Proposition d’un score prédictif d’infection bactérienne selon le taux d’éosinophiles : étude observationnelle

Introduction

Several studies have shown that eosinopenia less than 0.04 g/L is a marker of bacterial infection in the presence of unexplained inflammatory syndrome. The aim of our study was to test this hypothesis and to propose a predictive score for bacterial infection (score CIBLE, C reactive protein, bacterial infections, levels of leucocytes and eosinophils).

Présentation du Réseau d’Allergovigilance

The increased prevalence of food allergy and reports of allergy to novel foods led to the development of an “Allergy Vigilance Network.” This network is composed of 195 trained allergologists extending to 73% of the departments in France. Communications are carried out by e-mail or fax. The three objectives of this structure are: 1) to index the cases of lethal or prelethal anaphylaxis; 2) to evaluate the prevalence of food allergies, clinical pictures and allergens; and 3) to evaluate the allergic risk of novel foods. This network is composed of 195 allergologists as of 29 August 2001 (175 French, 11 Belgians, two from Fort-de-France, two from Luxembourg, one from Reunion island, one Greek, one Swiss, one Moroccan, two Poles). This network composed of trained allergologists appears to be essential in order to precisely evaluate the prevalence and allergic risk of food. It would be a helpful tool for public health organisms.     

Vascularite de l’artère hépatique : à propos d’un cas d’atteinte d’organe isolée

Introduction

Vasculitis usually have a systemic involvement. Rare cases of localized vasculitis have been described, but the exclusive involvement of the hepatic artery is exceptional. We report the case of a patient who developed a vasculitis of the right and left hepatic arteries.

Œdème insulinique au cours d’une glycogénose hépatique

Introduction

Hepatic glycogenosis is a rare syndrome, which includes poorly controlled diabetes mellitus, hepatomegaly, delayed puberty, and growth delay. Insulin edema is sometimes associated.

Sténose de l’artère rénale à distance d’une dénervation rénale pour HTA résistante

The onset of renal artery stenosis following a renal denervation is rare and occurs in the first few months after renal denervation. We report the onset of renal artery stenosis a long time after the renal denervation for resistant hypertension. This is a 74 year-old patient who stopped smoking in 1980 and who was treated for dyslipidemia with a revascularized coronary artery disease in 2011, a well-stabilized peripheral arterial disease since 2001, a stable asymptomatic carotid atheroma and a good kidney function. His hypertension known since 1995 became resistant. After the control of renal arteries by angio-CT scan, he had a renal denervation in October 2012. His blood pressure decreased 3 months later confirmed by self-blood pressure monitoring (SBPM) and ambulatory blood pressure monitoring (ABPM) with a CT scan with a non-significant renal artery stenosis in January 2014. He remained normotensive under treatment until July 2015 but his hypertension became uncontrolled at the end of 2015 then resistant and severe confirmed by SBPM in April 2017, despite a 5-drug antihypertensive treatment associated to atorvastatin and clopidogrel confirmed by SBPM in April 2017. A left post-ostial renal artery stenosis with decrease in size of left kidney and cortex as compared to 2011 was detected at CT and treated by angioplasty. It was associated with a rapid decrease in blood pressure but unfortunately a new increase related to a restenosis occurred at the end of 2017, which justified a new angioplasty. Discussion about the etiology and the management of this renal post-denervation late stenosis.     

Quand débuter et arrêter la désensibilisation aux venins d’hyménoptères ?

The efficacy of hymenoptera venom immunotherapy is well documented.The indication for this treatment is based on the history of a systemic allergic reaction to a sting by a honey bee or a vespid, the evidence for IgE-mediated allergy in skin tests or serologic examinations and our knowledge of the natural history of this allergy. The indication is given in the presence of a history of severe reaction with cardiovascular or respiratory symptoms and positive tests. Patients with mild to moderate reactions with predominant cutaneous symptoms and positive tests are only treated if they are heavily exposed and have developed repeated reactions. The optimal duration of venom immunotherapy has been analyzed in a number of prospective studies. In all of these the vast majority (> 80%) of those restung after discontinuation of an immunotherapy of at least 3 years’ duration was still protected. Relapses occurred more frequently in patients with a history of very severe pretreatment reaction and in those who developed systemic allergic symptoms during immunotherapy, either to treatment injections or to a sting by the insect in question. A treatment of 5 years was superior to a treatment of only 3 years. Therefore, a duration of 5 years is generally recommended, an even more prolonged treatment for patients with a history of very severe reactions or of allergic reactions during immunotherapy.     

Aortite à cellules géantes compliquée d’amylose AA diagnostiquée grâce aux examens d’imagerie : à propos d’un cas

Introduction

AA amyloidosis is a common but severe complication of many chronic inflammatory processes of infectious, autoimmune, or neoplastic origin. It frequently leads to renal damage, often presenting as a nephrotic syndrome. Giant cell arteritis is a common inflammatory arteritis in elderly people, but rarely complicated by AA amyloidosis.

Traitement chirurgical d’une anémie hémolytique auto-immune

Introduction

Auto-immune hemolytic anemia (AIHA) is a rare cause of anemia, characterized by autoantibodies directed against self red blood cells. It can be primary or secondary, in particular due to lymphoproliferative diseases.

Endocardite infectieuse aortopulmonaire d’évolution fatale : à propos d’un cas

We report the case of an aortic and pulmonary infective endocarditis in a 25-year-old patient originating from Guinea Conakry. The patient did not have any particular cardiovascular antecedent. He is allowed in a table of total heart failure and fever. The transthoracic echocardiography found vegetations on the level of sigmoid aortic and pulmonary ones. A probabilistic bi-antibiotherapy was instituted while waiting for the results of hemocultures. The patient was apyretic after one week, with regression of inflammatory biological syndrome. However, he was deceased after 20 days in a table of heart failure. The necropsy found vegetations on the level of sigmoid aortic and pulmonary ones, which were perforated, a right lung oedema and a cardiac liver.