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Guillet S, Crickx E, Azzaoui I, Chappert P, Boutin E, Viallard JF, Rivière E, Gobert D, Galicier L, Malphettes M, Cheze S, Lefrere F, Audia S, Bonnotte B, Lambotte O, Noel N, Fain O, Moulis G, Hamidou M, Gerfaud-Valentin M, Marolleau JP, Terriou L, Martis N, Morin AS, Perlat A, Le Gallou T, Roy-Peaud F, Robbins A, Lega JC, Puyade M, Comont T, Limal N, Languille L, Zarrour A, Luka M, Menager M, Belmondo T, Hue S, Canoui-Poitrine F, Michel M, Godeau B, Mahévas M. Prolonged response after TPO-RA discontinuation in primary ITP: results of a prospective multicenter study. Blood 2023; 141:2867-2877. [PMID: 36893453 DOI: 10.1182/blood.2022018665] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/30/2023] [Accepted: 02/18/2023] [Indexed: 03/11/2023] Open
Abstract
Sustained response off treatment (SROT) after thrombopoietin receptor agonist (TPO-RA) discontinuation has been reported in immune thrombocytopenia (ITP). This prospective multicenter interventional study enrolled adults with persistent or chronic primary ITP and complete response (CR) on TPO-RAs. The primary end point was the proportion of patients achieving SROT (platelet count >30 × 109/L and no bleeding) at week 24 (W24) with no other ITP-specific medications. Secondary end points included the proportion of sustained CR off-treatment (SCROT, platelet count >100 × 109/L and no bleeding) and SROT at W52, bleeding events, and pattern of response to a new course of TPO-RAs. We included 48 patients with a median age of 58.5 years; 30 of 48 had chronic ITP at TPO-RA initiation. In the intention-to-treat analysis, 27 of 48 achieved SROT, 15 of 48 achieved SCROT at W24; 25 of 48 achieved SROT, and 14 of 48 achieved SCROT at W52. No severe bleeding episode occurred in patients who relapsed. Among patients rechallenged with TPO-RA, 11 of 12 achieved CR. We found no significant clinical predictors of SROT at W24. Single-cell RNA sequencing revealed enrichment of a tumor necrosis factor α signaling via NF-κB signature in CD8+ T cells of patients with no sustained response after TPO-RA discontinuation, which was further confirmed by a significant overexpression of CD69 on CD8+ T cells at baseline in these patients as compared with those achieving SCROT/SROT. Our results strongly support a strategy based on progressive tapering and discontinuation of TPO-RAs for patients with chronic ITP who achieved a stable CR on treatment. This trial was registered at www.clinicaltrials.gov as #NCT03119974.
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Affiliation(s)
- Stéphanie Guillet
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Etienne Crickx
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM UMR U1163,Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Université de Paris Cité, Paris, France
| | - Imane Azzaoui
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U955, Équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Pascal Chappert
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U955, Équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Emmanuelle Boutin
- Unité de Recherche Clinique (Mondor), AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
- INSERM, Institut Mondor de Recherche Biomédicale, Équipe Clinical Epidemiology and Ageing, UPEC, Créteil, France
| | - Jean-François Viallard
- Service de Médecine Interne, Haut-Lévêque Hôpital, Université de Bordeaux, Bordeaux, France
| | - Etienne Rivière
- Service de Médecine Interne, Haut-Lévêque Hôpital, Université de Bordeaux, Bordeaux, France
| | - Delphine Gobert
- Service de Médecine Interne, Saint Antoine Hôpital, AP-HP, Sorbonne Université, Paris, France
| | - Lionel Galicier
- Service d'Immunologie Clinique, Saint Louis Hôpital, AP-HP, Université de Paris Cité, Paris, France
| | - Marion Malphettes
- Service d'Immunologie Clinique, Saint Louis Hôpital, AP-HP, Université de Paris Cité, Paris, France
| | - Stéphane Cheze
- Institut d'Hématologie de Basse-Normandie, Centre Hospitalier de Caen Normandie, Caen, France
| | | | - Sylvain Audia
- Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, Centre Hospitalier Universitaire (CHU) Dijon-Bourgogne, Dijon, France
| | - Bernard Bonnotte
- Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, Centre Hospitalier Universitaire (CHU) Dijon-Bourgogne, Dijon, France
| | - Olivier Lambotte
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Nicolas Noel
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Olivier Fain
- Service de Médecine Interne, Saint Antoine Hôpital, AP-HP, Sorbonne Université, Paris, France
| | - Guillaume Moulis
- Service de Médecine Interne, CHU de Toulouse, Toulouse, France
- CIC 1436, Équipe PEPSS, CHU de Toulouse, Toulouse, France
| | | | | | - Jean-Pierre Marolleau
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Amiens-Picardie, Amiens, France
| | - Louis Terriou
- Service de Médecine Interne et d'Immunologie Clinique, CHU de Lille, Lille, France
| | - Nihal Martis
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital de Nice, Nice, France
| | - Anne-Sophie Morin
- Service de Médecine Interne, Jean Verdier Hôpital, AP-HP, Bondy, France
| | - Antoinette Perlat
- Service de Médecine Interne et Immunologie Clinique, CHU de Rennes, Rennes, France
| | - Thomas Le Gallou
- Service de Médecine Interne et Immunologie Clinique, CHU de Rennes, Rennes, France
| | - Frédérique Roy-Peaud
- Service de Médecine Interne-Maladies Infectieuses et Tropicales, CHU de Poitiers, Poitiers, France
| | - Ailsa Robbins
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Robert Debré Hospital, Reims University Hospitals, Reims, France
| | - Jean-Christophe Lega
- Service de Médecine Interne, Hospices Civils de Lyon, Lyon Sud Hôpital, Pierre-Bénite, France
| | - Matthieu Puyade
- Service de Médecine Interne, CHU de Poitiers, Poitiers, France
| | - Thibault Comont
- Service de Médecine Interne, CHU de Toulouse (IUCT-Oncopole), Toulouse, France
| | - Nicolas Limal
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Laetitia Languille
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Anissa Zarrour
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Marine Luka
- Université Paris Cité, Institut Imagine, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, F-75015 Paris, France
| | - Mickael Menager
- Université Paris Cité, Institut Imagine, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, F-75015 Paris, France
| | - Thibault Belmondo
- Département Immunologie-Hématologie, Henri Mondor Hôpital, AP-HP, UPEC, Créteil, France
- UPEC, Faculté de Médecine, Créteil, France
- Service de Santé Publique, AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
| | - Sophie Hue
- Département Immunologie-Hématologie, Henri Mondor Hôpital, AP-HP, UPEC, Créteil, France
- UPEC, Faculté de Médecine, Créteil, France
- INSERM U955, Équipe 16, Institut Mondor de Recherche Biomédicale, UPEC, Créteil, France
| | - Florence Canoui-Poitrine
- Unité de Recherche Clinique (Mondor), AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
- Service de Santé Publique, AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Matthieu Mahévas
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U955, Équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
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Guillet S, Loustau V, Boutin E, Zarour A, Comont T, Souchaud-Debouverie O, Costedoat Chalumeau N, Pan-Petesch B, Gobert D, Cheze S, Viallard JF, Morin AS, Sauvetre G, Cliquennois M, Royer B, Masseau A, Terriou L, Fieschi C, Lambotte O, Girault S, Lioger B, Audia S, Sacre K, Lega JC, Langlois V, Benachi A, Orvain C, Devidas A, Humbert S, Gambier N, Ruivard M, Zarrouk V, Ebbo M, Willems L, Segaux L, Mahevas M, Haddad B, Michel M, Canoui-Poitrine F, Godeau B. Immune thrombocytopenia and pregnancy: an exposed/nonexposed cohort study. Blood 2023; 141:11-21. [PMID: 36054922 PMCID: PMC10644036 DOI: 10.1182/blood.2022017277] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/18/2022] [Accepted: 08/03/2022] [Indexed: 01/10/2023] Open
Abstract
The risk of immune thrombocytopenia (ITP) worsening during pregnancy and neonatal ITP (NITP) have never been prospectively studied. We included 180 pregnant and 168 nonpregnant women with ITP in a prospective, multicenter, observational cohort study. A total of 131 pregnant women with ITP were matched to 131 nonpregnant women with ITP by history of splenectomy, ITP status (no response, response, complete response), and duration. Groups were followed for 15 months. The primary outcome was the first occurrence of ITP worsening defined by a composite end point including bleeding events and/or severe thrombocytopenia (<30 × 109/L) and/or ITP treatment modification. We also studied the recurrence of ITP worsening and the incidence of NITP and risk factors. The first occurrence of ITP worsening did not differ between pregnant and nonpregnant women with ITP (53.4 per 100 person-years [95% confidence interval {CI}, 40.8-69.9] vs 37.1 [95% CI, 27.5-50.0]; hazard ratio {HR}, 1.35 [95% CI, 0.89-2.03], P = .16). Pregnant women with ITP were more likely to have recurrence of severe thrombocytopenia and treatment modification (HR, 2.71 [95% CI, 1.41-5.23], P = .003; HR, 2.01 [95% CI, 1.14-3.57], P = .017, respectively). However, recurrence of severe bleeding events was not different between groups (P = .4). Nineteen (14%) neonates showed NITP <50 × 109/L. By multivariable analysis, NITP was associated with a previous offspring with NITP and maternal platelet count <50 × 109/L within 3 months before delivery (adjusted odds ratio, 5.55 [95% CI, 1.72-17.89], P = .004 and 4.07 [95% CI, 1.41-11.73], P = .009). To conclude, women with ITP do not increase their risk of severe bleeding during pregnancy. NITP is associated with NITP history and the severity of maternal ITP during pregnancy. These results will be useful for counseling women with ITP.
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MESH Headings
- Infant, Newborn
- Female
- Humans
- Pregnancy
- Purpura, Thrombocytopenic, Idiopathic/epidemiology
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Purpura, Thrombocytopenic, Idiopathic/complications
- Cohort Studies
- Prospective Studies
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Complications, Hematologic/therapy
- Thrombocytopenia, Neonatal Alloimmune/therapy
- Retrospective Studies
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Affiliation(s)
- Stéphanie Guillet
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Valentine Loustau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Service de Médecine Interne, Centre Hospitalier Alpes Léman, Contamine sur Arve, France
| | - Emmanuelle Boutin
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Anissa Zarour
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Thibault Comont
- Service de Médecine Interne et d’Immunopathologie–IUCT-Oncopole, CHU de Toulouse, Toulouse, France
| | | | - Nathalie Costedoat Chalumeau
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
- Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, AP-HP, Université de Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | | | - Delphine Gobert
- Service de Médecine Interne, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Stéphane Cheze
- Institut d’Hématologie de Basse-Normandie, Centre Hospitalier de Caen Normandie, Caen, France
| | | | - Anne-Sophie Morin
- Service de Médecine Interne, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Gaetan Sauvetre
- Service de Médecine Interne, Hôpital Charles Nicolle, Université de Rouen, Rouen, France
| | - Manuel Cliquennois
- Service d'Onco-hématologie Adulte, Hôpital Saint-Vincent de Paul, GH de l'institut Catholique de Lille, Lille, France
| | - Bruno Royer
- Service d’Immuno-hématologie, Hôpital Saint Louis, Paris, France
- Service d’Hématologie clinique, CHU d’Amiens, Amiens, France
| | - Agathe Masseau
- Service de Médecine Interne, CHU de Nantes, Nantes, France
| | - Louis Terriou
- Service de Médecine Interne et d’Immunologie Clinique, CHU Lille, Université de Lille, Lille, France
| | - Claire Fieschi
- Service d’Immunologie Clinique, Hôpital Saint Louis, AP-HP, Paris, France
| | - Olivier Lambotte
- Service de Médecine Interne et d’Immunologie Clinique, Hôpital Bicêtre, Université Paris Sacly, Le Kremlin-Bicêtre, France
| | - Stéphane Girault
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Dupuytren, Limoges, France
| | | | - Sylvain Audia
- Service de Médecine Interne et d’Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, CHU Dijon-Bourgogne, Dijon, France
| | - Karim Sacre
- Service de Médecine Interne, Hôpital Bichat, AP-HP, Paris, France et Université de Paris, Centre de Recherche sur l’Inflammation, INSERM UMR1149, CNRS ERL8252, Laboratoire d’Excellence Inflamex, Paris, France
| | - Jean Christophe Lega
- Service de Médecine Interne et Médecine Vasculaire, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Université de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS-UMR 5588, Université Lyon 1, Lyon, France
| | - Vincent Langlois
- Service de Médecine Interne, Hôpital Jacques Monod, Le Havre, France
| | - Alexandra Benachi
- Service d’Obstétrique et Gynécologie, Hôpital Antoine-Béclère, AP-HP, Université Paris-Saclay, Clamart, France
| | - Corentin Orvain
- Service d’Hématologie, Hôpital d’Anger, INSERM, CRCINA, Université d’Angers, Angers, France
| | - Alain Devidas
- Service d’Hématologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | | | - Nicolas Gambier
- Service de Médecine Interne, CH Général Delafontaine, St Denis, France
| | - Marc Ruivard
- Service de Médecine Interne, CHU Estaing, Clermont-Ferrand, France
| | - Virginie Zarrouk
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Clichy, France
| | - Mikael Ebbo
- Service de Médecine Interne, Hôpital de la Conception, AP-HP, Université Aix-Marseille, Marseille, France
| | - Lise Willems
- Service d’Hématologie Clinique, Hôpital Cochin, Paris, France
| | - Lauriane Segaux
- Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Matthieu Mahevas
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Bassam Haddad
- Centre Hospitalier Inter-Communal de Créteil, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Equipe Immunorégulation et Biothérapie (I-BIOT), Université Paris Est Créteil, Univ Paris Est Créteil, INSERM U955, Institut Mondor De Recherche Biomédicale (IMRB), Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Florence Canoui-Poitrine
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
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3
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Martis N, Viau P, Zenone T, Andry F, Grados A, Ebbo M, Castela E, Brihaye B, Denis E, Liguori S, Audemard A, Schoindre Y, Morin AS, Terrier B, Marcq L, Mounier N, Lidove O, Chaborel JP, Quinsat D. Clinical value of a [18F]-FDG PET-CT muscle-to-muscle SUV ratio for the diagnosis of active dermatomyositis. Eur Radiol 2019; 29:6708-6716. [PMID: 31250167 DOI: 10.1007/s00330-019-06302-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/05/2019] [Revised: 05/11/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study a muscle-to-muscle standardised uptake value (SUV) ratio with FDG-PET/CT (FDG-PET) as a marker for the detection of disease activity in dermatomyositis (DM). METHODS Patients with DM (n = 24) who met the European Neuro-Muscular Centre diagnostic criteria were retrospectively identified over a 3-year period through a national survey. Muscle biopsy was performed in all patients. Maximum SUV was measured in proximal muscles (SUVPROX) that had the highest radiotracer uptake on visual grading as well as in the musculus longissimus thoracis (SUVMLT), whereas mean SUV was measured for the liver (SUVLIV). Muscle-to-liver SUV ratios for either muscle group were compared and a SUVPROX/SUVMLT ratio was calculated. SUVPROX/SUVMLT of DM patients were compared with age- and sex-matched control subjects (n = 24) with melanoma who had received FDG-PET scans. RESULTS DM patients presented with proximal and symmetrical muscle uptake. Differences in SUVPROX/SUVLIV and SUVMLT/SUVLIV ratios in DM subjects were significant (p < 0.001). SUVPROX/SUVMLT ratios in DM and their controls also differed significantly (p = 0.0012). The SUVPROX/SUVMLT ratio threshold between DM subjects and controls was 1.73 with a sensitivity of 50% (CI95%, 29.1 to 70.9%) and specificity at 83.3% (CI95%, 62.6 to 95.3%). When amyopathic DM patients were removed from the analysis, specificity was increased to 95% (CI95%, 75.1 to 99.9%) with a likelihood ratio of 10 and an AUC of 83.4% (CI95%, 71.4 to 95.4%). CONCLUSION A muscle-to-muscle SUVPROX/SUVMLT ratio with a cut-off value of 1.73 in FDG-PET imaging might serve as a non-invasive marker to determine disease activity in dermatomyositis. KEY POINTS • [18F]-FDG PET-scanner standardised uptake value (SUV) could reflect disease activity in dermatomyositis (DM). • A ratio of SUV in proximal muscles (SUVPROX) to SUV in musculus longissimus thoracis (SUVMLT) could be used to determine active DM. • Active disease is suspected for SUV PROX /SUV MLT ratios greater than 1.73.
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Affiliation(s)
- Nihal Martis
- Service de Médecine Interne, CHU de Nice, Université Côte d'Azur, Faculté de Médecine de Nice, Nice, France.
| | - Philippe Viau
- Service de Médecine Nucléaire, CHU de Nice, Université Côte d'Azur, Faculté de Médecine de Nice, Nice, France
| | - Thierry Zenone
- Service de Médecine Interne, CH de Valence, Valence, France
| | - Fanny Andry
- Service de Médecine Interne, CHU Michallon, Grenoble, France
| | - Aurélie Grados
- Service de Médecine Interne, Hôpital La Timone, AP-HM, Marseille, France
| | - Mikael Ebbo
- Service de Médecine Interne, Hôpital La Timone, AP-HM, Marseille, France
| | - Emeline Castela
- Service de Médecine Interne, CHU de Nice, Université Côte d'Azur, Faculté de Médecine de Nice, Nice, France
| | - Benoit Brihaye
- Service de Médecine Interne, CH Saint-Quentin, Saint-Quentin, France
| | - Eric Denis
- Service de Médecine Interne, CH d'Antibes-Juan-les-Pins, Antibes, France
| | - Stéphane Liguori
- Service de Biologie Médicale, CH d'Antibes-Juan-les-Pins, Antibes, France
| | | | - Yoland Schoindre
- Service de Médecine Interne, Hôpital de la Pitié Salpêtrière, AP-HP, Paris, France
| | - Anne-Sophie Morin
- Service de Médecine Interne, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, AP-HP, Paris, France
| | - Laurent Marcq
- Service de Médecine Interne, CH d'Antibes-Juan-les-Pins, Antibes, France
| | - Nicolas Mounier
- Service d'Onco-Hématologie, CHU de Nice, Université Côte d'Azur, Faculté de Médecine de Nice, Nice, France
| | - Olivier Lidove
- Service de Médecine Interne, CH Croix St-Simon, Paris, France
| | | | - Denis Quinsat
- Service de Médecine Interne, CH d'Antibes-Juan-les-Pins, Antibes, France
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4
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Mahevas M, Van Eeckhoudt S, Moulis G, Limal N, Languille L, Bierling P, Dossier A, Duriez F, Galicier L, Morin AS, Tamburini J, Chaoui D, Bouscary D, Jijakli AAL, Khellaf M, Vaida I, Michel M, Vercellino L, Jaddi H, Yollant A, Dosquet C, Godeau B, Chomienne C. Autologous 111 Indium-oxinate-labelled platelet sequestration study in patients with immune thrombocytopenia treated by thrombopoietin receptor-agonists. Br J Haematol 2019; 186:e44-e47. [PMID: 30950041 DOI: 10.1111/bjh.15890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Matthieu Mahevas
- Internal Medicine, French Referral Centre for Adult Immune Cytopenia, Henri Mondor University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est-Créteil (UPEC University), Créteil, France
| | - Sandrine Van Eeckhoudt
- Internal Medicine, French Referral Centre for Adult Immune Cytopenia, Henri Mondor University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est-Créteil (UPEC University), Créteil, France
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France.,UMR 1027, INSERM-University of Toulouse, Toulouse, France.,CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Nicolas Limal
- Internal Medicine, French Referral Centre for Adult Immune Cytopenia, Henri Mondor University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est-Créteil (UPEC University), Créteil, France
| | - Laetitia Languille
- Internal Medicine, French Referral Centre for Adult Immune Cytopenia, Henri Mondor University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est-Créteil (UPEC University), Créteil, France
| | - Philippe Bierling
- Internal Medicine, French Referral Centre for Adult Immune Cytopenia, Henri Mondor University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est-Créteil (UPEC University), Créteil, France
| | - Antoine Dossier
- Department of Internal Medicine, Hôpital Bichat, Paris, France
| | - Frédéric Duriez
- Oncology - Haematology, Les Hôpitaux de Chartres, Chartres, France
| | - Lionel Galicier
- Clinical Immunology, St-Louis University Hospital, Paris, France
| | - Anne-Sophie Morin
- Department of Internal Medicine, Hopital Jean Verdier, Bondy, France
| | | | - Driss Chaoui
- Haematology, CH Victor Dupouy, Agenteuil, France
| | | | | | - Mehdi Khellaf
- Internal Medicine, French Referral Centre for Adult Immune Cytopenia, Henri Mondor University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est-Créteil (UPEC University), Créteil, France
| | | | - Marc Michel
- Internal Medicine, French Referral Centre for Adult Immune Cytopenia, Henri Mondor University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est-Créteil (UPEC University), Créteil, France
| | - Laetitia Vercellino
- Service de Médecine Nucléaire, Assistance Publique des Hôpitaux de Paris (AP-HP), Saint Louis Hospital, Paris, France
| | - Hind Jaddi
- Cellular Biology, Assistance Publique des Hôpitaux de Paris (AP-HP), Saint Louis Hospital, Paris, France
| | - Armelle Yollant
- Cellular Biology, Assistance Publique des Hôpitaux de Paris (AP-HP), Saint Louis Hospital, Paris, France
| | - Christine Dosquet
- Cellular Biology, Assistance Publique des Hôpitaux de Paris (AP-HP), Saint Louis Hospital, Paris, France
| | - Bertrand Godeau
- Internal Medicine, French Referral Centre for Adult Immune Cytopenia, Henri Mondor University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est-Créteil (UPEC University), Créteil, France
| | - Christine Chomienne
- Cellular Biology, Assistance Publique des Hôpitaux de Paris (AP-HP), Saint Louis Hospital, Paris, France
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5
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Grimaldi-Bensouda L, Rossignol M, Koné-Paut I, Krivitzky A, Lebrun-Frenay C, Clet J, Brassat D, Papeix C, Nicolino M, Benhamou PY, Fain O, Costedoat-Chalumeau N, Courcoux MF, Viallard JF, Godeau B, Papo T, Vermersch P, Bourgault-Villada I, Breart G, Abenhaim L, Abbas F, Abdelmoumni A, Hilliquin P, Requeda E, Adoue D, Brassat D, Agard C, Masseau A, Aladjidi N, Clet J, Fernandes H, Lemasson G, Perel Y, Raymond I, Richer O, Vital A, Allain-Launay E, Bru M, Nicolino M, Thomas C, Altman JJ, Amsallem D, Aras N, Boukari L, Dubrel M, Fain O, Letellier E, Lucidarme N, Mekinian A, Morin AS, Stirnemann J, Atlan C, Audry D, Augustin J, Bakir R, Bartolucci P, Chevalier X, Godeau B, Guillaud C, Khellaf M, Limal N, Lousteau V, Mahevas M, Méliksetyan G, Michel M, Roumier M, Bayart S, Bonnet F, Decaux O, Bekherraz A, Brihaye B, Dachez R, Daugas E, Hayem G, Meyer O, Papo T, Pasqualoni E, Sacre K, Travert F, Bellon H, Beltrand J, Lefrere F, Simon A, Benhamou PY, Benveniste O, Bolgert F, Costedoat-Chalumeau N, De Paz R, Demeret S, Fautrel B, Jacqueminet S, Louapre C, Maillart E, Morel N, Papeix C, Rigabert J, Bensaid P, Berger C, Berquin P, Le Moing AG, Berroir S, Besson G, Boutte C, Casez O, Bonnotte B, Audia S, Bossu-Estour C, Bourgarit A, Dupuy A, Keshmandt H, Bourre B, Brac A, Perrin A, Pondarré C, Villar-Fimbel S, Bruckert I, Cosson A, Magy-Bertrand N, Tisserand G, Camu W, Carlander B, Morales RJ, Cances C, Pasquet M, Castilla Lievre MA, Chabroux S, Charif M, Chatelus E, Sibilia J, Chevrant-Breton J, Clavel S, Bille-Turc F, Cohen J, Courcoux MF, Leverger G, Machet L, Cuisset JM, Cony-Makhoul P, Darsy P, Favre S, Giraud P, Leitenschenck L, Monteiro I, Morati C, DeSeze J, Dinulescu M, Dhaoui T, Dommange-Romero F, Drevard E, Dupuis C, Dumuis ML, Durand JM, Farad S, Lecomte P, Pierre P, Fouyssac F, Gaudin P, Gautier A, Gellen-Dautremer J, Jarrin I, Richette P, Georget E, Gras P, Moreau T, Giraud E, Hacini M, Mayer A, Guillaumat C, Guillaume S, Guitton C, Kone-Paut I, Marsaud C, Rossi L, Guyot MH, Hassler P, Heimfert C, Heinzlef O, Hillion B, Hocquelet C, Husson H, Ichai P, Jeziorski E, Deslandre CJ, Le Guern V, Kamenov K, Kerlan V, Lemoine P, Misery L, Pan-Petesch B, Krivitzky A, Labauge P, Rodier M, Lacade C, Razafimahefa B, Lachgar K, Larmarau MP, Leblanc T, Lebrun-Frenay C, Lefèbvre P, Lejoyeux P, Leske C, Ly K, Magy L, Mansuy S, Marechaud R, Martin Negrier ML, Sole G, Maupetit J, Mazingue F, Mochon S, Moktar B, Morcamp D, Morlet-Barla N, Nicolas G, Pautot V, Pellier I, Verret JL, Outteryck O, Vermersch P, Pallot-Prades B, Paquet JM, Puechal X, Sortais A, Pelletier J, Rico A, Pez D, Stankoff B, Quittet P, Rémy C, Roba E, Rosario H, Roudaut N, Sonnet E, Ruel M, Sebban S, Schaepelynck P, Simonin MJ, Vial C, Viallard JF, Ladedan I, Zenone T. Risk of autoimmune diseases and human papilloma virus (HPV) vaccines: Six years of case-referent surveillance. J Autoimmun 2017; 79:84-90. [DOI: 10.1016/j.jaut.2017.01.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/08/2016] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
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6
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Michel M, Terriou L, Roudot-Thoraval F, Hamidou M, Ebbo M, Le Guenno G, Galicier L, Audia S, Royer B, Morin AS, Marie Michot J, Jaccard A, Frenzel L, Khellaf M, Godeau B. A randomized and double-blind controlled trial evaluating the safety and efficacy of rituximab for warm auto-immune hemolytic anemia in adults (the RAIHA study). Am J Hematol 2017; 92:23-27. [PMID: 27696475 DOI: 10.1002/ajh.24570] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 12/27/2022]
Abstract
This Phase 3 multicentre randomized double-blind and placebo-controlled trial aimed to compare the efficacy and safety of rituximab (RTX) to placebo for treating newly diagnosed warm autoimmune hemolytic anemia (wAIHA) in adults receiving prednisone. Adults with a confirmed diagnosis of wAIHA who previously received corticosteroids for less than 6 weeks could be included. At inclusion, all patients received prednisone at a daily dose of 1 mg/kg for 2 weeks, and then tapered according to a pre-defined recommended reduction scheme. Besides prednisone, eligible patients received 2 infusions of RTX or placebo at a fixed dose of 1,000 mg 2-week apart. The primary endpoint was overall response rate (complete response [CR] + partial response [PR]) in an intent-to-treat (ITT) analysis at 1 year. A total of 32 patients (17 females [53%], mean age at inclusion 71 ± 16 years) were enrolled and randomized. In all, 27 patients were followed for at least 1 year and their data were evaluable for response. With an ITT analysis, the overall response rate at 1 year was 75% [95%CI: 47.6-92.7] with 11 CR and 1 PR with RTX versus 31% [11.0-58.7] (5 CR) with placebo (P = 0.032). At 2 years, 10/16 patients with RTX versus 3/16 with placebo still showed CR (P = 0.011). Overall, eight severe infections occurred during follow-up, six with placebo and two with RTX (P = 0.39). At 2 years, six patients with placebo had died, but none with RTX (P = 0.017). Compared to placebo, RTX combined with prednisone may be effective and safe for treating newly-diagnosed wAIHA in adults. Am. J. Hematol. 92:23-27, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marc Michel
- Department of Internal Medicine; National Referral Center for Adult'Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil; Créteil France
| | - Louis Terriou
- Department of Internal Medecine and Clinical Hematology; Claude-Huriez University Hospital, Université Lille Nord de France; Lille France
| | - Francoise Roudot-Thoraval
- Department of Public Health and Statistics; Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil; Créteil France
| | - Mohamed Hamidou
- Department of Internal Medicine; Hôtel Dieu University Hospital; Nantes France
| | - Mikael Ebbo
- Department of Internal Medicine; La Timone University Hospital; Marseille France
| | - Guillaume Le Guenno
- Department of Internal Medicine; D'Estaing University Hospital; Clermont Ferrand France
| | - Lionel Galicier
- Department of Clinical Immunology; Saint Louis University Hospital; Paris France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology; Bocage Central University Hospital, CR INSERM 1098; Dijon France
| | - Bruno Royer
- Deparment of Hematology; University Hospital; Amiens France
| | - Anne-Sophie Morin
- Department of Internal Medicine; Jean Verdier University Hospital; Bondy France
| | - Jean Marie Michot
- Department of Internal Medicine and Clinical Immunology Assistance Publique-Hôpitaux de Paris; Bicêtre University Hospital, Université Paris Sud; Le Kremlin-Bicêtre France
| | - Arnaud Jaccard
- Department of Hematology; Dupuytren University Hospital; Limoges France
| | - Laurent Frenzel
- Department of Hematology; Necker University Hospital; Paris France
| | - Mehdi Khellaf
- Department of Internal Medicine; National Referral Center for Adult'Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil; Créteil France
| | - Bertrand Godeau
- Department of Internal Medicine; National Referral Center for Adult'Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil; Créteil France
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7
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Grimaldi-Bensouda L, Nordon C, Michel M, Viallard JF, Adoue D, Magy-Bertrand N, Durand JM, Quittet P, Fain O, Bonnotte B, Morin AS, Morel N, Costedoat-Chalumeau N, Pan-Petesch B, Khellaf M, Perlat A, Sacre K, Lefrere F, Abenhaim L, Godeau B. Immune thrombocytopenia in adults: a prospective cohort study of clinical features and predictors of outcome. Haematologica 2016; 101:1039-45. [PMID: 27229715 DOI: 10.3324/haematol.2016.146373] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/24/2016] [Indexed: 11/09/2022] Open
Abstract
This prospective observational cohort study aimed to explore the clinical features of incident immune thrombocytopenia in adults and predictors of outcome, while determining if a family history of autoimmune disorder is a risk factor for immune thrombocytopenia. All adults, 18 years of age or older, recently diagnosed with immune thrombocytopenia were consecutively recruited across 21 hospital centers in France. Data were collected at diagnosis and after 12 months. Predictors of chronicity at 12 months were explored using logistic regression models. The association between family history of autoimmune disorder and the risk of developing immune thrombocytopenia was explored using a conditional logistic regression model after matching each case to 10 controls. One hundred and forty-three patients were included: 63% female, mean age 48 years old (Standard Deviation=19), and 84% presented with bleeding symptoms. Median platelet count was 10×10(9)/L. Initial treatment was required in 82% of patients. After 12 months, only 37% of patients not subject to disease-modifying interventions achieved cure. The sole possible predictor of chronicity at 12 months was a higher platelet count at baseline [Odds Ratio 1.03; 95%CI: 1.00, 1.06]. No association was found between outcome and any of the following features: age, sex, presence of either bleeding symptoms or antinuclear antibodies at diagnosis. Likewise, family history of autoimmune disorder was not associated with incident immune thrombocytopenia. Immune thrombocytopenia in adults has been shown to progress to a chronic form in the majority of patients. A lower platelet count could be indicative of a more favorable outcome.
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Affiliation(s)
| | | | - Marc Michel
- Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Service de Médecine Interne, CHU Henri Mondor, Créteil, France
| | - Jean-François Viallard
- Service de Médecine Interne, Hôpital Haut-Lévêque, Pessac; Université Bordeaux 2, Bordeaux, France
| | | | | | - Jean-Marc Durand
- Service de Médecine Interne, Hôpital de la Timone, Marseille, France
| | - Philippe Quittet
- Département d'Hématologie Clinique, Hôpital St-Eloi, Montpellier, France
| | - Olivier Fain
- Service de Médecine Interne, Hôpital Saint Antoine; Hôpitaux Universitaires de l'Est Parisien, AP-HP Université Paris 6, Paris, France
| | - Bernard Bonnotte
- Service de Médecine Interne et Immunologie Clinique, INSERM 1098, CHU Bocage Central, Dijon, France
| | - Anne-Sophie Morin
- Service de Médecine Interne CHU Jean Verdier, Université Paris 13, Assistance Publique-Hôpitaux de Paris (AP-HP), Bondy, France
| | - Nathalie Morel
- Service de Médecine Interne, Hôpital Cochin, Paris, France
| | | | | | - Mehdi Khellaf
- Service des Urgences, Centre Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | | | - Karim Sacre
- Université Paris-Diderot, Paris; Assistance Publique Hôpitaux de Paris; INSERUM U1149, Paris, France
| | | | | | - Bertrand Godeau
- Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Service de Médecine Interne, CHU Henri Mondor, Créteil, France
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8
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Handra-Luca A, Haddar D, Morin AS. Nasopalpebral Schwannomas and Human Immunodeficiency Virus Infection. Med Princ Pract 2016; 25:96-8. [PMID: 26436768 PMCID: PMC5588322 DOI: 10.1159/000441455] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 10/04/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report a case of a schwannoma of nasopalpebral location, occurring in a human immunodeficiency virus (HIV)-positive patient. CLINICAL PRESENTATION AND INTERVENTION A 55-year-old man presented with a nasopalpebral painless tumefaction, pneumopathy and HIV-related immunodepression after stopping combination antiretroviral therapy. Magnetic resonance imaging showed subcutaneous masses, with contrast enhancement of the left nose pyramid, internal cantus and inferior palpebral area, suspicious of Kaposi sarcoma. The resected specimen showed schwannoma histology, with tumor cells expressing S100 protein and WT1. CONCLUSION The features of a rare case of facial schwannoma of nasopalpebral location in an HIV-positive patient are reported. The diagnosis may be difficult before microscopic examination, with imaging features suggesting a Kaposi sarcoma.
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Affiliation(s)
- Adriana Handra-Luca
- Service d'Anatomie Pathologique, Assistance Publique - Hopitaux de Paris (AP-HP), Université Paris Nord Sorbonne Cité, Bobigny, France
- *Adriana Handra-Luca, MD, PhD, Service d’Anatomie Pathologique, AP-HP GHU Avicenne, Université Paris Nord Sorbonne Cité, 125, rue de Stalingrad, FR–93009 Bobigny (France), E-Mail
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9
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Maman E, Morin AS, Soussan M, Coignard H, Lortholary O, Fain O. Multifocal bone aspergillosis by Aspergillus terreus in an apparently immunocompetent patient. Presse Med 2015; 44:1064-6. [PMID: 26337362 DOI: 10.1016/j.lpm.2015.07.019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/08/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Esther Maman
- AP-HP, hôpital Jean-Verdier, université Paris 13, service de médecine interne, 93140, Bondy, France
| | - Anne-Sophie Morin
- AP-HP, hôpital Jean-Verdier, université Paris 13, service de médecine interne, 93140, Bondy, France
| | - Michael Soussan
- AP-HP, hôpital Avicenne, université Paris 13, service de médecine nucléaire, 93000 Bobigny, France
| | - Hélène Coignard
- AP-HP, hôpital Necker, université Paris 5, service de maladies infectieuses, 75015 Paris, France
| | - Olivier Lortholary
- AP-HP, hôpital Necker, université Paris 5, service de maladies infectieuses, 75015 Paris, France
| | - Olivier Fain
- AP-HP hôpital Saint-Antoine, DHU i2B, Université Paris 6, service de médecine interne, 75014 Paris, France.
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10
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Stirnemann J, Kaddouri N, Khellaf M, Morin AS, Prendki V, Michel M, Mekinian A, Bierling P, Fenaux P, Godeau B, Fain O. Vincristine efficacy and safety in treating immune thrombocytopenia: a retrospective study of 35 patients. Eur J Haematol 2015; 96:269-75. [PMID: 25976731 DOI: 10.1111/ejh.12586] [Citation(s) in RCA: 24] [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] [Accepted: 05/11/2015] [Indexed: 11/27/2022]
Abstract
Although vincristine (VCR) is sometimes prescribed for newly diagnosed immune thrombocytopenia (ITP), its efficacy in refractory ITP and sustained efficacy has yet to be demonstrated. We describe our clinical experience and recommend vincristine's correct place in ITP management. This retrospective study analysed data from 35 patients with newly diagnosed (ND), persistent (P) or chronic (C) ITP treated with VCR. The initial response rate, defined as >30 × 10(9) platelets/L, reached 86% after a median of 7 [interquartile range (IQR) 6-13] days. In ND and P ITP, even when previous therapies were inefficient, initial response was 87.5%, suggesting that this treatment could be used particularly in rescue. Median survival time, without failure or relapse, was 15 months (Kaplan-Meier curve). Predictive factors (univariate analysis) of an initial and long-term response were a small number of prior treatments received. However, at 2 yr, only seven patients had sustained response. Eight (23%) patients experienced adverse events: neuropathy for seven and bowel obstruction for one. Vincristine efficacy in ITP was confirmed, and it could be a good strategy for treating resistant ITP, especially in emergencies. In this era of new therapeutics, VCR deserves to remain on the list of ITP treatments because of its initial efficacy, safety and low cost.
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Affiliation(s)
- Jérôme Stirnemann
- Hôpital Jean-Verdier, Service de Médecine Interne, Université Paris 13, Assistance Publique-hôpitaux de Paris (AP-HP), Bondy Cedex, France.,Département de Médecine Interne et de réadaptation, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Najett Kaddouri
- Hôpital Jean-Verdier, Service de Médecine Interne, Université Paris 13, Assistance Publique-hôpitaux de Paris (AP-HP), Bondy Cedex, France
| | - Medhi Khellaf
- Service de Médecine Interne, UPEC, Hôpital Henri-Mondor, AP-HP, Créteil Cedex, France
| | - Anne-Sophie Morin
- Hôpital Jean-Verdier, Service de Médecine Interne, Université Paris 13, Assistance Publique-hôpitaux de Paris (AP-HP), Bondy Cedex, France
| | - Virginie Prendki
- Hôpital Jean-Verdier, Service de Médecine Interne, Université Paris 13, Assistance Publique-hôpitaux de Paris (AP-HP), Bondy Cedex, France.,Département de Médecine Interne et de réadaptation, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marc Michel
- Service de Médecine Interne, UPEC, Hôpital Henri-Mondor, AP-HP, Créteil Cedex, France
| | - Arsène Mekinian
- Hôpital Jean-Verdier, Service de Médecine Interne, Université Paris 13, Assistance Publique-hôpitaux de Paris (AP-HP), Bondy Cedex, France.,Service de médecine interne, DHU i2B, Hôpital Saint Antoine, Université Paris 6, Paris, France
| | - Philippe Bierling
- Etablissement Français du Sang, Université Paris 12, Hôpital Henri-Mondor, AP-HP, Créteil Cedex, France
| | - Pierre Fenaux
- Service d'Hématologie Séniors, Université Paris 7, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Bertrand Godeau
- Service de Médecine Interne, UPEC, Hôpital Henri-Mondor, AP-HP, Créteil Cedex, France
| | - Olivier Fain
- Hôpital Jean-Verdier, Service de Médecine Interne, Université Paris 13, Assistance Publique-hôpitaux de Paris (AP-HP), Bondy Cedex, France.,Service de médecine interne, DHU i2B, Hôpital Saint Antoine, Université Paris 6, Paris, France
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11
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Gras J, Morin AS, Caux F, Mekinian A, Fain O. [Pemphigoid gestationis]. Rev Prat 2013; 63:1208. [PMID: 24422286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Julien Gras
- Service de médecine interne, hôpital Jean Verdier (AP-HP), université Paris 13, 93140 Bondy, France
| | - Anne-Sophie Morin
- Service de médecine interne, hôpital Jean Verdier (AP-HP), université Paris 13, 93140 Bondy, France
| | - Frédéric Caux
- Service de dermatologie, hôpital Avicenne (AP-HP), université Paris 13, 93000 Bobigny, France
| | - Arsène Mekinian
- Service de médecine interne, hôpital Jean Verdier (AP-HP), université Paris 13, 93140 Bondy, France
| | - Olivier Fain
- Service de médecine interne, hôpital Jean Verdier (AP-HP), université Paris 13, 93140 Bondy, France
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12
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Badescu A, Lae M, Morin AS, Handra-Luca A. Ileal leiomyosarcoma and lymph node granuloma. Relevance of a rare association. Clin Res Hepatol Gastroenterol 2012; 36:e96-9. [PMID: 22440051 DOI: 10.1016/j.clinre.2012.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 01/10/2012] [Accepted: 01/24/2012] [Indexed: 02/04/2023]
Abstract
Leiomyosarcoma is rare in ileal location. We report the case of a 61 years old female patient presenting with ileal leiomyosarcoma occurring at 14 years after a uterine carcinoma treated by radiotherapy. The ileal tumor was treated by surgical resection. This tumor was peculiar by the macroscopic polypoid appearance and by expression of PDGFRA protein together with muscle differentiation proteins: smooth muscle actin, desmin and h-caldesmon. Lymph node necrotizing granuloma diagnosis on the surgical resection specimen lead to the diagnosis of tuberculosis and the patient was treated accordingly. At 3 years after the diagnosis, the patient was well, without recurrence or metastases. In conclusion, we report the case of a patient diagnosed with ileal leiomyosarcoma occurring 14 years after adjuvant radiotherapy for uterine carcinoma. Analysis of the intestinal resection specimen lead to the diagnosis of associated tuberculosis. Moreover, the leiomyosarcoma was peculiar by PDGFRA expression, feature which might be of clinical relevance since the treatment options in radioinduced tumors associated with other conditions are limited.
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Affiliation(s)
- Alina Badescu
- Service d'Anatomie Pathologique, Hopitaux Universitaires Paris Seine Saint-Denis, AP-HP, Bobigny, France
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13
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Javaud N, Certal RDS, Stirnemann J, Morin AS, Chamouard JM, Augier A, Bouchaud O, Carpentier A, Dhote R, Dumas JL, Fantin B, Fain O. Tuberculous cerebral vasculitis: retrospective study of 10 cases. Eur J Intern Med 2011; 22:e99-104. [PMID: 22075322 DOI: 10.1016/j.ejim.2011.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/12/2011] [Accepted: 04/14/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tuberculous cerebral vasculitis is a complication of tuberculous meningitis. This study was undertaken to determine the epidemiological characteristics, context, diagnostic means and outcomes under treatment of tuberculous cerebral vasculitides. METHODS All consecutive patients diagnosed with tuberculous cerebral vasculitis were identified from the databases of three Internal Medicine, one Neurology and one Infectious Disease Departments in three suburban Parisian hospitals. RESULTS We describe 10 cases: five men and five women (median age 33.5 [range: 27-55] years). Two were infected with the human immunodeficiency virus. Nine patients had tuberculous meningitis, eight with extraneurological involvement. The following manifestations led to the diagnosis: motor deficit, acute confusional state, headaches, involvement, coma and/or seizures. The cerebral vasculitis revealed tuberculosis in three patients, but tuberculosis was already known when vasculitis was diagnosed for the seven others. The cerebral computed-tomography scan showed cerebral infarctions in five patients, hydrocephalus and tuberculomas in four, while magnetic resonance imaging detected infarctions and leptomeningitis in nine patients, pachymeningitis in one, hydrocephalus and tuberculomas in seven. Therapy combined antituberculous agents with oral corticosteroids for all patients, preceded by a methylprednisolone pulse for five patients. Outcome was favorable for nine patients. CONCLUSION We described the non-negligible frequency of tuberculous cerebral vasculitides, their clinical manifestations and their potential severity, and the diagnostic and monitoring contributions of magnetic resonance imaging and magnetic resonance angiography.
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MESH Headings
- Adult
- Databases, Factual/statistics & numerical data
- Female
- Humans
- Magnetic Resonance Angiography
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Retrospective Studies
- Tuberculosis, Lymph Node/cerebrospinal fluid
- Tuberculosis, Lymph Node/epidemiology
- Tuberculosis, Meningeal/cerebrospinal fluid
- Tuberculosis, Meningeal/epidemiology
- Tuberculosis, Meningeal/pathology
- Tuberculosis, Pulmonary/cerebrospinal fluid
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Splenic/cerebrospinal fluid
- Tuberculosis, Splenic/epidemiology
- Vasculitis, Central Nervous System/epidemiology
- Vasculitis, Central Nervous System/microbiology
- Vasculitis, Central Nervous System/pathology
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Affiliation(s)
- Nicolas Javaud
- Service des Urgences, Hôpital Jean-Verdier, Assistance Publique-Hôpitaux de Paris, Université Paris 13, Bondy Cedex, France.
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14
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Desdouits M, Cassar O, Maisonobe T, Desrames A, Aouba A, Hermine O, Mikol J, Polivka M, Penisson-Besnier I, Marcorelles P, Zagnoli F, Papo T, Lacour A, Amoura Z, Haroche J, Chérin P, Texeira A, Morin AS, Mortreux F, Wattel E, Huerre M, Cumont MC, Khun H, Bassot S, Martin-Latil S, Taylor G, Gessain A, Ozden S, Ceccaldi PE. Immunohistochemical and virological features of HTLV-1-associated myosites: a study of 13 patients from West Indies and Africa. Retrovirology 2011. [PMCID: PMC3112754 DOI: 10.1186/1742-4690-8-s1-a41] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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15
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Amathieu R, Pham I, Morin AS, Kamoun W, Dhonneur G. [Multiple pulmonary abcesses and right side endocarditis]. Rev Prat 2009; 59:603. [PMID: 19552193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Roland Amathieu
- Service de réanimation, CHU Jean-Verdier, AP-HP, 93143 Bondy Cedex.
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16
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Fain O, Handra-Luca A, Morin AS, Stirnemann J. [Giant cell arteritis]. Rev Prat 2009; 59:15. [PMID: 19253873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Olivier Fain
- Service de médecine interne, laboratoire d'anatomie pathologie, hôpital Jean-Verdier (AP-HP), université Paris-13, 93140 Bondy, France.
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17
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Fain O, Morin AS, Braun T, Agranat P, Stirnemann J. [Chylous ascites]. Rev Prat 2008; 58:1641. [PMID: 19044045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Olivier Fain
- Service de médecine interne, CHU Jean-Verdier, AP-HP, université Paris-Nord-13, 93140 Bandy.
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18
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Fain O, Morin AS, Bibi-Triki T, Stirnemann J. [Thrombotic microangiopathies]. Rev Prat 2008; 58:1294. [PMID: 18714647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Olivier Fain
- Service de médecine interne, CHU Jean-Verdier (AP-HP), université Paris-Nord-13, 93140 Bondy.
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19
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Morin AS, Aras N, Stirnemann J, Fain O. [Floating thrombus of the aortic arch]. Rev Prat 2008; 58:706. [PMID: 18546638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Anne-Sophie Morin
- Service de médecine interne, AP-HP, hôpital Jean-Verdier, université Paris-13, Bondy.
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20
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Fain O, Hamidou M, Cacoub P, Godeau B, Wechsler B, Pariès J, Stirnemann J, Morin AS, Gatfosse M, Hanslik T, Belmatoug N, Blétry O, Cevallos R, Delevaux I, Fisher E, Hayem G, Kaplan G, Le Hello C, Mouthon L, Larroche C, Lemaire V, Piette AM, Piette JC, Ponge T, Puechal X, Rossert J, Sarrot-Reynauld F, Sicard D, Ziza JM, Kahn MF, Guillevin L. Vasculitides associated with malignancies: analysis of sixty patients. ACTA ACUST UNITED AC 2008; 57:1473-80. [PMID: 18050165 DOI: 10.1002/art.23085] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe characteristics and outcomes of vasculitides associated with malignancies. METHODS The requirement for inclusion in this retrospective, 10-year study was development of vasculitis in patients with a progressing malignancy. Malignancies secondary to immunosuppressants used to treat vasculitis were excluded. The main characteristics of vasculitides were analyzed and compared according to the type of malignancy. RESULTS Sixty patients were included (male/female sex ratio 2.53, mean age 62.4 years). Mean followup duration was 45.2 months. Vasculitides were cutaneous leukocytoclastic (45%), polyarteritis nodosa (36.7%), Wegener's granulomatosis (6.7%), microscopic polyangiitis (5%), and Henoch-Schönlein purpura (5%). Malignancies were distributed as follows: hematologic in 63.1%, myelodysplastic syndrome (MDS) in 32.3%, lymphoid in 29.2%, and solid tumor in 36.9%. Vasculitides were diagnosed concurrently with malignancy in 38% of the cases. Manifestations of vasculitides were fever (41.7%), cutaneous involvement (78.3%), arthralgias (46.7%), peripheral neuropathy (31.7%), renal involvement (23.3%; 11.7% glomerulonephritis, 11.7% microaneurysms, 6.7% renal insufficiency), and antineutrophil cytoplasmic antibody (20.4%). Vasculitis treatments were corticosteroids (78.3%) and immunosuppressant(s) (41.7%). Vasculitis was cured in 65% of patients, but 58.3% died, with 1 death secondary to vasculitis. Independent of subtype, patients with vasculitides associated with MDS more frequently had renal manifestations (P = 0.02) and steroid dependence (P = 0.04) and achieved complete remission less often (P = 0.04) than patients with vasculitides associated with other malignancies. Patients with vasculitides associated with a solid tumor more frequently had peripheral neurologic involvement (P = 0.05). Patients with vasculitides associated with lymphoid malignancy had less frequent arthralgias (P = 0.01) and renal involvement (P = 0.02). CONCLUSION Vasculitides occurring during malignancies present distinctive features according to the vasculitis subtype and nature of the malignancy.
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Affiliation(s)
- Olivier Fain
- Assistance Publique Hôpitaux de Paris, Hôpital Jean-Verdier, Université Paris, Bondy, France.
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21
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Fain O, Triki TB, Morin AS, Stirnemann J. [Hereditary spherocytosis]. Rev Prat 2007; 57:2217. [PMID: 18320739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Olivier Fain
- Service de médecine interne, AP-HP, hôpital Jean-Verdier, université Paris-13, 93140 Bondy.
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22
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Fain O, Aras N, Morin AS, Stirnemann J. [Sjögren's syndrome, lymphoma, cryoglobulinemia]. Rev Prat 2007; 57:1287. [PMID: 17717938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Olivier Fain
- Service de médecine interne, AP-HP, hôpital Jean-Verdier. Université Paris-13, 93140 Bondy.
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Fain O, Morin AS, Stirnemann J. [PET, extended fever and tuberculous lymphadenitis]. Rev Prat 2007; 57:1179. [PMID: 17691259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Olivier Fain
- Service de médecine interne, AP-HP, hôpital Jean-Verdier, Université Paris-13, 93140 Bondy.
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Fain O, Morin AS, Agranat P, Stirnemann J. [Pancoast-Tobias syndrome]. Rev Prat 2007; 57:1057. [PMID: 17844797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Olivier Fain
- Service de médecine interne, AP-HP, hôpital Jean-Verdier, université Paris-13, 93140 Bondy.
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25
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Fain O, Morin AS, Stirnemann J. [POEMS syndrome]. Rev Prat 2007; 57:943. [PMID: 17695672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Olivier Fain
- Service de médecine interne, AP-HP, hôpital Jean-Verdier, Université Paris-13, 93140 Bondy.
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Rautou PE, Corcos O, Hammel P, Cazals-Hatem D, Slama JL, Morin AS, Réza K, Lévy P, Ruszniewski P. [Pseudo Zollinger-Ellison syndrome in a patient with duodenal stenosis caused by tuberculosis]. ACTA ACUST UNITED AC 2006; 29:1164-8. [PMID: 16505764 DOI: 10.1016/s0399-8320(05)82183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report the case of a 32-year-old Indian man with symptoms suggesting Zollinger-Ellison syndrome including abdominal pain, esaphagitis, duodenal stenosis that did not improve with antisecretory medication, elevated fasting gastrin serum levels that increased after intravenous secretin injections, elevated chromogranin A serum levels and tumoral aspect of pancreatic uncus on CT scan examination. A pancreaticoduodenectomy was performed. Histological examination of the resected specimen showed that there was no endocrine tumour of the pancreas or the duodenum, but identified marked lesions of follicular and caseous tuberculosis. The final diagnosis retained pseudo Zollinger-Ellison syndrome due to gastric outlet obstruction caused by duodenal stenosis of a tuberculosis origin.
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Affiliation(s)
- Pierre-Emmanuel Rautou
- Fédération Médico-Chirurgicale d'Hepato-Gastroentérologie, Centre Hospitalier Intercommunal Robert Ballanger, Aulnay-sous-Bois
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Morin AS, Poirel L, Mory F, Labia R, Nordmann P. Biochemical-genetic analysis and distribution of DES-1, an Ambler class A extended-spectrum beta-lactamase from Desulfovibrio desulfuricans. Antimicrob Agents Chemother 2002; 46:3215-22. [PMID: 12234847 PMCID: PMC128801 DOI: 10.1128/aac.46.10.3215-3222.2002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Desulfovibrio spp. are gram-negative anaerobes phylogenetically related to Bacteroides spp., which are rarely isolated and which are mostly isolated from intra-abdominal abscesses. Desulfovibrio desulfuricans clinical isolate D3 had a clavulanic acid-inhibited beta-lactam resistance profile and was resistant to some expanded-spectrum cephalosporins. A beta-lactamase gene, bla(DES-1), was cloned from whole-cell DNA of isolate D3 and expressed in Escherichia coli. Purified beta-lactamase DES-1, with a pI value of 9.1, had a relative molecular mass of ca. 31 kDa and a mature protein of 288 amino acids. DES-1 was distantly related to Ambler class A beta-lactamases and most closely related to PenA from Burkholderia pseudomallei (48% amino acid identity). It was weakly related to class A beta-lactamases CblA, CepA, CfxA, and CfxA2 from other anaerobic species, Bacteroides spp. and Prevotella intermedia. Its hydrolysis spectrum included amino- and ureidopenicillins, narrow-spectrum cephalosporins, ceftriaxone, and cefoperazone. bla(DES-1)-like genes were not identified in phylogenetically related Desulfovibrio fairfieldensis isolates. However, they were found in some but not all D. desulfuricans strains, thus suggesting that these genes may be present in a given D. desulfuricans subspecies.
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Affiliation(s)
- Anne-Sophie Morin
- Service de Bactériologie-Virologie, Hôpital de Bicêtre, Assistance Publique/Hôpitaux de Paris, Faculté de Médecine Paris-Sud, 94275 Le Kremlin-Bicêtre, France
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Bossi P, Morin AS, Datry A, Katlama C, Bricaire F. [Pulmonary cryptococcoma in a patient infected by HIV virus]. Presse Med 2000; 29:1819. [PMID: 11109437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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