Survenue de cancers au cours de la sclérodermie systémique : facteurs de risque,impact sur la survie et revue de la littérature

IntroductionPatients with systemic sclerosis (SSc) have an increased risk of malignancy. In this study, we aimed to analyze the prevalence of cancer, the risk factors and the impact on overall survival.Patients and methodsWe analyzed clinical (history of cancer, toxic exposition, organ involvement), immunological and treatment data in a monocentric cohort of SSc patients followed between January 2004 and December 2017.ResultsTwo hundred and ten patients with SSc were included. During the follow-up, twenty-one patients (10 %) were diagnosed with malignancies. The underlying malignancies were breast adenocarcinoma (n = 6, 28%), lung cancer (n = 6, 28%), colorectal (colic adenocarcinoma, carcinoid tumor of the appendix), ovarian and cervix uteri, melanoma, kidney and papillary thyroid carcinoma (one of each). The median time between the first visit and the diagnosis of cancer was 4 [2–10] years. The overall survival in SSc patients with cancer was not significantly different from patients without cancer, with median survival during the first quartile (75%) at 12 years for patients with cancer and 11.6 years for those without cancer (P = 0.9). The history of renal scleroderma crisis (HR 10.99, IC95% [1.95–62.07]; P = 0.006) and the presence of anti-topoisomerase I antibodies (HR 5.5, IC95% [1.40–21.67]; P = 0.01) were associated with an increased risk of cancer, whereas the presence of gastroesophageal reflux was inversely associated with the cancer occurrence (HR 0.22, IC95% [0.056–0.867]; P = 0.03).ConclusionThe history of renal scleroderma crisis and the positivity of anti-topoisomerase I antibodies were associated with an increased risk of cancer in SSc patients in this monocentric study.     

La pancréatite aiguë au cours de la rectocolite ulcérohémorragique : complication rare de la mésalazine

Acute pancreatitis secondary to mesalazine is rare. Thirty-nine cases were described. We report a new case of pancreatitis during treatment of distal ulcerative colitis (UC) with mesalazine in a 38-year-old woman, without alcohol consumption. Treatment with enema and oral mesalazine was started. One week later, the patient was admitted for pancreatic epigastric pain; lipasemia was raised to threefold the upper normal limit. Ultrasound and abdominal CT scan showed an enlarged heterogeneous pancreatic head without Wirsung or biliary ducts abnormalities; treatment was stopped with regression of symptomatology as well as normalization of lipasemia after 10 days. Acute pancreatitis secondary to mezalasine is a rare side effect in the treatment of chronic inflammatory bowel diseases. This diagnosis must be evoked in any patient receiving mesalazine and presents pancreatic epigastric pain after excluding other causes of pancreatitis, particularly autoimmune etiology.     

Contribution de la cytométrie de flux au diagnostic d’une allergie

For the laboratory investigation of allergic diseases, flow cytometric methods to detect leukocytes that have been activated by allergen in vitro have recently been developed. Cellular tests for the detection of in vitro-activated blood basophils are complementary to specific IgE determinations. After in vitro incubation with allergen, basophils are fixed and then labeled with anti-IgE antibodies, and activation is then identified with anti-CD63 or anti-CD203c monoclonal antibodies. Assays based on basophil activation complement the measurement of specific IgE. With some allergens, particularly in cases of drug-induced allergy, flow cytometry has greater sensitivity than specific IgE determination. However, high concentrations of drugs can induce cell toxicity, and this may be confused with basophil activation. Cytometry can also be used to explore allergies with a cell-mediated mechanism. The detection of cytokine synthesis in T cells and basophils incubated with allergen is now technically feasible, but the usefulness of this procedure in the diagnosis of allergy remains to be demonstrated. We believe that the application of flow cytometry to the investigation of allergy is likely to increase.