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Jarrot PA, Mirouse A, Ottaviani S, Cadiou S, Salmon JH, Liozon E, Parreau S, Michaud M, Terrier B, Gavand PE, Trefond L, Lavoiepierre V, Keraen J, Rekassa D, Bouldoires B, Weitten T, Roche D, Poulet A, Charpin C, Grobost V, Hermet M, Pallure M, Wackenheim C, Karkowski L, Grumet P, Rogier T, Belkefi N, Pestre V, Broquet E, Leurs A, Gautier S, Gras V, Gilet P, Holubar J, Sivova N, Schleinitz N, Durand JM, Castel B, Petrier A, Arcani R, Gramont B, Guilpain P, Lepidi H, Weiller PJ, Micallef J, Saadoun D, Kaplanski G. Polymyalgia rheumatica and giant cell arteritis following COVID-19 vaccination: Results from a nationwide survey. Hum Vaccin Immunother 2024; 20:2334084. [PMID: 38563792 PMCID: PMC10989707 DOI: 10.1080/21645515.2024.2334084] [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: 01/17/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
We conducted a national in-depth analysis including pharmacovigilance reports and clinical study to assess the reporting rate (RR) and to determine the clinical profile of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) in COVID-19-vaccinated individuals. First, based on the French pharmacovigilance database, we estimated the RR of PMR and GCA cases in individuals aged over 50 who developed their initial symptoms within one month of receiving the BNT162b2 mRNA, mRNA-1273, ChAdOx1 nCoV-19, and Ad26.COV2.S vaccines. We then conducted a nationwide survey to gather clinical profiles, therapeutic management, and follow-up data from individuals registered in the pharmacovigilance study. A total of 70 854 684 COVID-19 vaccine doses were administered to 25 260 485 adults, among which, 179 cases of PMR (RR 7. 1 cases/1 000 000 persons) and 54 cases of GCA (RR 2. 1 cases/1 000 000 persons) have been reported. The nationwide survey allowed the characterization of 60 PMR and 35 GCA cases. Median time to the onset of first symptoms was 10 (range 2-30) and 7 (range 2-25) days for PMR and GCA, respectively. Phenotype, GCA-related ischemic complications and -large vessel vasculitis as well as therapeutic management and follow-up seemed similar according to the number of vaccine shots received and when compared to the literature data of unvaccinated population. Although rare, the short time between immunization and the onset of first symptoms of PMR and GCA suggests a temporal association. Physician should be aware of this potential vaccine-related phenomenon.
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Affiliation(s)
- Pierre-André Jarrot
- Department of Internal Medicine and Clinical Immunology, Hôpital de La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S1263, Aix-Marseille University, Marseille, France
| | - Adrien Mirouse
- Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l’Amylose inflammatoire (CEREMAIA), Sorbonne Universités, Paris, France
- INSERM, UMR_S 959 Lab, Immunology, Immunotherapeutics, Paris, France
- DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Sébastien Ottaviani
- Department of Rheumatology, DMU Locomotion, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France
| | - Simon Cadiou
- Department of Rheumatology, CHU de Rennes, Université de Rennes 1, Rennes, France
| | - Jean-Hugues Salmon
- Department of Rheumatology, Hôpital de La Maison Blanche, Université de Reims, Reims, France
| | - Eric Liozon
- Department of Internal Medicine, Hôpital Universitaire de Limoges, Limoges, France
| | - Simon Parreau
- Department of Internal Medicine, Hôpital Universitaire de Limoges, Limoges, France
| | - Martin Michaud
- Department of Internal Medicine, Clinique Saint-Exupery, Toulouse, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Disease, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre, Université Paris Cité, Paris, France
| | | | - Ludovic Trefond
- Department of Internal Medicine, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Virginie Lavoiepierre
- Department of Internal Medicine and Clinical Immunology, Hôpital de La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Jeremy Keraen
- Department of Internal Medicine, Hôpital de Cornouaille, Quimper, France
| | - Daniel Rekassa
- Department of Rehabilitation, Centre Thermal, Greoux Les Bains, France
| | | | - Thierry Weitten
- Department of Internal Medicine, Hôpital des Alpes du Sud, Gap, France
| | - Damien Roche
- Department of Rheumatology, Hôpital Saint-Joseph, Marseille, France
| | - Antoine Poulet
- Department of Internal Medicine, Hôpital Saint-Joseph, Marseille, France
| | - Caroline Charpin
- Department of Rheumatology, Hôpital Saint-Joseph, Marseille, France
| | - Vincent Grobost
- Department of Internal Medicine, Hôpital Estaing, Clermont-Ferrand, France
| | - Marion Hermet
- Department of Internal Medicine, Hôpital de Vichy, Vichy, France
| | - Magali Pallure
- Department of Rheumatology, Hôpital de Cannes Simone Veil, Cannes, France
| | - Chloe Wackenheim
- Department of Internal Medicine, Medipole Hôpital Privé, Villeurbanne, France
| | - Ludovic Karkowski
- Department of Internal Medicine, Hôpital d’Instruction des Armées Sainte-Anne, Toulon, France
| | - Pierre Grumet
- Department of Internal Medicine, Hôpital des Alpes du Sud, Gap, France
| | - Thomas Rogier
- Department of Internal Medicine and Systemic Disease, Hôpital François Mitterand, Dijon, France
| | - Nabil Belkefi
- Department of Internal Medicine, CH de Melun, Melun, France
| | - Vincent Pestre
- Department of Internal Medicine and Infectious Disease, CH d’Avignon, Avignon, France
| | | | - Amélie Leurs
- Department of Internal Medicine and Infectious Disease, CH de Dunkerque, Dunkerque, France
| | - Sophie Gautier
- Department of Pharmacology, centre régional de pharmacovigilance Nord Pas de Calais, CHRU de Lille, Lille, France
| | - Valérie Gras
- Department of Clinical Pharmacology, Centre régional de pharmacovigilance, service de pharmacologie clinique, CHU Amiens-Picardie, Amiens, France
| | - Pierre Gilet
- Regional Center of Pharmacovigilance, CHRU de Nancy, Hôpital Central, Nancy, France
| | - Jan Holubar
- Department of Internal Medicine, CHU de Nîmes, Nîmes, France
| | - Nadia Sivova
- Department of Internal Medicine, CH de Tourcoing, Tourcoing, France
| | - Nicolas Schleinitz
- Department of Internal Medicine, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Jean-Marc Durand
- Department of Internal Medicine, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Brice Castel
- Department of Internal Medicine, CH de Tarbes, Tarbes, France
| | | | - Robin Arcani
- Department of Internal Medicine and Therapeutics Department, Hôpital de La Timone, Marseille, France
| | - Baptiste Gramont
- Department of Internal Medicine, CHU de Saint-Etienne, Saint-Etienne, France
| | - Philippe Guilpain
- Department of Internal Medicine, CHU Saint-Eloi, Montpellier, France
| | - Hubert Lepidi
- Pathological Laboratory, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | | | - Joelle Micallef
- Department of Clinical Pharmacology and pharmacosurveillance, Regional Pharmacovigilance Center of Marseille, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l’Amylose inflammatoire (CEREMAIA), Sorbonne Universités, Paris, France
- INSERM, UMR_S 959 Lab, Immunology, Immunotherapeutics, Paris, France
- DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gilles Kaplanski
- Department of Internal Medicine and Clinical Immunology, Hôpital de La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S1263, Aix-Marseille University, Marseille, France
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Peel JN, Yang R, Le Voyer T, Gervais A, Rosain J, Bastard P, Behere A, Cederholm A, Bodansky A, Seeleuthner Y, Conil C, Ding JY, Lei WT, Bizien L, Soudee C, Migaud M, Ogishi M, Yatim A, Lee D, Bohlen J, Perpoint T, Perez L, Messina F, Genet R, Karkowski L, Blot M, Lafont E, Toullec L, Goulvestre C, Mehlal-Sedkaoui S, Sallette J, Martin F, Puel A, Jouanguy E, Anderson MS, Landegren N, Tiberghien P, Abel L, Boisson-Dupuis S, Bustamante J, Ku CL, Casanova JL. Neutralizing IFN-γ autoantibodies are rare and pathogenic in HLA-DRB1*15:02 or 16:02 individuals. J Clin Invest 2024; 134:e178263. [PMID: 38470480 PMCID: PMC11014650 DOI: 10.1172/jci178263] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/01/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUNDWeakly virulent environmental mycobacteria (EM) can cause severe disease in HLA-DRB1*15:02 or 16:02 adults harboring neutralizing anti-IFN-γ autoantibodies (nAIGAs). The overall prevalence of nAIGAs in the general population is unknown, as are the penetrance of nAIGAs in HLA-DRB1*15:02 or 16:02 individuals and the proportion of patients with unexplained, adult-onset EM infections carrying nAIGAs.METHODSThis study analyzed the detection and neutralization of anti-IFN-γ autoantibodies (auto-Abs) from 8,430 healthy individuals of the general population, 257 HLA-DRB1*15:02 or 16:02 carriers, 1,063 patients with autoimmune disease, and 497 patients with unexplained severe disease due to EM.RESULTSWe found that anti-IFN-γ auto-Abs detected in 4,148 of 8,430 healthy individuals (49.2%) from the general population of an unknown HLA-DRB1 genotype were not neutralizing. Moreover, we did not find nAIGAs in 257 individuals carrying HLA-DRB1* 15:02 or 16:02. Additionally, nAIGAs were absent in 1,063 patients with an autoimmune disease. Finally, 7 of 497 patients (1.4%) with unexplained severe disease due to EM harbored nAIGAs.CONCLUSIONThese findings suggest that nAIGAs are isolated and that their penetrance in HLA-DRB1*15:02 or 16:02 individuals is low, implying that they may be triggered by rare germline or somatic variants. In contrast, the risk of mycobacterial disease in patients with nAIGAs is high, confirming that these nAIGAs are the cause of EM disease.FUNDINGThe Laboratory of Human Genetics of Infectious Diseases is supported by the Howard Hughes Medical Institute, the Rockefeller University, the St. Giles Foundation, the National Institutes of Health (NIH) (R01AI095983 and U19AIN1625568), the National Center for Advancing Translational Sciences (NCATS), the NIH Clinical and Translational Science Award (CTSA) program (UL1 TR001866), the French National Research Agency (ANR) under the "Investments for the Future" program (ANR-10-IAHU-01), the Integrative Biology of Emerging Infectious Diseases Laboratory of Excellence (ANR-10-LABX-62-IBEID), ANR-GENMSMD (ANR-16-CE17-0005-01), ANR-MAFMACRO (ANR-22-CE92-0008), ANRSECTZ170784, the French Foundation for Medical Research (FRM) (EQU201903007798), the ANRS-COV05, ANR GENVIR (ANR-20-CE93-003), and ANR AI2D (ANR-22-CE15-0046) projects, the ANR-RHU program (ANR-21-RHUS-08-COVIFERON), the European Union's Horizon 2020 research and innovation program under grant agreement no. 824110 (EASI-genomics), the Square Foundation, Grandir - Fonds de solidarité pour l'enfance, the Fondation du Souffle, the SCOR Corporate Foundation for Science, the Battersea & Bowery Advisory Group, William E. Ford, General Atlantic's Chairman and Chief Executive Officer, Gabriel Caillaux, General Atlantic's Co-President, Managing Director, and Head of business in EMEA, and the General Atlantic Foundation, Institut National de la Santé et de la Recherche Médicale (INSERM) and of Paris Cité University. JR was supported by the INSERM PhD program for doctors of pharmacy (poste d'accueil INSERM). JR and TLV were supported by the Bettencourt-Schueller Foundation and the MD-PhD program of the Imagine Institute. MO was supported by the David Rockefeller Graduate Program, the Funai Foundation for Information Technology (FFIT), the Honjo International Scholarship Foundation (HISF), and the New York Hideyo Noguchi Memorial Society (HNMS).
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Affiliation(s)
- Jessica N. Peel
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
| | - Rui Yang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
| | - Tom Le Voyer
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- Clinical Immunology Department, Assistance Publique Hôpitaux de Paris (AP-HP), Saint-Louis Hospital, Paris, France
| | - Adrian Gervais
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Jérémie Rosain
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- Study Center for Primary Immunodeficiencies and
| | - Paul Bastard
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- Pediatric Hematology-Immunology and Rheumatology Unit, Necker Hospital for Sick Children, Assistante Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Anish Behere
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Axel Cederholm
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Aaron Bodansky
- Department of Pediatric Critical Care Medicine and
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Yoann Seeleuthner
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Clément Conil
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Jing-Ya Ding
- Laboratory of Human Immunology and Infectious Disease, Graduate Institute of Clinical Medical Sciences; Center for Molecular and Clinical Immunology, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Te Lei
- Laboratory of Human Immunology and Infectious Disease, Graduate Institute of Clinical Medical Sciences; Center for Molecular and Clinical Immunology, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
| | - Lucy Bizien
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Camille Soudee
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Mélanie Migaud
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Masato Ogishi
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
| | - Ahmad Yatim
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
| | - Danyel Lee
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Jonathan Bohlen
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Thomas Perpoint
- Infectious and Tropical Diseases Service, Hospices Civils of Lyon, Lyon, France
| | - Laura Perez
- Immunology and Rheumatology Unit, Prof. Dr. Juan P. Garrahan National Hospital of Pediatrics, Buenos Aires, Argentina
| | - Fernando Messina
- Mycology Unit, Dr. Francisco J. Muñiz Hospital, Buenos Aires, Argentina
| | - Roxana Genet
- Infectious Diseases Service, Regional Hospital of Metz-Thionville, France
| | - Ludovic Karkowski
- Deparement of Internal Medicine, Sainte Anne Armed Forces Teaching Hospital, Toulon, France
| | - Mathieu Blot
- Department of Infectious Diseases, Dijon-Bourgogne University Hospital, Dijon, France
| | - Emmanuel Lafont
- Department of Infectious Diseases and Tropical Medicine, Paris Cité University, Necker Hospital for Sick Children and
| | - Laurie Toullec
- Laboratory of Immunology, Cochin hospital, AP-HP, Paris, France
| | | | | | | | | | - Anne Puel
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Emmanuelle Jouanguy
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | | | - 3C-Dijon Study
- Details are available in the Supplemental Acknowledgments
| | | | - Mark S. Anderson
- Department of Pediatric Critical Care Medicine and
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Nils Landegren
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Centre for Molecular Medicine, Department of Medicine (Solna), Karolinska Institute, Stockholm, Sweden
| | - Pierre Tiberghien
- Etablissement Français Du Sang, La Plaine Saint-Denis, France
- 20UMR1098 RIGHT, INSERM, EFS, Université de Franche-Comté, Besançon, France
| | - Laurent Abel
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Stéphanie Boisson-Dupuis
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Jacinta Bustamante
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- Study Center for Primary Immunodeficiencies and
| | - Cheng-Lung Ku
- Laboratory of Human Immunology and Infectious Disease, Graduate Institute of Clinical Medical Sciences; Center for Molecular and Clinical Immunology, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
- Laboratory of Human Genetics of Infectious Diseases, Inserm U1163, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
- Pediatric Hematology-Immunology and Rheumatology Unit, Necker Hospital for Sick Children, Assistante Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Howard Hughes Medical Institute, New York, New York, USA
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Hübsch T, Mettler C, Poisnel E, Antoine C, Cambon A, Delarbre D, Dutasta F, Karkowski L, Pangnarind V, Paris JF, Defuentes G, Granel-Rey B. [Autoimmune and inflammatory pathologies associated with systemic scleroderma: Clinical, serological and prognostic profiles. Bi-centric retrospective series in the PACA region]. Rev Med Interne 2023; 44:402-409. [PMID: 37100631 DOI: 10.1016/j.revmed.2023.03.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Systemic sclerosis (SSc) is a rare auto-immune disease, affecting principally women between 40 and 60 years old. It is caracterised by a cutaneous and visceral fibrosis, an alteration of the microvascular network and the presence of autoantibodies. SSc can be associated with another connectivite tissue disease or to other autoimmune diseases, thus defining the overlap syndrome. The goal of our study is to describe these overlap syndromes. METHODS We have analysed the data of a retrospective and bicentrique cohort, from the internal medicine unit of Hôpital Nord in Marseille and from the internal medicine unit of the Hôpital Sainte-Anne in Toulon, of patients followed for a SSc between January 1st, 2019 and December 1st, 2021. We have collected clinical, imunological features, associated auto-immune and inflammatory diseases with its morbidity and mortality. RESULTS The cohort included 151 patients including 134 limited cutaneous SSc. Fifty-two (34.4%) patients presented at least one associated auto-immune or inflammatory disease. The association of two connectivite tissue diseases including SSc was found in 24 patients (15.9%), a third with Sjögren's syndrome and a third with autoimmune myositis. The principal associated disease to SSc was the autoimmune thyroiditis found in 17 patients (11.3%). The occurrence of complications (hospitalization, long-term oxygene therapy, death) was not significantly different depending on the existence or not of an overlap syndrom. CONCLUSION SSc is often associated with other autoimmune diseases. This interrelation between associated pathologies and SSc, modifying sometimes the evolution of SSc, enhances the need of a personalized follow-up.
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Affiliation(s)
- T Hübsch
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France.
| | - C Mettler
- Service de médecine interne, hôpital Cochin, Paris, France
| | - E Poisnel
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - C Antoine
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - A Cambon
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - D Delarbre
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - F Dutasta
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - L Karkowski
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - V Pangnarind
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - J-F Paris
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - G Defuentes
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - B Granel-Rey
- PU-PH, Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), Aix-Marseille université, Marseille, France
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Paleiron N, Karkowski L, Bronstein AR, Amabile JC, Delarbre D, Mullot JU, Cazoulat A, Entine F, le Floch Brocquevieille H, Dorandeu F. [The role of the pulmonologist in an armed conflict]. Rev Mal Respir 2023; 40:156-168. [PMID: 36690507 DOI: 10.1016/j.rmr.2023.01.002] [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: 11/30/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Recent news points to the eventuality of an armed conflict on the national territory. STATE OF THE ART In this situation, pulmonologists will in all likelihood have a major role to assume in caring for the injured, especially insofar as chest damage is a major cause of patient death. PERSPECTIVES The main injuries that pulmonologists may be called upon to treat stem not only from explosions, but also from chemical, biological and nuclear hazards. In this article, relevant organizational and pedagogical aspects are addressed. Since exhaustiveness on this subject is unattainable, we are proposing training on specific subjects for interested practitioners. CONCLUSION The resilience of the French health system in a situation of armed conflict depends on the active participation of all concerned parties. With this in mind, it is of prime importance that the pneumological community be sensitized to the potential predictable severity of war-related injuries.
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Affiliation(s)
- N Paleiron
- HIA Sainte-Anne, service de pneumologie, Toulon, France.
| | - L Karkowski
- HIA Sainte-Anne, service de médecine interne-maladies infectieuses, Toulon, France
| | - A-R Bronstein
- HIA Sainte-Anne, service de pneumologie, Toulon, France
| | - J-C Amabile
- Service de protection radiologique des armées, Paris, France
| | - D Delarbre
- HIA Sainte-Anne, service de médecine interne-maladies infectieuses, Toulon, France
| | - J-U Mullot
- Service de santé des armées, Paris, France
| | - A Cazoulat
- Service de santé des armées, service médical de la base opérationnelle de l'Île Longue, Lanveoc Poulmic, France
| | - F Entine
- Service de santé des armées, service médical de la base opérationnelle de l'Île Longue, Lanveoc Poulmic, France
| | | | - F Dorandeu
- Service de santé des armées, Institut de recherche biomédicale des armées, Brétigny, France
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Roussotte M, Gerfaud-Valentin M, Hot A, Audia S, Bonnotte B, Thibault T, Lobbes H, Le Guenno G, Goulabchand R, Cathebras P, Varron L, Dufour JF, Deroux A, Compain C, Baudet A, Karkowski L, Pérard L, Ebbo M, Lega JC, Sève P. Immune thrombocytopenia with clinical significance in systemic lupus erythematosus: a retrospective cohort study of 90 patients. Rheumatology (Oxford) 2021; 61:3627-3639. [PMID: 34918048 DOI: 10.1093/rheumatology/keab925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/26/2021] [Revised: 12/07/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To describe the characteristics, treatment, and outcome of patients with immune thrombocytopenia with clinical significance (ITPCS) associated with systemic lupus erythematosus (SLE). METHODS This retrospective multicentre study included SLE patients who experienced ≥1 ITPCS (defined as ITP with attributable bleeding disorders and/or a platelet count <30 x109/L). Other causes of secondary thrombocytopenia were excluded. Major bleeding event (MBG) was defined as Khellaf score>8 and/or WHO score>2. RESULTS A total of 90 patients were included, the median (range) follow-up duration was 80 (6-446) months. ITP was diagnosed before SLE in 25 patients. They presented high rate of autoimmune haemolytic anaemia (15%), antiphospholipid antibody (62%), and antiphospholipid syndrome (19%). The 25 (28%) patients who experienced MBG had significantly more bleedings at ITP diagnosis and higher bleeding scores, and serositis and thrombosis during follow-up. They required significantly more treatment lines, transfusions, and hospitalizations. The 11 (12%) patients who experienced no bleeding event presented a significantly more restricted SLE phenotype (cutaneous and/or articular). Patients received a mean (range) of 4.2 (1-11) treatment lines. Corticosteroids and hydroxychloroquine allowed ITPCS overall response in one third of patients. The median relapse-free survival of rituximab (n = 34), azathioprine (n = 19), mycophenolate mofetil (n = 8), thrombopoietin-receptor agonists (n = 16), and splenectomy (n = 19) were 53, 31.5, 61, 24.5, and 78 months, respectively. Four patients experienced thrombotic events after splenectomy and one occurred under thrombopoietin-receptor agonist treatment. CONCLUSION SLE-ITCS patients displayed a high rate of haematological abnormalities and MBG patients exhibited higher morbidity. Management of thrombocytopenia was highly heterogeneous and many options seem viable.
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Affiliation(s)
| | | | - Arnaud Hot
- Department of Internal Medicine, Hospices Civils de Lyon, France
| | - Sylvain Audia
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, France
| | - Thomas Thibault
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, France
| | - Hervé Lobbes
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, France
| | - Guillaume Le Guenno
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, France
| | - Radjiv Goulabchand
- Department of Internal Medicine, Centre Hospitalier Universitaire de Montpellier, France
| | - Pascal Cathebras
- Department of Internal Medicine, Centre Hospitalier Universitaire de Saint Etienne, France
| | - Loig Varron
- Department of Internal Medicine, Centre Hospitalier de Montélimar, France
| | | | - Alban Deroux
- Department of Internal Medicine, Centre Hospitalier Universitaire de Grenoble, France
| | - Caroline Compain
- Department of Internal Medicine, Centre Hospitalier de Chambéry, France
| | - Antoine Baudet
- Department of Internal Medicine, Centre Hospitalier d'Annecy, France
| | - Ludovic Karkowski
- Department of Internal Medicine, Centre Hospitalier Militaire de Desgenettes, Lyon, France
| | - Laurent Pérard
- Department of Internal Medicine, Centre Hospitalier de St. Joseph St. Luc, Lyon, France
| | - Mikael Ebbo
- Department of Internal Medicine, Centre Hospitalier de La Timone, Marseille, France
| | | | - Pascal Sève
- Department of Internal Medicine, Hospices Civils de Lyon, France.,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
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6
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Barguil S, Sousa Alves A, Christen JR, De Jerphanion C, Valero J, Gaillard T, Karkowski L. Pharyngeal abscess complicated by Lemierre's syndrome: Identification of an atypical germ. IDCases 2021; 25:e01180. [PMID: 34235050 PMCID: PMC8246386 DOI: 10.1016/j.idcr.2021.e01180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/07/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Lemierre's syndrome is a rare but serious complication of an oral infection mostly related to Fusobacterium necrophorum. This condition combines jugular vein thrombosis and septic emboli to the lungs or other organs. CASE PRESENTATION We report here an original case of a pharyngeal abscess complicated by Lemierre's syndrome in a young healthy male patient. Samples taken from the pus of the pharyngeal abscess showed the presence of Gardnerella vaginalis associated with Fusobacterium necrophorum. The patient was treated by draining the abscess, antibiotic therapy and preventive anticoagulation for 1 month. The evolution was good with a resolution of the thrombosis. CONCLUSIONS This case highlights the need for bacterial identification to adapt antibiotic therapy in Lemierre's syndrome. It also shows the possibility of extragenital localization of Gardnerella vaginalis in a male patient having oral sex with women. In contrast to sexually transmitted infections such as syphilis and pharyngeal gonococcus, this oral localization of Gardnerella vaginalis has not been described previously in the literature.
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Affiliation(s)
- Solène Barguil
- Hôpital d’Instruction des Armées Desgenettes, Lyon, France
| | | | | | | | - Joris Valero
- Hôpital d’Instruction des Armées Desgenettes, Lyon, France
| | - Tiphaine Gaillard
- Laboratoire de Biologie Médicale, HIA Desgenettes, Lyon, France
- Laboratoire de Biologie Médicale, CH Croix-Rousse, Lyon, France
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7
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Roussotte M, Gerfaud-Valentin M, Lega J, Thibault T, Lobbes H, Goulabchand R, Cathébras P, Varron L, Dufour J, Deroux A, Le Guenno G, Compain C, Baudet A, Karkowski L, Perard L, Ebbo M, Hot A, Sève P. Traitement de la thrombopénie immunologique cliniquement significative secondaire au lupus érythémateux systémique : étude rétrospective de 90 patients en vie réelle. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.073] [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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8
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Roussotte M, Gerfaud-Valentin M, Lega J, Audia S, Ruivard M, Goulabchand R, Cathébras P, Varron L, Dufour J, Alban D, Le Guenno G, Compain C, Baudet A, Karkowski L, Perard L, Hot A, Sève P. Thrombopénie immunologique cliniquement significative secondaire au lupus érythémateux systémique : description d’une cohorte rétrospective de 74 cas. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.023] [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: 10/25/2022]
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9
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Savini H, Janvier F, Karkowski L, Billhot M, Aletti M, Bordes J, Koulibaly F, Cordier PY, Cournac JM, Maugey N, Gagnon N, Cotte J, Cambon A, Mac Nab C, Moroge S, Rousseau C, Foissaud V, De Greslan T, Granier H, Cellarier G, Valade E, Kraemer P, Alla P, Mérens A, Sagui E, Carmoi T, Rapp C. Occupational Exposures to Ebola Virus in Ebola Treatment Center, Conakry, Guinea. Emerg Infect Dis 2018; 23:1380-1383. [PMID: 28726614 PMCID: PMC5547773 DOI: 10.3201/eid2308.161804] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We report 77 cases of occupational exposures for 57 healthcare workers at the Ebola Treatment Center in Conakry, Guinea, during the Ebola virus disease outbreak in 2014−2015. Despite the high incidence of 3.5 occupational exposures/healthcare worker/year, only 18% of workers were at high risk for transmission, and no infections occurred.
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10
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de Greslan T, Billhot M, Rousseau C, Mac Nab C, Karkowski L, Cournac JM, Bordes J, Gagnon N, Dubrous P, Duron S, Moroge S, Quentin B, Koulibaly F, Bompaire F, Renard JL, Cellarier G. Ebola Virus-Related Encephalitis. Clin Infect Dis 2016; 63:1076-1078. [PMID: 27418576 DOI: 10.1093/cid/ciw469] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 03/28/2016] [Accepted: 07/03/2016] [Indexed: 01/23/2023] Open
Abstract
Ebola patients frequently exhibit behavioral modifications with ideation slowing and aggressiveness, sometimes contrasting with mild severity of Ebola disease. We performed lumbar punctures in 3 patients with this presentation and found Ebola virus in all cerebrospinal fluid samples. This discovery helps to discuss the concept of a specific Ebola virus encephalitis.
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Affiliation(s)
- Thierry de Greslan
- French Military Ebola Virus Disease Treatment Centre.,Hôpital d'Instruction des Armées Percy, Clamart
| | - Magali Billhot
- French Military Ebola Virus Disease Treatment Centre.,Hôpital d'Instruction des Armées Bégin, Saint Mandé
| | - Claire Rousseau
- French Military Ebola Virus Disease Treatment Centre.,Hôpital d'Instruction des Armées Clermont Tonnerre, Brest
| | - Christine Mac Nab
- French Military Ebola Virus Disease Treatment Centre.,Hôpital d'Instruction des Armées Percy, Clamart
| | - Ludovic Karkowski
- French Military Ebola Virus Disease Treatment Centre.,Hôpital d'Instruction des Armées Legouest, Metz
| | - Jean-Marie Cournac
- French Military Ebola Virus Disease Treatment Centre.,Hôpital d'Instruction des Armées Percy, Clamart
| | - Julien Bordes
- French Military Ebola Virus Disease Treatment Centre.,Hôpital d'Instruction des Armées Sainte Anne, Toulon
| | - Nicolas Gagnon
- French Military Ebola Virus Disease Treatment Centre.,Hôpital d'Instruction des Armées Legouest, Metz
| | - Philippe Dubrous
- French Military Ebola Virus Disease Treatment Centre.,Hôpital d'Instruction des Armées Robert Picqué, Bordeaux
| | | | - Sophie Moroge
- French Military Ebola Virus Disease Treatment Centre.,Hôpital d'Instruction des Armées Laveran, Marseille
| | - Benoit Quentin
- French Military Ebola Virus Disease Treatment Centre.,Direction Centrale du Service de Santé des Armées, Paris, France
| | - Fassou Koulibaly
- French Military Ebola Virus Disease Treatment Centre.,Guinean Military Teaching Hospital, Conakry, Guinea
| | | | | | - Gilles Cellarier
- French Military Ebola Virus Disease Treatment Centre.,Hôpital d'Instruction des Armées Sainte Anne, Toulon
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11
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Bonnefond S, Catroux M, Melenotte C, Karkowski L, Rolland L, Trouillier S, Raffray L. Clinical features of actinomycosis: A retrospective, multicenter study of 28 cases of miscellaneous presentations. Medicine (Baltimore) 2016; 95:e3923. [PMID: 27311002 PMCID: PMC4998488 DOI: 10.1097/md.0000000000003923] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Actinomycosis is a rare heterogeneous anaerobic infection with misleading clinical presentations that delay diagnosis. A significant number of misdiagnosed cases have been reported in specific localizations, but studies including various forms of actinomycosis have rarely been published.We performed a multicenter retrospective chart review of laboratory-confirmed actinomycosis cases from January 2000 until January 2014. We described clinical characteristics, diagnostic procedures, differential diagnosis, and management of actinomycosis of clinical significance.Twenty-eight patients were included from 6 hospitals in France. Disease was diagnosed predominately in the abdomen/pelvis (n = 9), orocervicofacial (n = 5), cardiothoracic (n = 5), skeletal (n = 3), hematogenous (n = 3), soft tissue (n = 2), and intracranially (n = 1). Four patients (14%) were immunocompromised. In most cases (92 %), the diagnosis of actinomycosis was not suspected on admission, as clinical features were not specific. Diagnosis was obtained from either microbiology (50%, n = 14) or histopathology (42%, n = 12), or from both methods (7%, n = 2). Surgical biopsy was needed for definite diagnosis in 71% of cases (n = 20). Coinfection was found in 13 patients (46%), among which 3 patients were diagnosed from histologic criteria only. Two-thirds of patients were treated with amoxicillin. Median duration of antibiotics was 120 days (interquartile range 60-180), whereas the median follow-up time was 12 months (interquartile range 5.25-18). Two patients died.This study highlights the distinct and miscellaneous patterns of actinomycosis to prompt accurate diagnosis and earlier treatments, thus improving the outcome. Surgical biopsy should be performed when possible while raising histologist's and microbiologist's awareness of possible actinomycosis to enhance the chance of diagnosis and use specific molecular methods.
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Affiliation(s)
- Simon Bonnefond
- Internal Medicine Unit, Teaching Hospital of La Réunion, France
| | - Mélanie Catroux
- Department of internal Medicine and Infectious Diseases, Teaching Hospital of Poitiers, France
| | - Cléa Melenotte
- Department of Internal Medicine, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Ludovic Karkowski
- Internal Medicine Unit, French Army Teaching Hospital of Metz, France
| | | | | | - Loic Raffray
- Internal Medicine Unit, Teaching Hospital of La Réunion, France
- Internal Medicine Unit, Teaching Hospital of Bordeaux, France
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12
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Le Vot-Duault L, Karkowski L, Carassou P, Dutasta F, Jacquet C, Clerc G, Ouzaa S, Lachaux J, Wnekowicz M, Lorvellec A, De Rousiers A, Cinquetti G. Mise en place et évaluation d’un service Internet de télé-expertise en médecine interne à l’attention des médecins généralistes de Moselle : « S@S interniste ». Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.310] [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: 11/29/2022]
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13
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Karkowski L, Perez P, Cabon M, Cinquetti G, Dutasta F. Intérêt de la PCR paludisme en pratique quotidienne. Étude rétrospective dans un service de maladies infectieuses. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.027] [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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14
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Karkowski L, Dutasta F, Cabon M, Carassou P, Cinquetti G, Rabar D, Sockel P, Rey P, Crevon L. Abcès hépatiques à pyogènes. Étude descriptive rétrospective de 31 patients. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.018] [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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15
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Karkowski L, Bustamante J, Cabon M, Valois A, Perez P, Carassou P, Dutasta F, Cinquetti G. Un déficit immunitaire traité par immunomodulateur. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.200] [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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16
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Bordes J, Gagnon N, Cotte J, Greslan TD, Rousseaul C, Billhot M, Cournac JM, Karkowski L, Moroge S, Duron S, Quentin B, Cellarier G. Caring for Critically Ill Patients Infected With the Ebola Virus: Logistic and Human Challenges. Chest 2015; 148:e64-e65. [PMID: 26238846 DOI: 10.1378/chest.15-0818] [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: 11/01/2022] Open
Affiliation(s)
- Julien Bordes
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Sainte Anne Military Teaching Hospital, Toulon, France.
| | - Nicolas Gagnon
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Legouest Military Teaching Hospital, Metz, France
| | - Jean Cotte
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Sainte Anne Military Teaching Hospital, Toulon, France
| | - Thierry de Greslan
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Val De Grâce Military Teaching Hospital, Paris, France
| | | | - Magali Billhot
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Val De Grâce Military Teaching Hospital, Paris, France
| | - Jean Marie Cournac
- Percy Military Teaching Hospital, Paris, France; French Military Ebola Virus Disease Treatment Centre, Toulon, France
| | - Ludovic Karkowski
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Legouest Military Teaching Hospital, Metz, France
| | - Sophie Moroge
- Laveran Military Teaching Hospital, Marseille, France
| | - Sandrine Duron
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; French Military Health Service Headquarter, Paris, France
| | - Benoit Quentin
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; French Military Health Service Headquarter, Paris, France
| | - Gilles Cellarier
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Sainte Anne Military Teaching Hospital, Toulon, France
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17
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Cournac JM, Karkowski L, Bordes J, Aletti M, Duron S, Janvier F, Foissaud V, Savini H, de Greslan T, Rousseau C, Billhot M, Gagnon N, Mac Nab C, Dubrous P, Moroge S, Broto H, Cotte J, Maugey N, Cordier PY, Sagui E, Merens A, Rapp C, Quentin B, Granier H, Carmoi T, Cellarier G. Rhabdomyolysis in Ebola Virus Disease. Results of an Observational Study in a Treatment Center in Guinea. Clin Infect Dis 2015; 62:19-23. [PMID: 26338789 DOI: 10.1093/cid/civ779] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 05/06/2015] [Accepted: 08/20/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The pathogenesis of Ebola virus disease (EVD) remains unclear. The sporadic nature of Ebola outbreaks and their occurrence in resource-limited settings have precluded the acquisition of extensive clinical and laboratory data. Rhabdomyolysis during EVD has been suggested to occur in previous studies showing increased aspartate aminotransferase-alanine aminotransferase ratios, but, to date, has not been confirmed with creatine kinase (CK) assays. METHODS We performed an observational study of 38 patients admitted to an Ebola treatment center from January to April 2015. CK values from patients with confirmed EVD were compared with those in patients without confirmed EVD. A panel of other analyses were also performed. In patients with EVD, characteristics were compared between survivors and nonsurvivors. RESULTS High levels of CK were more frequent in patients with EVD than in those without (P = .002), and rhabdomyolysis was more frequent (59% vs 19%, respectively; P = .03). CK levels >5000 U/L were observed in 36% of patients with EVD. Also in patients with EVD, fatal outcome was significantly associated with higher creatinine and bilirubin levels, international normalized ratio, and viral load. CONCLUSIONS Rhabdomyolysis is a frequent disorder in EVD and seems to be more common than in other viral infections. It may contribute to the renal failure observed in nonsurviving patients. More studies are needed to determine the impact of rhabdomyolysis on EVD outcome.
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Affiliation(s)
- Jean Marie Cournac
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Percy Military Teaching Hospital, Clamart
| | - Ludovic Karkowski
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Legouest Military Teaching Hospital, Metz
| | - Julien Bordes
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Sainte Anne Military Teaching Hospital, Toulon
| | - Marc Aletti
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Percy Military Teaching Hospital, Clamart
| | - Sandrine Duron
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea French Military Center for Epidemiology and Public Health
| | - Frédéric Janvier
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Sainte Anne Military Teaching Hospital, Toulon
| | - Vincent Foissaud
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Percy Military Teaching Hospital, Clamart
| | - Hélène Savini
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Laveran Military Teaching Hospital, Marseille
| | - Thierry de Greslan
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Val De Grâce Military Teaching Hospital
| | - Claire Rousseau
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Clermont Tonnerre Military Teaching Hospital, Brest
| | - Magali Billhot
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Val De Grâce Military Teaching Hospital
| | - Nicolas Gagnon
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Legouest Military Teaching Hospital, Metz
| | - Christine Mac Nab
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Percy Military Teaching Hospital, Clamart
| | - Philippe Dubrous
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Robert Picqué Military Teaching Hospital, Bordeaux
| | - Sophie Moroge
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Laveran Military Teaching Hospital, Marseille
| | - Helene Broto
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea French Military Center for Health Supplies, Orléans
| | - Jean Cotte
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Sainte Anne Military Teaching Hospital, Toulon
| | - Nancy Maugey
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea French Military Health Service Surgeon General Office, Paris
| | - Pierre-Yves Cordier
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Laveran Military Teaching Hospital, Marseille
| | - Emmanuel Sagui
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Laveran Military Teaching Hospital, Marseille
| | - Audrey Merens
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Bégin Military Teaching Hospital, Saint-Mandé, France
| | - Christophe Rapp
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Bégin Military Teaching Hospital, Saint-Mandé, France
| | - Benoit Quentin
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea French Military Health Service Surgeon General Office, Paris
| | - Hervé Granier
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Clermont Tonnerre Military Teaching Hospital, Brest
| | - Thierry Carmoi
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Val De Grâce Military Teaching Hospital
| | - Gilles Cellarier
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Sainte Anne Military Teaching Hospital, Toulon
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Bordes J, Janvier F, Aletti M, de Greslan T, Gagnon N, Cotte J, Rousseau C, Billhot M, Cournac JM, Karkowski L, Moroge S, Duron S, Carmoi T, Cellarier G. Organ failures on admission in patients with Ebola virus disease. Intensive Care Med 2015; 41:1504-5. [PMID: 26134358 DOI: 10.1007/s00134-015-3912-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Julien Bordes
- French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea,
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19
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Bordes J, Karkowski L, Cournac JM, Gagnon N, Billhot M, Rousseau C, De Greslan T, Cellarier G. Dyspnea and Risk of Death in Ebola Infected Patients: Is Lung Really Involved? Clin Infect Dis 2015; 61:852. [PMID: 26063724 DOI: 10.1093/cid/civ441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julien Bordes
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Intensive Care and Anesthesia Department, Sainte Anne Military Teaching Hospital, Toulon
| | - Ludovic Karkowski
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Internal Medicine Department, Legouest Military Teaching Hospital, Metz
| | - Jean Marie Cournac
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Internal Medicine Department, Percy Military Teaching Hospital, Paris
| | - Nicolas Gagnon
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Intensive Care and Anesthesia Department, Legouest Military Teaching Hospital, Metz
| | - Magali Billhot
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Internal Medicine Department, Val de Grâce Military Teaching Hospital, Paris
| | - Claire Rousseau
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Internal Medicine Department, Clermont Tonnerre Military Teaching Hospital, Brest
| | - Thierry De Greslan
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Neurology Department, Val de Grâce Military Teaching Hospital, Paris
| | - Gilles Cellarier
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Cardiology Department, Sainte Anne Military Teaching Hospital, Toulon, France
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20
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Audemard A, Descloux E, Deroux A, Fantin B, Fieschi C, Bouldouyre M, Karkowski L, Moulis G, Froissart A, Fremeaux-Bacchi V, Ponard D, Bienvenu B. Déficits en complément révélés à l’âge adulte par un épisode infectieux. Résultats des 41 patients inclus dans l’étude DECORAPI. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.03.326] [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: 10/23/2022]
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Cellarier GR, Bordes J, Karkowski L, Gagnon N, Billhot M, Cournac JM, Rousseau C, De Greslan T, Mac Nab C, Dubrous P, Duron S, Moroge S, Quentin B. Safety, feasibility, and interest of transthoracic echocardiography in a deployed French military Ebola virus disease treatment center in Guinea. Intensive Care Med 2015; 41:1491-2. [PMID: 25952824 DOI: 10.1007/s00134-015-3821-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 11/24/2022]
Affiliation(s)
- G R Cellarier
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea,
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22
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Raffray L, Karkowski L, Dupon M, Constans J, Pellegrin JL, Catroux M. Actinomycoses en service de médecine : série de 21 cas. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.103] [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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23
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Karkowski L, Cinquetti G, Galland J, Cabon M, Carassou P. Anticoagulant circulant lupique et syndrome hémorragique. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.287] [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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24
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Karkowski L, Cinquetti G, Galland J, Cabon M, Vedy S, Perez P, Carassou P. Angine et érythèmes noueux des membres supérieurs. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.173] [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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25
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Cabon M, Roux X, Karkowski L, Cinquetti G, Vedy S, Carassou P, Cuvelier C, Charmillon A, Maugard D, Graffin B. Un cas d’arthrite primitive du poignet à méningocoque chez une patiente de 90ans. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.205] [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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26
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Karkowski L, Hot A, Pasquet F, Perard L, Durieu I, Salles G, Laville M, Sebag L, Pavic M, Guesquieres H, Ninet J. Amylose cardiaque : étude rétrospective descriptive et analyse de survie à partir de 46 dossiers. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.03.118] [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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Pasquet F, Karkowski L, Hajek V, Pavic M, Guilloton L. Une manifestation inaugurale inhabituelle de la granulomatose de Wegener : l’accident vasculaire cérébral ischémique. Rev Med Interne 2012; 33:e6-9. [DOI: 10.1016/j.revmed.2011.02.003] [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] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Accepted: 02/03/2011] [Indexed: 11/28/2022]
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Karkowski L, Wolf M, Lescampf J, Coppérré B, Veyradier A, Ninet J, Hot A. Purpura thrombotique thrombocytopénique secondaire à l’utilisation du clopidogrel. Rev Med Interne 2011; 32:762-5. [DOI: 10.1016/j.revmed.2011.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 06/07/2011] [Accepted: 10/05/2011] [Indexed: 11/28/2022]
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29
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Pasquet F, Karkowski L, Hajek V, Bergmann C, Pavic M. Un cas d’ecchymoses multiples. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.196] [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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Pavic M, Camus C, Pasquet F, Karkowski L, Galoo E, Nibaud A, Debourdeau P. [Seriousness of AL amyloidosis of the digestive system]. Rev Med Interne 2011; 32:e52-4. [PMID: 21349611 DOI: 10.1016/j.revmed.2009.09.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 09/15/2009] [Accepted: 09/27/2009] [Indexed: 12/22/2022]
Abstract
Systemic amyloidosis usually does not spare the digestive tract but its involvement is rarely symptomatic. The clinical manifestations are not specific. We report a 64-year-old patient, presenting with a weight loss related to an AL amyloidosis. The amyloidosis was apparently limited to the digestive tract. We discuss the various presentations of the digestive amyloidosis and we insist on the seriousness of this localization.
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Affiliation(s)
- M Pavic
- Service de médecine interne-oncologie, HIA Desgenettes, 108, boulevard Pinel, 69003 Lyon, France.
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Pasquet F, Karkowski L, Hajek V, Tsouka G, Rabar D, Crevon L, Pavic M. Une manifestation rare de la maladie de Still. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.220] [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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32
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Karkowski L, Pérard L, Mausserey C, Desmurs-Clavel H, Lachenal F, Debourdeau P, Salles G, Cathebras P, Pavic M, Ninet J, Hot A. Efficacité sur le long terme du traitement par rituximab du purpura thrombotique thrombocytopénique acquis. À propos de 12 cas. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.014] [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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33
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Pasquet F, Karkowski L, Felten D, Farthouat P, Crozes C, Vitry T, Debourdeau P, Pavic M. Une cause rare d’amaigrissement. Rev Med Interne 2010; 31:645-6. [DOI: 10.1016/j.revmed.2009.11.013] [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: 11/05/2009] [Accepted: 11/15/2009] [Indexed: 11/25/2022]
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Dufour-Gaume F, Pavic M, Karkowski L, Pasquet F, Rabar D, Meeus P, Gerôme P, Crevon L. Pseudotumeur rétropéritonéale : la brucellose autochtone reste d’actualité. Rev Med Interne 2010; 31:e7-9. [DOI: 10.1016/j.revmed.2009.12.013] [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: 04/09/2009] [Revised: 11/05/2009] [Accepted: 12/21/2009] [Indexed: 10/19/2022]
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Pasquet F, Chauffer M, Karkowski L, Debourdeau P, Mc Grégor B, Labeeuw M, Laville M, Pavic M. [Granulomatous interstitial nephritis: A retrospective study of 44 cases]. Rev Med Interne 2010; 31:670-6. [PMID: 20605281 DOI: 10.1016/j.revmed.2010.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 04/10/2010] [Accepted: 04/25/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Granulomatous interstitial nephritis (GIN) are identified in 0.5 to 1,3% of all renal biopsies. Renal outcome and treatment modalities are not clearly established in the literature. METHODS We retrospectively analyzed a case series of 44 GIN identified among all renal biopsies performed between 1984 and 2005 in the Rhône-Alpes area. RESULTS The study population included 25 men and 19 women with a mean age of 56 years, and mean diagnostic delay was 11 months. Renal function was severely impaired (mean creatinine clearance 24mL/min). Proteinuria was observed in 77% (mean value 0,9 g/24h) of the patients and associated with microscopic hematuria and leukocyturia in 30% and 25%, respectively. The most common diagnosis was sarcoidosis (25%, n = 11), followed by drug-induced GIN (9%, n = 4), tuberculosis (6,8%, n=3), hemopathy-related paraneoplastic GIN (6,8%, n = 3), HIV infection (n = 1) and chronic renal allograft rejection (n = 1). In other patients, no aetiology was found (48%, n = 21). Severity of renal failure justified hemodialysis in 34% (n = 15) of the patients. Three patients underwent renal transplantation. Nonetheless, renal outcome was generally favorable: renal function improved in 41% (n = 18) and stabilized in 34% (n = 15) of patients. CONCLUSIONS Sarcoidosis, drug-induced and infections represent the main causes of GIN. Histologic features are not specific enough to determine the aetiology. Corticosteroids is the gold standard in sarcoidosis, drug-induced, and idiopathic GIN. Treatment is etiologic in the other cases.
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Affiliation(s)
- F Pasquet
- Service de médecine interne-oncologie, hôpital d'instruction des armées Desgenettes, 69003 Lyon, France.
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Hajek V, Pavic M, Lachenal F, Pasquet F, Karkowski L, Gerôme P. Étude rétrospective de 168 valeurs de protéine C réactive supérieure à 500mg/L : quelles étiologies et quelle gravité ? Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.447] [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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Pasquet F, Karkowski L, Guilloton L, Debourdeau P, Pavic M. Un accident vasculaire cérébral révélateur d’une maladie de Wegener. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.343] [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: 11/26/2022]
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38
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Pasquet F, Karkowski L, Foucher B, Debourdeau P, Gérôme P, Pavic M. Syndromes myélodysplasiques : étude rétrospective de 33 cas sur 5 ans pris en charge dans un service de médecine interne. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.081] [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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39
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Karkowski L, Pasquet F, Rabar D, Debourdeau P, Crevon L, Gerome P, Pavic M. La fausse protection ! Infection à Plasmodium vivax chez un patient porteur d’un déficit en pyruvate kinase. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.415] [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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Pasquet F, Pavic M, Mounier C, Karkowski L, Colle B. Vascularite avec anticorps anticytoplasme des polynucléaires neutrophiles : une complication rare du propylthiouracile. Rev Med Interne 2009; 30:882-5. [DOI: 10.1016/j.revmed.2009.04.002] [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: 09/14/2008] [Revised: 02/01/2009] [Accepted: 04/05/2009] [Indexed: 10/20/2022]
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41
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Karkowski L, Pasquet F, Kaddouri S, Hajek V, Rabar D, Crevon L, Pavic M. C’est dengue çà ! Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.03.306] [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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42
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Pasquet F, Pavic M, Karkowski L, Debourdeau P. Des reins qui décoiffent. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.03.200] [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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43
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Karkowski L, Pasquet F, Kaddouri S, Hajek V, Debourdeau P, Pavic M. Grippe, Leptospirose… ? Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.03.331] [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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44
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Pasquet F, Pavic M, Gomez P, Karkowski L, Gérome P, Debourdeau P. Pertinence de la prescription des antigènes solubles urinaires pneumocoque et légionelle dans un service d’urgences. Étude rétrospective monocentrique portant sur 131 dossiers. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.064] [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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45
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Karkowski L, Pasquet F, Dufour-Gaume F, Rabar D, Debourdeau P, Crevon L, Pavic M. Une masse pseudotumorale rétropéritonéale. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.271] [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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46
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Vinurel H, Karkowski L, Freymond N, Pacheco Y, Rousset H, Devouassoux G, Sailler L. Verrues et infections pulmonaires à répétition. Rev Med Interne 2008; 29:943-5. [DOI: 10.1016/j.revmed.2008.07.003] [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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47
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Pasquet F, Pavic M, Karkowski L, Galoo E, Vitry T, Debourdeau P. Une complication rare de la gastroscopie. Rev Med Interne 2008; 29:823-4. [DOI: 10.1016/j.revmed.2007.12.021] [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: 12/10/2007] [Accepted: 12/20/2007] [Indexed: 11/17/2022]
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48
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Camus C, Pavic M, Pasquet F, Karkowski L, Crozes C, Gérôme P, Galoo E, Debourdeau P. Gravité de l’amylose AL de localisation strictement digestive. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.233] [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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Pavic M, Pasquet F, Rabar D, Karkowski L, Lablanche C, Debourdeau P. Méningite puriforme aseptique liée à une infection à Parvovirus B19. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.173] [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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Affiliation(s)
- L Karkowski
- Service de médecine, hôpital d'instruction des armées Desgenettes, 108 boulevard Pinel, Lyon, France.
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