 1).
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Affiliation(s)
- Adèle de Masson
- From Université Paris Diderot, Sorbonne Paris Cité; AP-HP; Service de Dermatologie (AdM, JDB, MR, MB) and Service de Greffe de Moëlle et Centre de Référence Maladies Rares des Aplasies Médullaires (RPdL, DM, GS), Hôpital Saint Louis, Paris; Service de Médecine Interne (YB, HL) and Service d’Anatomopathologie (AL), Hôpital Charles-Nicolle, Rouen; Service d’Hématologie (CMC, JOB), Hôpital Estaing, Clermont-Ferrand; Service d’Anatomopathologie (JMP) and Service d’Hématologie (FJ), Centre Henri Becquerel, Rouen; and Service de Médecine Interne et Immunologie Clinique (VLS, BB), Hôpital Le Bocage, Dijon; France
| | - Jean-David Bouaziz
- From Université Paris Diderot, Sorbonne Paris Cité; AP-HP; Service de Dermatologie (AdM, JDB, MR, MB) and Service de Greffe de Moëlle et Centre de Référence Maladies Rares des Aplasies Médullaires (RPdL, DM, GS), Hôpital Saint Louis, Paris; Service de Médecine Interne (YB, HL) and Service d’Anatomopathologie (AL), Hôpital Charles-Nicolle, Rouen; Service d’Hématologie (CMC, JOB), Hôpital Estaing, Clermont-Ferrand; Service d’Anatomopathologie (JMP) and Service d’Hématologie (FJ), Centre Henri Becquerel, Rouen; and Service de Médecine Interne et Immunologie Clinique (VLS, BB), Hôpital Le Bocage, Dijon; France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Martine Bagot
- From Université Paris Diderot, Sorbonne Paris Cité; AP-HP; Service de Dermatologie (AdM, JDB, MR, MB) and Service de Greffe de Moëlle et Centre de Référence Maladies Rares des Aplasies Médullaires (RPdL, DM, GS), Hôpital Saint Louis, Paris; Service de Médecine Interne (YB, HL) and Service d’Anatomopathologie (AL), Hôpital Charles-Nicolle, Rouen; Service d’Hématologie (CMC, JOB), Hôpital Estaing, Clermont-Ferrand; Service d’Anatomopathologie (JMP) and Service d’Hématologie (FJ), Centre Henri Becquerel, Rouen; and Service de Médecine Interne et Immunologie Clinique (VLS, BB), Hôpital Le Bocage, Dijon; France
| | - Gérard Socié
- From Université Paris Diderot, Sorbonne Paris Cité; AP-HP; Service de Dermatologie (AdM, JDB, MR, MB) and Service de Greffe de Moëlle et Centre de Référence Maladies Rares des Aplasies Médullaires (RPdL, DM, GS), Hôpital Saint Louis, Paris; Service de Médecine Interne (YB, HL) and Service d’Anatomopathologie (AL), Hôpital Charles-Nicolle, Rouen; Service d’Hématologie (CMC, JOB), Hôpital Estaing, Clermont-Ferrand; Service d’Anatomopathologie (JMP) and Service d’Hématologie (FJ), Centre Henri Becquerel, Rouen; and Service de Médecine Interne et Immunologie Clinique (VLS, BB), Hôpital Le Bocage, Dijon; France
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Boulard C, Girszyn N, Lévesque H, Marie I. [A big nose]. Rev Med Interne 2012. [PMID: 23207553 DOI: 10.1016/j.revmed.2012.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- C Boulard
- Département de médecine interne, CHU de Rouen, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France
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