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de Valence B, Delaune M, Nguyen Y, Jachiet V, Heiblig M, Jean A, Riescher Tuczkiewicz S, Henneton P, Guilpain P, Schleinitz N, Le Guenno G, Lobbes H, Lacombe V, Ardois S, Lazaro E, Langlois V, Outh R, Vinit J, Martellosio JP, Decker P, Moulinet T, Dieudonné Y, Bigot A, Terriou L, Vlakos A, de Maleprade B, Denis G, Broner J, Kostine M, Humbert S, Lifermann F, Samson M, Pechuzal S, Aouba A, Kosmider O, Dion J, Grosleron S, Bourguiba R, Terrier B, Georgin-Lavialle S, Fain O, Mekinian A, Morgand M, Comont T, Hadjadj J. Serious infections in patients with VEXAS syndrome: data from the French VEXAS registry. Ann Rheum Dis 2024; 83:372-381. [PMID: 38071510 DOI: 10.1136/ard-2023-224819] [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: 08/07/2023] [Accepted: 10/22/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is an acquired autoinflammatory monogenic disease with a poor prognosis whose determinants are not well understood. We aimed to describe serious infectious complications and their potential risk factors. METHODS Retrospective multicentre study including patients with VEXAS syndrome from the French VEXAS Registry. Episodes of serious infections were described, and their risk factors were analysed using multivariable Cox proportional hazards models. RESULTS Seventy-four patients with 133 serious infections were included. The most common sites of infection were lung (59%), skin (10%) and urinary tract (9%). Microbiological confirmation was obtained in 76%: 52% bacterial, 30% viral, 15% fungal and 3% mycobacterial. Among the pulmonary infections, the main pathogens were SARS-CoV-2 (28%), Legionella pneumophila (21%) and Pneumocystis jirovecii (19%). Sixteen per cent of severe infections occurred without any immunosuppressive treatment and with a daily glucocorticoid dose ≤10 mg. In multivariate analysis, age >75 years (HR (95% CI) 1.81 (1.02 to 3.24)), p.Met41Val mutation (2.29 (1.10 to 5.10)) and arthralgia (2.14 (1.18 to 3.52)) were associated with the risk of serious infections. JAK inhibitors were most associated with serious infections (3.84 (1.89 to 7.81)) compared with biologics and azacitidine. After a median follow-up of 4.4 (2.5-7.7) years, 27 (36%) patients died, including 15 (56%) due to serious infections. CONCLUSION VEXAS syndrome is associated with a high incidence of serious infections, especially in older patients carrying the p.Met41Val mutation and treated with JAK inhibitors. The high frequency of atypical infections, especially in patients without treatment, may indicate an intrinsic immunodeficiency.
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Affiliation(s)
| | - Marion Delaune
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | - Yann Nguyen
- Médecine interne, Université Paris Cité, Hôpital Beaujon, Clichy, France
| | - Vincent Jachiet
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Mael Heiblig
- Hématologie clinique, Université Claude Bernard Lyon 1, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Alexis Jean
- Médecine interne, CHU de Bordeaux, Bordeaux, France
| | | | - Pierrick Henneton
- Service de Médecine Interne A, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier, France
| | - Philippe Guilpain
- Service de Médecine Interne A, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier, France
| | - Nicolas Schleinitz
- Médecine interne, Aix-Marseille Universite, Hôpital de la Timone, Marseille, France
| | | | - Hervé Lobbes
- Médecine interne, CHU Estaing, Clermont-Ferrand, France
| | - Valentin Lacombe
- Médecine interne et immunologique clinique, CHU Angers, Angers, France
| | | | | | - Vincent Langlois
- Médecine interne et infectieuse, Hospital Group Le Havre, Le Havre, France
| | - Roderau Outh
- Service de médecine interne et générale, CH Perpignan, Perpignan, France
| | - Julien Vinit
- Médecine interne, Hospital Centre Chalon-sur-Saon, Chalon-sur-Saone, France
| | | | - Paul Decker
- Médecine interne et immunologie clinique, CHU de Nancy, Nancy, France
| | - Thomas Moulinet
- Médecine interne et immunologie clinique, CHU de Nancy, Nancy, France
| | - Yannick Dieudonné
- Immunologie Clinique et Médecine Interne, CHU de Strasbourg, Strasbourg, France
| | | | - Louis Terriou
- Médecine interne - hématologie, CHU Lille, Lille, France
| | - Alexandre Vlakos
- Médecine interne, Haute-Saône Hospital Group Vesoul Site, Vesoul, France
| | | | - Guillaume Denis
- Médecine interne et hématologie, Centre Hospitalier de Rochefort, Rochefort, France
| | | | - Marie Kostine
- Rhumatologie, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - Sebastien Humbert
- Hématologie, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | | | | | - Susann Pechuzal
- Médecine interne-polyvalente, Hôpitaux Drôme Nord, Romans, France
| | | | - Olivier Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen, APHP, Paris, France
| | - Jeremie Dion
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | | | - Rim Bourguiba
- Médecine interne, CEREMAIA, Sorbonne Université, Hospital Tenon, Paris, France
| | - Benjamin Terrier
- Médecine interne, Université Paris Cité, Hospital Cochin, Paris, France
| | | | - Olivier Fain
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Arsène Mekinian
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Marjolaine Morgand
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Thibault Comont
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | - Jerome Hadjadj
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
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Jachiet V, Ricard L, Hirsch P, Malard F, Pascal L, Beyne-Rauzy O, Peterlin P, Maria ATJ, Vey N, D'Aveni M, Gourin MP, Dimicoli-Salazar S, Banos A, Wickenhauser S, Terriou L, De Renzis B, Durot E, Natarajan-Ame S, Vekhoff A, Voillat L, Park S, Vinit J, Dieval C, Dellal A, Grobost V, Willems L, Rossignol J, Solary E, Kosmider O, Dulphy N, Zhao LP, Adès L, Fenaux P, Fain O, Mohty M, Gaugler B, Mekinian A. Reduced peripheral blood dendritic cell and monocyte subsets in MDS patients with systemic inflammatory or dysimmune diseases. Clin Exp Med 2022:10.1007/s10238-022-00866-5. [PMID: 35953763 DOI: 10.1007/s10238-022-00866-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systemic inflammatory and autoimmune diseases (SIADs) occur in 10-20% of patients with myelodysplastic syndrome (MDS). Recently identified VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome, associated with somatic mutations in UBA1 (Ubiquitin-like modifier-activating enzyme 1), encompasses a range of severe inflammatory conditions along with hematological abnormalities, including MDS. The pathophysiological mechanisms underlying the association between MDS and SIADs remain largely unknown, especially the roles of different myeloid immune cell subsets. The aim of this study was to quantitatively evaluate peripheral blood myeloid immune cells (dendritic cells (DC) and monocytes) by flow cytometry in MDS patients with associated SIAD (n = 14, most often including relapsing polychondritis or neutrophilic dermatoses) and to compare their distribution in MDS patients without SIAD (n = 23) and healthy controls (n = 7). Most MDS and MDS/SIAD patients had low-risk MDS. Eight of 14 (57%) MDS/SIAD patients carried UBA1 somatic mutations, defining VEXAS syndrome.Compared with MDS patients, most DC and monocyte subsets were significantly decreased in MDS/SIAD patients, especially in MDS patients with VEXAS syndrome. Our study provides the first overview of the peripheral blood immune myeloid cell distribution in MDS patients with associated SIADs and raises several hypotheses: possible redistribution to inflammation sites, increased apoptosis, or impaired development in the bone marrow.
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Affiliation(s)
- Vincent Jachiet
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France. .,Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France.
| | - Laure Ricard
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Pierre Hirsch
- Service d'Hématologie Biologique, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Florent Malard
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Laurent Pascal
- Service d'Oncologie et d'Hématologie, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France
| | - Odile Beyne-Rauzy
- Service de Médecine Interne, CHU de Toulouse, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Pierre Peterlin
- Service d'Hématologie Clinique, CHU de Nantes, Nantes, France
| | - Alexandre Thibault Jacques Maria
- Service de Médecine Interne, maladies multi-organiques de l'adulte, Hôpital Saint-Éloi, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Norbert Vey
- Institut Paoli-Calmettes, CRCM, Aix-Marseille Univ, Inserm, CNRS, Marseille, France
| | - Maud D'Aveni
- Service d'Hématologie et de Médecine Interne, Hôpital Brabois, CHRU Nancy, Nancy, France
| | - Marie-Pierre Gourin
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Dupuytren, CHU de Limoges, Limoges, France
| | | | - Anne Banos
- Service d'Hématologie Clinique, Centre Hospitalier Côte Basque, Bayonne, France
| | - Stefan Wickenhauser
- Service d'Hématologie Clinique, Hôpital Universitaire Carémeau, Institut de Cancérologie du Gard, Nîmes, France
| | - Louis Terriou
- Service de Médecine Interne et Immunologie Clinique, CHU Lille, 59000, Lille, France
| | - Benoit De Renzis
- Service d'Hématologie Clinique, Hôpital Estaing, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Eric Durot
- Service d'Hématologie Clinique, Hôpital Robert Debré, CHU de Reims, Reims, France
| | - Shanti Natarajan-Ame
- Service d'Hématologie, Institut de Cancérologie Strasbourg Europe (ICANS), 17 rue Albert Calmette, Strasbourg, France
| | - Anne Vekhoff
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Laurent Voillat
- Service d'Hématologie et Oncologie, CH William Morey, Chalon sur Saône, France
| | - Sophie Park
- Service d'Hématologie, Université Grenoble Alpes Et CHU Grenoble Alpes, Grenoble, France
| | - Julien Vinit
- Service de Médecine Interne, CH William Morey, Chalon sur Saône, France
| | - Céline Dieval
- Service de Médecine Interne et Hématologie, GHLA, CH de Rochefort, Rochefort, France
| | - Azeddine Dellal
- Service de Rhumatologie, Hôpital Montfermeil, Montfermeil, France
| | - Vincent Grobost
- Service de Médecine Interne, CHU Estaing, Clermont-Ferrand, France
| | - Lise Willems
- Service d'Hématologie, AP-HP, Hôpital Cochin, Paris, France
| | - Julien Rossignol
- Service d'Hématologie Adultes, AP-HP, Hôpital Necker-Enfants Malades, 75015, Paris, France
| | - Eric Solary
- Département d'Hématologie, Institut Gustave Roussy, Villejuif, France
| | - Olivier Kosmider
- Service d'Hématologie Biologique, Université de Paris, AP-HP, Hôpital Cochin, 75014, Paris, France
| | - Nicolas Dulphy
- Institut de Recherche Saint Louis, Hôpital Saint Louis, Université de Paris, INSERM U1160, Paris, France
| | - Lin Pierre Zhao
- Département d'Hématologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Lionel Adès
- Département d'Hématologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Pierre Fenaux
- Département d'Hématologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Olivier Fain
- Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Mohamad Mohty
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Béatrice Gaugler
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Arsène Mekinian
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
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Comont T, Heiblig M, Riviere E, Terriou L, Rossignol J, Bouscary D, Rieu V, Le Guenno G, Mathian A, Aouba A, Vinit J, Dion J, Kosmider O, Terrier B, Georgin-Lavialle S, Fenaux P, Mekinian A. Utilisation de l’azacitidine dans le VEXAS chez des patients porteurs d’un syndrome myélodysplasique : données du registre Français VEXAS. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.250] [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: 10/19/2022]
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Comont T, Heiblig M, Rivière E, Terriou L, Rossignol J, Bouscary D, Rieu V, Le Guenno G, Mathian A, Aouba A, Vinit J, Dion J, Kosmider O, Terrier B, Georgin-Lavialle S, Fenaux P, Mekinian A. Azacitidine for patients with Vacuoles, E1 Enzyme, X-linked, Autoinflammatory, Somatic syndrome (VEXAS) and myelodysplastic syndrome: data from the French VEXAS registry. Br J Haematol 2021; 196:969-974. [PMID: 34651299 DOI: 10.1111/bjh.17893] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [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: 08/24/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022]
Abstract
Azacitidine can be effective in myelodysplastic syndromes (MDS) associated with inflammatory/autoimmune diseases. Vacuoles, E1 Enzyme, X-linked, Autoinflammatory, Somatic syndrome (VEXAS) is a new monogenic autoinflammatory syndrome caused by somatic ubiquitin-like modifier-activating enzyme 1 (UBA1) mutation, often associated with MDS, whose treatment is difficult and not yet codified. Based on a French nationwide registry of 116 patients with VEXAS, we report the efficacy and safety of azacitidine treatment in 11 patients with VEXAS with MDS. Clinical response of VEXAS to azacitidine was achieved in five patients (46%), during 6, 8+, 12, 21, 27+ months respectively, suggesting that azacitidine can be effective in selected patients with VEXAS and associated MDS.
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Affiliation(s)
- Thibault Comont
- Department of Internal Medicine, IUCT-Oncopole, University Hospital of Toulouse, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Mael Heiblig
- Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Université Lyon Sud, Pierre Bénite, France
| | - Etienne Rivière
- Department of Internal Medicine, University of Bordeaux, Haut-Lévêque Hospital, Pessac, France
| | - Louis Terriou
- Department of Internal Medicine and Clinical Immunology, University of Lille, CHU Lille, Lille, France
| | - Julien Rossignol
- French Reference Center for Mastocytosis (CEREMAST), Hôpital Necker, Assistance Publique-Hôpitaux de Paris (APH-HP), Université de Paris, Paris, France
| | - Didier Bouscary
- Departement of Hematology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APH-HP), Université de Paris, Paris, France
| | - Virginie Rieu
- Department of Internal Medicine, University Hospital Estaing, Université de Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Le Guenno
- Department of Internal Medicine, University Hospital Estaing, Université de Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexis Mathian
- Department of Internal Medicine, Pitie-Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Achille Aouba
- Department of Clinical Immunology and Internal Medicine, CHU of Caen Normandie, Université de Caen, Caen, France
| | - Julien Vinit
- Department of Internal Medicine, CHWM, Chalon-sur-Saône, France
| | - Jeremie Dion
- Department of Internal Medicine, IUCT-Oncopole, University Hospital of Toulouse, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Olivier Kosmider
- Hematology laboratory, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APH-HP), Université de Paris, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Sophie Georgin-Lavialle
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris (AP-HP), Tenon Hospital, National reference center for autoinflammatory diseases and AA amyloidosis (CEREMAIA), Sorbonne University, Université de Paris, Paris, France
| | - Pierre Fenaux
- Department of Hematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Arsène Mekinian
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Sorbonne University, Paris, France
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5
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Georgin-Lavialle S, Terrier B, Guedon AF, Heiblig M, Comont T, Lazaro E, Lacombe V, Terriou L, Ardois S, Bouaziz JD, Mathian A, Le Guenno G, Aouba A, Outh R, Meyer A, Roux-Sauvat M, Ebbo M, Zhao LP, Bigot A, Jamilloux Y, Guillotin V, Flamarion E, Henneton P, Vial G, Jachiet V, Rossignol J, Vinzio S, Weitten T, Vinit J, Deligny C, Humbert S, Samson M, Magy-Bertrand N, Moulinet T, Bourguiba R, Hanslik T, Bachmeyer C, Sebert M, Kostine M, Bienvenu B, Biscay P, Liozon E, Sailler L, Chasset F, Audemard-Verger A, Duroyon E, Sarrabay G, Borlot F, Dieval C, Cluzeau T, Marianetti P, Lobbes H, Boursier G, Gerfaud-Valentin M, Jeannel J, Servettaz A, Audia S, Larue M, Henriot B, Faucher B, Graveleau J, de Sainte Marie B, Galland J, Bouillet L, Arnaud C, Ades L, Carrat F, Hirsch P, Fenaux P, Fain O, Sujobert P, Kosmider O, Mekinian A. Further characterization of clinical and laboratory features occurring in VEXAS syndrome in a large-scale analysis of multicenter case-series of 116 French patients. Br J Dermatol 2021; 186:564-574. [PMID: 34632574 DOI: 10.1111/bjd.20805] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A new autoinflammatory syndrome related to somatic mutations of UBA1 was recently described and called VEXAS syndrome. OBJECTIVE To describe clinical characteristics, laboratory findings and outcomes of VEXAS syndrome. DESIGN Case-series. SETTING Patients referred to a French multicenter registry between November 2020 and May 2021. PATIENTS 116 patients with VEXAS syndrome. MEASUREMENTS Frequency and median of parameters and vital status, from diagnosis to the end of the follow-up. RESULTS Main clinical features were skin lesions (83.5%), non-infectious fever (63.6%), weight loss (62%), lung involvement (49.6%), ocular symptoms (38.8%), relapsing chondritis (36.4%), venous thrombosis (34.7%), lymph nodes (33.9%), and arthralgia (27.3%). Hematological disease was present in 58 cases (50%), considered as myelodysplastic syndrome (MDS, n= 58) and monoclonal gammapathy of unknown significance (n=12).UBA1 mutations included p.M41T (44.8%), p.M41V (30.2%), p.M41L (18.1%), and splice mutations (6.9%). After a median follow-up of 3.0 years, 18 patients died (15.5%), from infectious origin (n=9) and MDS progression (n=3). Unsupervised analysis identified 3 clusters: cluster 1 (47%) with mild-to-moderate disease; cluster 2 (16%) with underlying MDS and higher mortality rates; cluster 3 (37%) with constitutional manifestations, higher C-reactive protein levels and less frequent chondritis. Five-year probability of survival was 84.2% in cluster 1, 50.5 % in cluster 2, and 89.6% in cluster 3. UBA1 p.Met41Leu mutation was associated with a better prognosis. CONCLUSION VEXAS syndrome displays a large spectrum of organ manifestations and shows different clinical and prognostic profiles. It also raises a potential impact of the identified UBA1 mutation.
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Affiliation(s)
- S Georgin-Lavialle
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - B Terrier
- University of Paris, AP-HP, Cochin Hospital, Department of Internal Medicine, F-75014, Paris, France
| | - A F Guedon
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Hôpital Saint-Antoine, APHP, Paris
| | | | - T Comont
- University Hospital of Toulouse, Department of Internal Medicine and Clinical Immunology, Toulouse, France
| | - E Lazaro
- Department of Internal Medicine and Infectious Diseases, Hôpital Haut-Lévêque, Bordeaux, France
| | - V Lacombe
- Department of Internal Medicine, Angers University Hospital, Angers, France
| | - L Terriou
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - S Ardois
- Service de médecine interne, CHU de Rennes, Rennes, France
| | - J-D Bouaziz
- Université de Paris, Service de dermatologie, Hôpital Saint Louis, APHP, INSERM U944, Paris, France
| | - A Mathian
- Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - G Le Guenno
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - A Aouba
- Caen Université, Hôpital de Caen, Department of Internal Medicine, Caen, France
| | - R Outh
- Service de médecine interne et générale, Centre Hospitalier de Perpignan, Perpignan, France
| | - A Meyer
- Service d'immunologie clinique et médecine interne, Nouvel Hôpital Civil, CHU Strasbourg
| | - M Roux-Sauvat
- GHND, Centre Hospitalier Pierre Oudot, 30 avenue du Médipôle, BP 40348, 38302 Bourgoin-Jallieu Cedex
| | - M Ebbo
- Aix Marseille Université, AP-HM, Hôpital de la Timone, Department of Internal Medicine, Marseille, France
| | - L P Zhao
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - A Bigot
- 19University of Tours, Tours, France, Department of Internal Medicine and Clinical
| | - Y Jamilloux
- University Hospital of Lyon, Hospices Civils de Lyon, Department of Internal Medicine and Clinical Immunology, Lyon, France
| | - V Guillotin
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - E Flamarion
- Université de Paris, Service de médecine interne, HEGP Paris, France
| | - P Henneton
- Service de Médecine Vasculaire, CHU Montpellier, 80 Av Augustin Fliche, Montpellier, 34090
| | - G Vial
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - V Jachiet
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
| | - J Rossignol
- Université de Paris, Service d'hématologie, Necker Enfants Malades, Paris, France
| | - S Vinzio
- Univ. Grenoble Alpes, Inserm, U1036, CHU Grenoble Alpes, CEA, IRIG-BCI, 38000, Grenoble, France
| | - T Weitten
- Service de médecine interne, Centre Hospitalier (CHICAS), GAP, France
| | - J Vinit
- Service de médecine interne, Centre Hospitalier, Chalons, France
| | - C Deligny
- Service de Rhumatologie - Médecine Interne 5D · CHU de Martinique - Hôpital P. Zobda-Quitman, France
| | - S Humbert
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - M Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - N Magy-Bertrand
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - T Moulinet
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Nancy University Hospital, UMR 7365, IMoPA, Lorraine University, CNRS, Vandoeuvre-lès-Nancy, France
| | - R Bourguiba
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - T Hanslik
- AP-HP, Hôpital Ambroise Paris, service de médecine interne, Paris, France
| | - C Bachmeyer
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - M Sebert
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - M Kostine
- Department of Rheumatology, Hôpital Haut-Lévesque, Bordeaux, France
| | - B Bienvenu
- Hôpital Saint Joseph, service de médecine interne, Marseille, France
| | - P Biscay
- Clinique Mutualiste Pessac Médecine Interne, Pessac, France
| | - E Liozon
- Service de Médecine Interne, CHU Dupuytren, Limoges, France
| | - L Sailler
- University Hospital of Toulouse, Department of Internal Medicine, Toulouse, France
| | - F Chasset
- Sorbonne Université, Hôpital Tenon, service de dermatologie et allergologie et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75020, Paris, France
| | - A Audemard-Verger
- 19University of Tours, Tours, France, Department of Internal Medicine and Clinical
| | - E Duroyon
- Service d'Hématologie Biologique, DMU BioPhyGen GH AP-HP. Centre-University de Paris
| | - G Sarrabay
- Laboratory of Rare and Autoinflammatory Genetic Diseases and Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), CHU Montpellier, University of Montpellier, Montpellier, France
| | - F Borlot
- Service de médecine Interne, CH Béziers, France
| | - C Dieval
- Service de médecine interne et hématologie, CH régional, Rochefort, France
| | - T Cluzeau
- Hematology department, CHU of Nice, Cote d'Azur University, Nice, France
| | - P Marianetti
- CHU de REIMS, Service de médecine interne, maladies infectieuses, immunologie clinique
| | - H Lobbes
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - G Boursier
- Laboratory of Rare and Autoinflammatory Genetic Diseases and Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), CHU Montpellier, University of Montpellier, Montpellier, France
| | - M Gerfaud-Valentin
- University Hospital of Lyon, Hospices Civils de Lyon, Department of Haematology, Lyon, France
| | - J Jeannel
- Université de Paris, Service de médecine interne, HEGP Paris, France
| | - A Servettaz
- CHU de REIMS, Service de médecine interne, maladies infectieuses, immunologie clinique
| | - S Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - M Larue
- APHP, Service de rhumatologie, Hôpital Henri Mondor, Créteil, France
| | - B Henriot
- Service de médecine interne, Centre Hospitalier René Pleven, Dinan, France
| | - B Faucher
- Aix Marseille Université, AP-HM, Hôpital de la Timone, Department of Internal Medicine, Marseille, France
| | - J Graveleau
- CHU de Nantes Hôtel Dieu, Service de Médecine Interne, Nantes, France
| | - B de Sainte Marie
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - J Galland
- Service de médecine interne, hôpital Fleyriat, Centre hospitalier Bourg-en-Bresse, France
| | - L Bouillet
- Univ. Grenoble Alpes, Inserm, U1036, CHU Grenoble Alpes, CEA, IRIG-BCI, 38000, Grenoble, France
| | - C Arnaud
- University Hospital of Toulouse, Department of Internal Medicine, Toulouse, France
| | - L Ades
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - F Carrat
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Hôpital Saint-Antoine, APHP, Paris
| | - P Hirsch
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service d'hématologie biologique, F-75012, Paris, France
| | - P Fenaux
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - O Fain
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
| | - P Sujobert
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - O Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen GH AP-HP. Centre-University de Paris
| | - A Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
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Corfmat M, Willekens C, Vinit J, Bussone G, Fenaux P, Fain O, Klatzmann D, Mekinian A, Comont T. Low dose IL-2 in patients with steroid-dependent dysimmune manifestations associated with myelodysplastic syndromes: a three-case report. Rheumatology (Oxford) 2021; 60:3404-3408. [PMID: 33164099 DOI: 10.1093/rheumatology/keaa696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/29/2020] [Revised: 09/19/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Systemic inflammatory and autoimmune diseases can be associated with myelodysplastic syndromes. Current treatments (steroids, immunosuppressive agents, biologics) are unsatisfactory because of their low response rate, dependence or adverse events. We aimed at evaluating the effects of low doses of IL-2 (ld-IL2) as a regulatory T-cell inducer in this context. METHODS We treated three patients with ld-IL2 with myelodysplastic syndromes and an associated dysimmune disorder (polymyalgia rheumatic, relapsing polychondritis associated with Sweet's syndrome and vasculitis with cutaneous and joint involvement, respectively). All three patients were dependent on steroids and refractory to biologics or azacitidine. They received doses of 1-1.5 million units of proleukin/day during 5 days and then every fortnight. RESULTS The treatment led to a clinical improvement and steroid sparing in 2/3 patients with no serious adverse events, and no progression of the disease. CONCLUSION Our results support the investigation of ld-IL2 in MDS associated with immune disorders in controlled clinical studies.
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Affiliation(s)
- Marion Corfmat
- Service de Médecine Interne, IUCT Oncopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse
| | - Christophe Willekens
- Département d'Hématologie, Institut Gustave Roussy, Université Paris Sud, Villejuif
| | - Julien Vinit
- Service de Médecine Interne, CHWM, 4, Rue Capitaine-Drillien, Chalon-sur-Saône
| | - Guillaume Bussone
- Service de Médecine Interne, Immunologie Clinique, Médecine Aigüe Polyvalente, Hôpital Antoine-Béclère-AP-HP, Clamart
| | - Pierre Fenaux
- Service d'Hématologie Séniors Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Université de Paris
| | - Olivier Fain
- Service de Médecine Interne, AP-HP, Hôpital Saint Antoine, Sorbonne Université
| | - David Klatzmann
- INSERM, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université.,Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - Arsene Mekinian
- Service de Médecine Interne, AP-HP, Hôpital Saint Antoine, Sorbonne Université
| | - Thibault Comont
- Service de Médecine Interne, IUCT Oncopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse.,Centre de Recherche en Cancérologie de Toulouse, Inserm UMR 1037, Toulouse, France
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Auvens C, Schneider V, Eberl I, Mausservey C, Vinit J, Ricolfi F, Monard E. TIPIC syndrome : à propos d’un cas. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.253] [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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Grienay N, Teysseire M, Goujon E, Monard E, Mausserve C, Vinit J. Un chancre révélateur d’une granulomatose avec polyangéite. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.128] [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: 11/16/2022]
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9
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Grienay N, Richard N, Fortunet C, Mausservey C, Vinit J, Monard E. Une tétraparésie fébrile révélatrice d’une chondrocalcinose intracanalaire. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.122] [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: 11/30/2022]
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10
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Cosserat J, Du Breuil F, Validire P, Lenoir S, Wolf S, Gayraud M, Vinit J. Le microbiote au cœur du psychisme. Rev Med Interne 2018; 39:369-372. [DOI: 10.1016/j.revmed.2017.06.017] [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: 06/07/2017] [Accepted: 06/20/2017] [Indexed: 10/17/2022]
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11
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Grienay N, Henaff M, Sagot P, Gompel A, Coutant C, Loustalot C, De Maistre E, Delay E, Costedoat-Chalumeau N, Eric M, Mausservey C, Vinit J. Gigantomastie : un lien étroit avec l’auto-immunité ? Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.150] [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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Mekinian A, Dervin G, Lapidus N, Kahn JE, Terriou L, Liozon E, Grignano E, Piette JC, Rauzy OB, Grobost V, Godmer P, Gillard J, Rossignol J, Launay D, Aouba A, Cardon T, Bouillet L, Broner J, Vinit J, Ades L, Carrat F, Salvado C, Toussirot E, Versini M, Costedoat-Chalumeau N, Fraison JB, Guilpain P, Fenaux P, Fain O. Biologics in myelodysplastic syndrome-related systemic inflammatory and autoimmune diseases: French multicenter retrospective study of 29 patients. Autoimmun Rev 2017; 16:903-910. [DOI: 10.1016/j.autrev.2017.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/17/2017] [Indexed: 12/23/2022]
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Dervin G, Mekinian A, Kahn J, Terriou L, Liozon E, Grignano E, Piette J, Beyne-Rauzy O, Geraldine F, Godmer P, Fenaux P, Fain O, Rossignol J, Launay D, Aouba A, Gillard J, Cardon T, Bouillet L, Broner T, Vinit J, Ades L, Salvado C, Toussirot E, Guilpain P, Groh M, Lapidus N, Carrat F. Efficacité des biothérapies dans les manifestations auto-immunes et systémiques des syndromes myélodysplasiques : étude multicentrique rétrospective de 29 patients. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.134] [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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Maillet T, Vinit J, Rouland A, Gandon C, Mausservey C. Polychondrite atrophiante associée à une méningite : à propos d’un cas de rémission sous immunosuppresseurs. Presse Med 2016; 45:938-939. [DOI: 10.1016/j.lpm.2016.06.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/25/2016] [Accepted: 06/05/2016] [Indexed: 11/29/2022] Open
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Maillet T, Nguyen-Baranoff D, Rouland A, Vinit J, Gandon C, Martha B, Salles E, Mausservey C. Pneumopathie interstitielle à l’azathioprine : à propos d’un nouveau cas et revue de la littérature. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.026] [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: 11/16/2022]
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Samson M, Audia S, Fraszczak J, Trad M, Ornetti P, Lakomy D, Ciudad M, Leguy V, Berthier S, Vinit J, Manckoundia P, Maillefert JF, Besancenot JF, Aho-Glele S, Olsson NO, Lorcerie B, Guillevin L, Mouthon L, Saas P, Bateman A, Martin L, Janikashvili N, Larmonier N, Bonnotte B. Th1 and Th17 lymphocytes expressing CD161 are implicated in giant cell arteritis and polymyalgia rheumatica pathogenesis. ACTA ACUST UNITED AC 2013; 64:3788-98. [PMID: 22833233 DOI: 10.1002/art.34647] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Giant cell arteritis (GCA) is the most frequently occurring vasculitis in elderly individuals, and its pathogenesis is not fully understood. The objective of this study was to decipher the role of the major CD4+ T cell subsets in GCA and its rheumatologic form, polymyalgia rheumatica (PMR). METHODS A prospective study of the phenotype and the function of major CD4+ T cell subsets (Th1, Th17, and Treg cells) was performed in 34 untreated patients with GCA or PMR, in comparison with 31 healthy control subjects and with the 27 treated patients who remained after the 7 others withdrew. RESULTS Compared with control subjects, patients with GCA and patients with PMR had a decreased frequency of Treg cells and Th1 cells, whereas the percentage of Th17 cells was significantly increased. Furthermore, an analysis of temporal artery biopsy specimens obtained from patients affected by GCA for whom biopsy results were positive demonstrated massive infiltration by Th17 and Th1 lymphocytes without any Treg cells. After glucocorticoid treatment, the percentages of circulating Th1 and Th17 cells decreased, whereas no change in the Treg cell frequency was observed. The frequency of CD161+CD4+ T cells, which are considered to be Th17 cell precursors, was similar in patients and control subjects. However, these cells highly infiltrated GCA temporal artery biopsy specimens, and their ability to produce interleukin-17 in vitro was significantly enhanced in patients with GCA and patients with PMR and was correlated with a decrease in the phosphorylated form of STAT-1. CONCLUSION This study is the first to demonstrate that the frequency of Treg cells is decreased in patients with GCA and patients with PMR, and that CD161+CD4+ T lymphocytes, differentiated into Th1 cells and Th17 cells, are involved in the pathogenesis of GCA and PMR.
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Affiliation(s)
- Maxime Samson
- Université de Bourgogne and CHU Dijon le Bocage, Dijon, France
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Muller G, Gandon C, Bouiller K, Picque JB, Bielefeld P, Vinit J, Besancenot JF. Hypersensibilité à l’azathioprine. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.253] [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: 11/16/2022]
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Picque JB, Bouiller K, Gandon C, Vinit J, Muller G, Couailler J, Bielefeld P, Besancenot JF. Efficacité de l’infliximab dans le traitement d’une hypophysite lymphocytaire. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.235] [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: 10/27/2022]
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Nicolas B, Vinit J, Muller G, Bielefeld P, Besancenot F. Des cervicalgies peu banales. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.03.236] [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: 11/28/2022]
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20
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Vinit J, Duvillard C, Bonnabel A, Nicolas B, Mathieu B, Bonnot PH, Bielefeld P, Muller G, Turcu A, Besancenot JF. Aspergillose invasive sphénoïdale d’allure pseudotumorale. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.03.235] [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: 10/28/2022]
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Vinit J, de Maistre E, Naulin T, Devilliers H, Muller G, Bielefeld P, Besancenot JF. Microsphérocytose héréditaire splénectomisée et maladie thromboembolique veineuse : à propos de trois cas. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.03.170] [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: 10/28/2022]
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Muselier A, Bielefeld P, Bidot S, Vinit J, Besancenot JF, Bron A. Efficacy of tocilizumab in two patients with anti-TNF-alpha refractory uveitis. Ocul Immunol Inflamm 2012; 19:382-3. [PMID: 21970668 DOI: 10.3109/09273948.2011.606593] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To report on two patients with refractory uveitis treated with tocilizumab; a new humanized monoclonal antibody against the interleukin-6 receptor (IL-6R). DESIGN Retrospective interventional case series. METHODS Both patients received a monthly infusion of tocilizumab 8 mg/kg; associated with corticosteroids. Outcome measures were visual acuity and central retinal thickness evaluated with optical coherence tomography. RESULTS An improvement in visual acuity and a decrease in macular edema were observed in these two patients. CONCLUSIONS Tocilizumab seems to be a promising treatment in refractory uveitis. A prospective study is needed to evaluate the role of this new agent in the management of refractory uveitis.
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Affiliation(s)
- Aurore Muselier
- Ophthalmology Department, University Hospital, Dijon, France
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Vinit J, Bielefeld P, Muller G, Besancenot JF. Efficacy of tocilizumab in refractory giant cell arteritis. Joint Bone Spine 2012; 79:317-8. [PMID: 22284606 DOI: 10.1016/j.jbspin.2011.11.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/29/2011] [Indexed: 02/06/2023]
Abstract
Giant cell arteritis is the most frequent form of vasculitis characterized by a high risk of vascular thrombosis. Major complications are blindness and other vascular ischemia but bowel ischemic involvement is rare. Treatment is based on long-term steroid therapy with numerous side effects. The efficacy of immunosuppressive drugs like azathioprine methotrexate or anti-tumor necrosis factor antibodies appears to be too low to reduce the use of steroids. Th17 lymphocytes and interleukin-6 play an important role in pathogenesis of giant cell arteritis. We report here a case of effective interleukin-6 blocker in the treatment of refractory giant cell arteritis with ileitis and high-dose steroid dependence despite 2 years of treatment with steroids and methotrexate. After infusions of tocilizumab, no relapse at 6 months was found despite the decrease in corticosteroids.
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Affiliation(s)
- Julien Vinit
- Service de médecine interne et maladies systémiques, hôpital Général, University Hospital of Dijon, 3, rue Faubourg-Raines, 21033 Dijon cedex, France.
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Bielefeld P, Muselier A, Vinit J, Devilliers H, Muller G, Bron A, Besancenot JF. Intérêt du cotrimoxazole dans les sclérites antérieures idiopathiques récidivantes. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.316] [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: 10/15/2022]
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Lakomy D, Janikashvili N, Fraszczak J, Trad M, Audia S, Samson M, Ciudad M, Vinit J, Vergely C, Caillot D, Foucher P, Lagrost L, Chouaib S, Katsanis E, Larmonier N, Bonnotte B. Cytotoxic dendritic cells generated from cancer patients. J Immunol 2011; 187:2775-82. [PMID: 21804019 DOI: 10.4049/jimmunol.1004146] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Known for years as professional APCs, dendritic cells (DCs) are also endowed with tumoricidal activity. This dual role of DC as killers and messengers may have important implications for tumor immunotherapy. However, the tumoricidal activity of DCs has mainly been investigated in animal models. Cancer cells inhibit antitumor immune responses using numerous mechanisms, including the induction of immunosuppressive/ tolerogenic DCs that have lost their ability to present Ags in an immunogenic manner. In this study, we evaluated the possibility of generating tumor killer DCs from patients with advanced-stage cancers. We demonstrate that human monocyte-derived DCs are endowed with significant cytotoxic activity against tumor cells following activation with LPS. The mechanism of DC-mediated tumor cell killing primarily involves peroxynitrites. This observed cytotoxic activity is restricted to immature DCs. Additionally, after killing, these cytotoxic DCs are able to activate tumor Ag-specific T cells. These observations may open important new perspectives for the use of autologous cytotoxic DCs in cancer immunotherapy strategies.
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Affiliation(s)
- Daniela Lakomy
- INSERM Unité Mixte de Recherche 866, Institut de Recherche Fédératif 100, Faculté de Médecine, 21079 Dijon, France
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Bielefeld P, Beynat J, Vinit J, Putot A, Cayot A, Fiordaliso L, Muller G, Muselier A, Bron A, Besancenot JF. Exophtalmie basedowienne résistante : une bonne indication des anti-TNF ? Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.03.236] [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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Vinit J, Bielefeld P, Muller G, Bonnotte B, Lorcerie B, Besancenot JF, Terriat B. Mesure systématique des index de pression systolique à la cheville pour le dépistage de l’artériopathie oblitérante des membres inférieurs dans les services de médecine interne : comparaison aux recommandations de la Haute Autorité de santé. Étude prospective descriptive chez 106 patients. Presse Med 2011; 40:e163-72. [DOI: 10.1016/j.lpm.2010.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 08/05/2010] [Accepted: 10/15/2010] [Indexed: 11/28/2022] Open
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Vinit J, Friedel J, Bielefeld P, Muller G, Goudet P, Besancenot JF. Syndrome de Birt-Hogg-Dubé et tumeurs multiples récidivantes. Rev Med Interne 2011; 32:e40-2. [DOI: 10.1016/j.revmed.2010.01.016] [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: 10/06/2009] [Revised: 12/30/2009] [Accepted: 01/18/2010] [Indexed: 11/29/2022]
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Vinit J, Bielefeld P, Muller G, Turcu A, Dargent A, Blot M, Court S, Bidot S, Besancenot JF. Efficacité potentielle du tocilizumab au cours de la rétinopathie de Birdshot : à propos d’un cas. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.167] [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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Vinit J, Devilliers H, Pisker G, Ez Zemman C, Cottin Y, Besancenot JF. Dysplasie fibromusculaire des coronaires. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.265] [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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Blot M, Court S, Dargent A, Bielefeld P, Bidot S, Muller G, Vinit J, Turcu A, Besancenot J. Uvéite granulomateuse et méningite lymphocytaire révélant une infection à Toxocara canis. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.280] [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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Bielefeld P, Bidot S, Vinit J, Muller G, Dargent A, Blot M, Court S, Bron A, Besancenot JF. Uvéite intermédiaire chez une femme de 35 ans : ne pas oublier le médicament. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.343] [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: 11/28/2022]
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Samson M, Audia S, Lakomy D, Trad M, Devilliers H, Vinit J, Manckoundia C, Maillefert JF, Martin L, Besancenot JF, Lorcerie B, Bonnotte B. Balance Th17/Treg au cours de la maladie de Horton et la Pseudopolyarthrite rhizomélique : une nouvelle cible thérapeutique ? Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.045] [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] [Indexed: 11/17/2022]
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Vinit J, Bielefeld P, Muller G, Pfitzenmeyer P, Bonniaud P, Lorcerie B, Besancenot JF. Heart involvement in Churg-Strauss syndrome: retrospective study in French Burgundy population in past 10 years. Eur J Intern Med 2010; 21:341-6. [PMID: 20603049 DOI: 10.1016/j.ejim.2010.05.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 04/29/2010] [Accepted: 05/10/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Heart manifestations of Churg-Strauss syndrome (CSS) are varied. In the early stages of the disease, it is difficult to distinguish between lesions that are specific to CSS and those of other etiologies. The aim of our work was to compare the characteristics of patients with heart manifestations linked or not to Churg-Strauss syndrome. MATERIAL AND METHODS We recorded all clinical symptoms of patients with CSS hospitalized between 1998 and 2008 in Burgundy, France, and determined the possible relationships between heart symptoms and CSS. RESULTS From a cohort of 31 patients, we found 20 with heart lesions. When heart lesions were present, we noted fewer initial symptoms of digestive disorders (p<0.05), lower levels of lung infiltrates and fewer anti-MPO pANCA (p<0.05). Heart lesions were linked to CSS in 75% of cases. Their patients were thus younger than those in the other cardiac patients (p<0.05), were more likely to have clinical manifestations of heart involvement at diagnosis, were less likely to have lung infiltrates on the X-ray at diagnosis and during flare-ups and less likely to have lung abnormalities on X-rays during flare-ups (p<0.05) and higher level of leucocytes and eosinophils at diagnosis. CONCLUSION Heart lesions directly attributable to CSS are frequent, severe and probably underestimated. A specific physiopathology that is not mediated by ANCA seems to be involved in the genesis of CSS-related heart lesions.
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Affiliation(s)
- J Vinit
- Department of Internal Medicine and Systemic Diseases, General Hospital, University Hospital, 3 rue Faubourg Raines, Dijon Cedex, France.
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Muller G, Bielefeld P, Souchier M, Rouche J, Devilliers H, Vinit J, Bron A, Besancenot J. Enophtalmie révélatrice d’un cancer du sein. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.336] [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: 11/27/2022]
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Bielefeld P, Bidot S, Vinit J, Muller G, Rouche J, Lefebvre PH, Bron A, Besancenot JF. Pseudo-tumeur inflammatoire de la rate et uvéite : une association non fortuite. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.298] [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: 10/19/2022]
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Vinit J, Bielefeld P, Muller G, Antier N, Lefevre PH, Rouche J, Besancenot JF. Deux complications inhabituelles d’une bêta-thalassémie hétérozygote. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.135] [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: 11/25/2022]
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Ornetti P, Turcu A, Vinit J. Clinical images: Calcific iliopsoas bursitis in a patient with scleroderma mimicking avascular hip osteonecrosis. ACTA ACUST UNITED AC 2010; 62:1562. [PMID: 20155825 DOI: 10.1002/art.27407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Vinit J, Muller G, Bielefeld P, Pfitzenmeyer P, Bonniaud P, Lorcerie B, Besancenot JF. Churg-Strauss syndrome: retrospective study in Burgundian population in France in past 10 years. Rheumatol Int 2009; 31:587-93. [PMID: 20039171 DOI: 10.1007/s00296-009-1275-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 11/29/2009] [Indexed: 11/28/2022]
Abstract
Churg-Strauss Syndrome (SCS) is a systemic vasculitis associated with asthma and eosinophilia. The aim of our work is to describe this pathology in the Burgundian population in France. We counted from the hospitalisation data-processing summaries, the whole of the SCS hospitalised in Burgundy between 1998 and 2008. During the follow-up, the clinical and paraclinical characteristics of every patient were collected. The average prevalence is of 11.3 per million inhabitants and the incidence is of 1.2 new cases per million inhabitants per annum. There exists however, a great prevalence disparity and incidence amongst the various departments of the area. The patient's average follow-up is of 7.7 years. In 23% of the cases one finds a starting factor for vasculitis. The delay between the first signs and the diagnostic is an average of 61 months. The ANCA are positive in 26% of cases and of anti-myeloperoxidase specificity in 83% of cases (P < 0.001). The most profitable biopsies are essentially cutaneous and neuromuscular. At the diagnostic, two-third of the patients have had a treatment adapted according to the current recommendations based on the Five Factor Score. The remission rate within a 1-year period is of 77%. The remission is strongly correlated to the therapeutic protocol associating corticoids and cyclophosphamide (P < 0.05). In conclusion, the prevalence of SCS in our area is similar to that observed in other European regions. However, this vasculitis remains a difficult and often a tardive diagnostic pathology.
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Affiliation(s)
- Julien Vinit
- Department of Internal Medicine and Systemic Diseases, General Hospital, University Hospital, Dijon Cedex, France.
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Devilliers H, Vinit J, Court S, Leguy V, Audia S, Samson M, Bonnotte B, Muller G, Amoura Z, Besancenot JF. Facteurs associés à la connaissance du lupus systémique par les patients. Une étude sur questionnaire. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.141] [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: 11/25/2022]
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Bertrand G, Vinit J, Bielefeld P, Turcu A, Couailler JF, Duong M, Piroth L, Besancenot JF. Syndrome du piriforme révélant une pyomyosite. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.407] [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: 11/25/2022]
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Audia S, Lakomy D, Vinit J, Leguy V, Olsson NO, Besancenot JF, Lorcerie B, Bonnotte B. Anticorps anti-Sm dosés par immunofluorimétrie en flux au cours du lupus érythémateux disséminé. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.03.176] [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: 10/20/2022]
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Vinit J, Friedel J, Bielefeld P, Muller G, Goudet P, Besancenot JF. Syndrome de Birt-Hogg-Dubé et tumeurs multiples récidivantes. À propos d’un cas. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.03.294] [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: 11/30/2022]
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Vinit J, Muller G, Bielefeld P, Pfitzenmeyer P, Camus P, Lorcerie B, Besancenot JF. Atteinte cardiaque dans le syndrome de Churg et Strauss : étude rétrospective en Bourgogne. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.049] [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: 10/21/2022]
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Vinit J, Audia S, Boichot C, Couaillier JF, Berthier S, Bonnotte B, Besancenot JF, Lorcerie B. Multiples hyperfixations sur une scintigraphie osseuse. Rev Med Interne 2008; 29:922-3. [DOI: 10.1016/j.revmed.2008.01.012] [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: 01/15/2008] [Accepted: 01/19/2008] [Indexed: 10/22/2022]
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Vinit J, Audia S, Fromont A, Berthier S, Bonnotte B, Giroud M, Lorcerie B, Moreau T. [A neurological deficit multifocal pseudo infectious revealing a disseminated acute encephalomyelitis]. Presse Med 2008; 37:1825-8. [PMID: 18829250 DOI: 10.1016/j.lpm.2007.11.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 11/21/2007] [Accepted: 11/26/2007] [Indexed: 10/21/2022] Open
Affiliation(s)
- Julien Vinit
- Service de médecine interne et immunologie, Bocage CHU, F-21079 Dijon Cedex, France.
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Muller G, Vinit J, Bousquet O, Blazkova S, Bielefeld P, Ricolfi F, Besancenot JF. Méningo-encéphalite au cours d’une rectocolite hémorragique. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.208] [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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Devilliers H, Grandvuillemin A, Montoloy M, Sgro C, Mura H, Leguy V, Bonotte B, Lorcerie B, Samson M, Vinit J, Berthier S. Dérivés des terpènes et convulsions chez l'adulte, à propos de deux cas. Rev Med Interne 2007. [DOI: 10.1016/j.revmed.2007.03.227] [Citation(s) in RCA: 2] [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] [Indexed: 11/16/2022]
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Vinit J, Devilliers H, Audia S, Leguy V, Mura H, Falvo N, Berthier S, Besancenot JF, Bonnotte B, Lorcerie B. Des sueurs antalgiques. Rev Med Interne 2007. [DOI: 10.1016/j.revmed.2007.03.230] [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: 12/01/2022]
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