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Deshayes S, Martin Silva N, Grandhomme F, Khoy K, Mariotte D, Boutemy J, Maigné G, Brière-Bellier C, Delmas C, Bienvenu B, Lobbedez T, de Boysson H, Aouba A. Clinical Effect of Alpha-1 Antitrypsin Deficiency in Antineutrophil Cytoplasmic Antibody-associated Vasculitis: Results from a French Retrospective Monocentric Cohort. J Rheumatol 2019; 46:1502-1508. [PMID: 30824651 DOI: 10.3899/jrheum.180591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Deficiency in alpha-1 antitrypsin (AAT) is a possible pathogenic cofactor in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, the clinical effect of AAT deficiency remains poorly established in this setting. This study aimed to describe the clinical phenotypes and outcomes of AAV according to AAT phenotypes. METHODS This study was conducted retrospectively at Caen University Hospital and included all consecutive granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) patients with positive proteinase 3-ANCA or myeloperoxidase-ANCA, from January 2000 or September 2011, respectively, to June 2016. AAT dosage (nephelometry) and phenotyping (isoelectric focusing in agarose gel) were performed. RESULTS Among the 142 patients with AAV, including 88 GPA and 54 MPA, 102 (72%) had the MM phenotype, 5 (4%) had a nonpolymerogenic M-variant phenotype, 18 (13%) had the deficient allele MZ, 12 (8%) had MS, 2 (1%) had ZZ, 2 (1%) had SZ, and 1 (1%) had SS. M, Z, and S allele frequencies were 84%, 8%, and 6%, respectively. No association was observed between AAT deficiency and ANCA subtype or AAV phenotype, except for intraalveolar hemorrhage (IAH), which was more frequent in patients harboring at least 1 of the deficient Z or S alleles than in those without any deficient alleles (p < 0.01). Global, renal, or relapse-free survival rates were similar for all subgroups. CONCLUSION This study shows that AAT deficiency confers, independently of ANCA subtype, a higher risk of IAH. Prospective studies are required to refine these data and to assess the need for replacement therapy in AAT-deficient patients with AAV.
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Affiliation(s)
- Samuel Deshayes
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Nicolas Martin Silva
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Frédérique Grandhomme
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Kathy Khoy
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Delphine Mariotte
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Jonathan Boutemy
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Gwénola Maigné
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Claire Brière-Bellier
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Claire Delmas
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Boris Bienvenu
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Thierry Lobbedez
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Hubert de Boysson
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Achille Aouba
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France. .,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie.
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