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Ingen-Housz-Oro S, Milpied B, Bensaid B, Elshot Y, Brüggen MC, Starace M, Kaffenberger BH, Carrera C, Pham-Ledard A, Freites-Martinez A, Sanchez-Pena P, Lebrun-Vignes B, French LE, Sibaud V. Drug reactions with eosinophilia and systemic symptoms induced by immune checkpoint inhibitors: an international cohort of 13 cases. Melanoma Res 2023; 33:155-158. [PMID: 36749114 DOI: 10.1097/cmr.0000000000000877] [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: 02/08/2023]
Abstract
Among dermatologic adverse events induced by immune checkpoint inhibitors (ICI), drug reactions with eosinophilia and systemic symptoms (DRESS) have been very rarely reported. The objective of this study is to better define the clinical and histologic features, treatment and prognosis of ICI-related DRESS. This retrospective case series was conducted between 01 January 2015 and 31 December 2021 by the dermatology departments of five international networks involved in drug reactions. Inclusion criteria were age ≥18 years old, DRESS with Regiscar score ≥4 (probable or certain) and ICI as a suspect drug. Clinical, biologic and follow-up data were extracted from the medical charts. Thirteen patients were included. The median time to onset was 22 days (3-11). No patients had a high-risk drug introduced in the past 3 months. A majority of patients presented fever (92%), diffuse exanthema (77%) and facial edema (69%). Biologic features included hypereosinophilia in eight patients (61.5%), hyperlymphocytosis in 3 (23%), elevated liver function tests in 11 (85%, grade 1 or 2 in most cases) and renal involvement in 5 (38%). Two patients (15%) had lung involvement. PCR evidence of viral replication was detected in five patients (38.5%). Treatment involved discontinuation of the suspect ICI and systemic steroids with variable dose and duration regimens. Among the four patients in which ipilimumab + nivolumab combination therapy was initially suspected, one was rechallenged with nivolumab monotherapy with good tolerance. Five patients were switched to another anti-PD-1 plus low-dose systemic steroids, with good tolerance in four cases. No patient died because of DRESS. DRESS induced by ICI are rare and of moderate severity. A consensus for management is still pending.
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Affiliation(s)
- Saskia Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- University Paris est Créteil EpidermE, Créteil, France
- EADV European Task Force 'Dermatology for cancer patients'
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
| | - Brigitte Milpied
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- EADV European Task Force 'Dermatology for cancer patients'
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
- Dermatology Department, CHU Bordeaux, Bordeaux
| | - Benoit Bensaid
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
- Dermatology Department, CHU Edouard Herriot, Lyon, France
| | - Yannick Elshot
- EADV European Task Force 'Dermatology for cancer patients'
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie Charlotte Brüggen
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
- Department of Dermatology, University Hospital Zurich
- Faculty of Medicine, University Zurich, Zurich
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Michela Starace
- EADV European Task Force 'Dermatology for cancer patients'
- Dermatology -IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna, Italy
| | - Benjamin H Kaffenberger
- EADV European Task Force 'Dermatology for cancer patients'
- Dermatology Department, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cristina Carrera
- EADV European Task Force 'Dermatology for cancer patients'
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona
- CIBERER Centro de investigaciones Biomedicas en Red de Enfermedades Raras Insituto de Salud Carlos III
- Pharmacovigilance Technical Committee Hospital Clinic Barcelona
| | | | - Azael Freites-Martinez
- EADV European Task Force 'Dermatology for cancer patients'
- Oncodermatology Clinic, Hospital Ruber Juan Bravo and Universidad Europea, Madrid, Spain
| | - Paola Sanchez-Pena
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- Pharmacovigilance Department, CHU Bordeaux, Bordeaux
| | - Bénédicte Lebrun-Vignes
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- Pharmacovigilance Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Lars E French
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilan University (LMU) Munich, Munich, Germany
- Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vincent Sibaud
- EADV European Task Force 'Dermatology for cancer patients'
- Department of Oncodermatology, Claudius Regaud Institute and University Cancer Institute Toulouse Oncopole, Toulouse, France
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Kridin K, Brüggen MC, Walsh S, Bensaid B, Ranki A, Oppel E, Meyersburg D, Chua SL, Seeli C, Sandberg H, French LE, Vorobyev A, Ingen-Housz-Oro S. Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases. J Eur Acad Dermatol Venereol 2023; 37:753-762. [PMID: 36479739 DOI: 10.1111/jdv.18808] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. OBJECTIVE To explore treatment approaches across Europe and their impact on the disease course, as well as prognostic factors and culprit drugs. METHODS In this retrospective European multicentric study, we included patients with probable or certain DRESS (RegiSCAR score ≥ 4) between January 2016 and December 2020. Independent associations between clinical parameters and the risk of intensive care unit admission and mortality at three months were assessed using a multivariable-adjusted logistic regression model. RESULTS A total of 141 patients from 8 tertiary centres were included. Morbilliform exanthem was the most frequent cutaneous manifestation (78.0%). The mean affected body surface area (BSA) was 67%, 42% of the patients presented with erythroderma, and 24.8% had mucosal involvement. Based on systemic involvement, 31.9% of the patients had a severe DRESS. Anticonvulsants (24.1%) and sulphonamides (22.0%) were the most frequent causative agents. In all, 73% of the patients were treated with systemic glucocorticoids, and 25.5% received topical corticosteroids as monotherapy. Few patients received antiviral drugs or anti-IL5. No patients received intravenous immunoglobulins. The overall mortality was 7.1%. Independent predictors of mortality were older age (≥57.0 years; fully adjusted OR, 9.80; 95% CI, 1.20-79.93; p = 0.033), kidney involvement (fully adjusted OR, 4.70; 95% CI, 1.00-24.12; p = 0.049), and admission in intensive care unit (fully adjusted OR, 8.12; 95% CI, 1.90-34.67; p = 0.005). Relapse of DRESS and delayed autoimmune sequelae occurred in 8.5% and 12.1% of patients, respectively. CONCLUSIONS This study underlines the need for diagnostic and prognostic scores/markers as well as for prospective clinical trials of drugs with the potential to reduce mortality and complications of DRESS.
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Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Marie-Charlotte Brüggen
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Medical Campus Davos, Davos, Switzerland.,ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin)
| | - Sarah Walsh
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Department of Dermatology, King's College Hospital, London, UK
| | - Benoit Bensaid
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Department of Dermatology, Edouard Herriot Hospital, Lyon, France
| | - Annamari Ranki
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Inflammation Center, Helsinki, Finland
| | - Eva Oppel
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Damian Meyersburg
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ser-Ling Chua
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Corsin Seeli
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Heidi Sandberg
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Inflammation Center, Helsinki, Finland
| | - Lars E French
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany.,Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Artem Vorobyev
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Saskia Ingen-Housz-Oro
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,Univ Paris Est Créteil EpiDermE, Créteil, France
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Ingen-Housz-Oro S, Milpied B, Badrignans M, Carrera C, Elshot YS, Bensaid B, Segura S, Apalla Z, Markova A, Staumont-Sallé D, Marti-Marti I, Giavedoni P, Chua SL, Darrigade AS, Dezoteux F, Starace M, Torre AC, Riganti J, de Prost N, Lebrun-Vignes B, Bauvin O, Walsh S, Ortonne N, French LE, Sibaud V. Severe blistering eruptions induced by immune checkpoint inhibitors: a multicentre international study of 32 cases. Melanoma Res 2022; 32:205-210. [PMID: 35377864 PMCID: PMC9377568 DOI: 10.1097/cmr.0000000000000819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Among dermatologic adverse events induced by immune checkpoint inhibitors (ICI), bullous life-threatening reactions are rare. To better define the clinical and histological features, treatment, and prognosis of ICI-related severe blistering cutaneous eruptions. This retrospective case series was conducted between 2014/05/15 and 2021/04/15 by the dermatology departments of four international registries involved in drug reactions. Inclusion criteria were age ≥18 years old, skin eruption with blisters with detachment covering ≥1% body surface area and at least one mucous membrane involved, available pictures, and ICI as suspect drug. Autoimmune bullous disorders were excluded. Each participant medical team gave his own diagnosis conclusion: epidermal necrolysis (EN), severe lichenoid dermatosis (LD), or unclassified dermatosis (UD). After a standardized review of pictures, cases were reclassified by four experts in EN or LD/UD. Skin biopsies were blindly reviewed. Thirty-two patients were included. Median time to onset was 52 days (3-420 days). Cases were originally diagnosed as EN in 21 cases and LD/UD in 11 cases. After review by experts, 10/21 EN were reclassified as LD/UD. The following manifestations were more frequent or severe in EN: fever, purpuric macules, blisters, ocular involvement, and maximal detachment. Most patients were treated with topical with or without systemic corticosteroids. Eight patients (25%) died in the acute phase. The culprit ICI was not resumed in 92% of cases. In three patients, another ICI was given with a good tolerance. Histology did not reveal significant differences between groups. Severe blistering cutaneous drug reactions induced by ICI are often overdiagnosed as EN. Consensus for management is pending.
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Affiliation(s)
- Saskia Ingen-Housz-Oro
- Dermatology department, AP-HP, Henri Mondor hospital, Créteil, France
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- FISARD group, Paris, France
- Univ Paris est Créteil EpidermE, Créteil, France
- European Task Force “Dermatology for cancer patients” of EADV
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
| | - Brigitte Milpied
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- FISARD group, Paris, France
- European Task Force “Dermatology for cancer patients” of EADV
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
- Dermatology department, CHU Bordeaux, Bordeaux, France
| | - Marine Badrignans
- Pathology department, AP-HP, Henri Mondor hospital, Créteil, France
- Université Paris Est Créteil Val de Marne UPEC, Créteil, France
| | - Cristina Carrera
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
- CIBERER Centro de investigaciones Biomedicas en Red de Enfermedades Raras Insituto de Salud Carlos III, Spain
- Pharmacovigilance Technical Committee Hospital Clinic Barcelona, Spain
| | - Yannick S. Elshot
- European Task Force “Dermatology for cancer patients” of EADV
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC, Univ. of Amsterdam, The Netherlands
| | - Benoit Bensaid
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- FISARD group, Paris, France
- Dermatology department, CHU Edouard Herriot, Lyon, France
| | - Sonia Segura
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Department, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Zoé Apalla
- European Task Force “Dermatology for cancer patients” of EADV
- Second Dermatology Department, Medical School, Aristotle University of Thessaloniki, Greece
| | - Alina Markova
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Dermatology, Weill Cornell Medical College, New York, NY, USA
| | - Delphine Staumont-Sallé
- FISARD group, Paris, France
- Dermatology Department, CHU Lille, University Lille, INFINITE U1286 Inserm, Lille, France
| | - Ignasi Marti-Marti
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Priscila Giavedoni
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Ser-Ling Chua
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
- Department of Dermatology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Anne-Sophie Darrigade
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- FISARD group, Paris, France
- Dermatology department, CHU Bordeaux, Bordeaux, France
| | - Frédéric Dezoteux
- FISARD group, Paris, France
- Dermatology Department, CHU Lille, University Lille, INFINITE U1286 Inserm, Lille, France
| | - Michela Starace
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology -IRCCS Policlinico di Sant’Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna, Italy
| | - Ana Clara Torre
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Julia Riganti
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nicolas de Prost
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- Intensive care unit, AP-HP, Henri Mondor hospital, Créteil, France
| | - Bénédicte Lebrun-Vignes
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- FISARD group, Paris, France
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
- Regional Pharmacovigilance Center, AP-HP, Pitié-Salpêtrière hospital, Paris, France
| | - Olivia Bauvin
- FISARD group, Paris, France
- Dermatology department, CHU Charles Nicolle, Rouen, France
| | - Sarah Walsh
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
- Department of Dermatology, King’s College Hospital, London, United Kingdom
| | - Nicolas Ortonne
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- Pathology department, AP-HP, Henri Mondor hospital, Créteil, France
- Université Paris Est Créteil Val de Marne UPEC, Créteil, France
| | - Lars E. French
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilan University (LMU) Munich, Munich, Germany
- Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Vincent Sibaud
- European Task Force “Dermatology for cancer patients” of EADV
- Department of Oncodermatology, Claudius Regaud Institute and University Cancer Institute Toulouse Oncopole, Toulouse, France
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Sutter W, Hentgen B, Mercier L, Delattre M, Ouldsalek E, Bensaid B, Renard R, Fallouh A, Feito B, Cheysson E, Davaine JM. Surgical treatment of femoral artery bifurcation without material. Technique and follow up. Ann Vasc Surg 2022; 86:190-198. [PMID: 35513126 DOI: 10.1016/j.avsg.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Complete eversion of the femoral tripod is interesting to reduce clinical consequences of wound infection, in particular for patients at high risk (eg: obese, diabetics, cancer). Experience and follow up of this technique are scarce. The different technical possibilities and results are reported here. METHODS Single center prospective study including patients operated on for femoral occlusive lesions using eversion of the common femoral artery and its bifurcation. Clinical and imaging preoperative data, surgical technique and follow up are detailed. RESULTS Thirty-five patients (37 limbs) have been included between June 2014 and April 2016. Mean Rutherford index was 3.6 and 65% of the patients were claudicants. Lesions were limited to the common femoral artery in 14 (38%) of the cases and spread to the superficial femoral artery in 2 (7%) and to the three branches in 21 (57%) of the cases, respectively. Postoperatively, one death, one major amputation and 3 reinterventions were noted, resulting in a 8% rate of major complications. The mean follow up was 37 months. At this time, 11 MACE, 9 deaths and no additional major amputation were noted. The mean Rutherford index was 1.7 (P<.001) and 3 reinterventions were necessary (1 for septic occlusion at 3 months and 2 for restenosis at 12 and 42 months), translating into a primary and secondary patency rates of 93.3% and 96.1%. CONCLUSION This work further confirms that eversion of the femoral tripod is safe and effective. This experience adds to the existing body of the literature and describe alternative techniques of eversion. The technique should be considered when treating patients at high risk of postoperative infection.
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Affiliation(s)
- W Sutter
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - B Hentgen
- Sorbonne Université, 15-21 Rue de l'École de Médecine, 75006 Paris
| | - L Mercier
- Sorbonne Université, 15-21 Rue de l'École de Médecine, 75006 Paris
| | - M Delattre
- Clinical Research Unit, Centre Hospitalier René Dubos, Pontoise, France
| | - E Ouldsalek
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - B Bensaid
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - R Renard
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - A Fallouh
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - B Feito
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - E Cheysson
- Centre Hospitalier René Dubos, 6 Av de L'Ile-de-France, 95300 Pontoise, France
| | - J M Davaine
- Sorbonne Université, 15-21 Rue de l'École de Médecine, 75006 Paris.
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5
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Guerrois F, Thibault C, Lheure C, Sohier P, Bensaid B, Ingen-Housz-Oro S, Dupin N. Life-threatening skin reaction with Enfortumab Vedotin: Six cases. Eur J Cancer 2022; 167:168-171. [DOI: 10.1016/j.ejca.2022.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
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6
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Giraud-Kerleroux L, Bellon N, Welfringer-Morin A, Leclerc-Mercier S, Costedoat I, Coquin J, Brun A, Roguedas-Contios AM, Bernier C, Milpied B, Tétart F, Du Thanh A, Cordel N, Bensaid B, Fargeas C, Tauber M, Renolleau S, Boralevi F, Ingen-Housz-Oro S, Bodemer C. Childhood epidermal necrolysis and erythema multiforme major: a multicentre French cohort study of 62 patients. J Eur Acad Dermatol Venereol 2021; 35:2051-2058. [PMID: 34157175 DOI: 10.1111/jdv.17469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The distinction between epidermal necrolysis [EN; including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and overlap syndrome] and erythema multiforme major (EMM) in children is confusing. We aimed to better describe and compare these entities. MATERIALS AND METHODS This French retrospective multicentre study included children ≤18 years old referred for EN or EMM between 1 January 2008 and 1 March 2019. According to pictures, children were reclassified into TEN/overlap, SJS or EMM/unclassified (SJS/EMM) groups and compared for epidemiological and clinical data, triggers, histology and follow-up. RESULTS We included 62 children [43 boys, median age 10 years (range 3-18)]: 16 with TEN/overlap, 11 SJS and 35 EMM. The main aetiologies were drugs in EN and infections (especially Mycoplasma pneumoniae) in EMM (P < 0.001), but 35% of cases remained idiopathic (TEN/overlap, 47%; SJS, 24%; EMM, 34%). The typical target lesions predominated in EMM (P < 0.001), the trunk was more often affected in EN (P < 0.001), and the body surface area involved was more extensive in EN (P < 0.001). Mucosal involvement did not differ between the groups. Two patients with idiopathic TEN died. Histology of EMM and EN showed similar features. The recurrence rate was 42% with EMM, 7% with TEN/overlap and 0 with SJS (P < 0.001). Sequelae occurred in 75% of EN but involved 55% of EMM. CONCLUSION Clinical features of EN and EMM appeared well demarcated, with few overlapping cases. Idiopathic forms were frequent, especially for EN, meaning that a wide and thorough infectious screening, repeated if needed, is indicated for all paediatric cases of EN/EMM without any trigger drug. We propose a comprehensive panel of investigations which could be a standard work-up in such situation. Sequelae affected both EN and EMM.
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Affiliation(s)
- L Giraud-Kerleroux
- Dermatology Department, AP-HP, CHU Necker-Enfants Malades, Paris Centre University, Paris, France.,Dermatology Department, AP-HP, CHU Henri Mondor, Créteil, France
| | - N Bellon
- Dermatology Department, AP-HP, CHU Necker-Enfants Malades, Paris Centre University, Paris, France.,Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| | - A Welfringer-Morin
- Dermatology Department, AP-HP, CHU Necker-Enfants Malades, Paris Centre University, Paris, France.,Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| | - S Leclerc-Mercier
- Dermatology Department, AP-HP, CHU Necker-Enfants Malades, Paris Centre University, Paris, France.,Pathology Department, AP-HP, CHU Necker-Enfants Malades, Paris, France
| | - I Costedoat
- Dermatology Department, CHU Pellegrin-Enfants, Bordeaux, France
| | - J Coquin
- Dermatology Department, CHU Charles Nicolle, Rouen, France
| | - A Brun
- Dermatology Department, CHU Charles Nicolle, Rouen, France
| | - A-M Roguedas-Contios
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHRU Morvan, Brest, France
| | - C Bernier
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHU Hôtel-Dieu, Nantes, France
| | - B Milpied
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHU Pellegrin-Enfants, Bordeaux, France
| | - F Tétart
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHU Charles Nicolle, Rouen, France
| | - A Du Thanh
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHU Saint-Eloi, Montpellier, France
| | - N Cordel
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Department of Dermatology and Clinical Immunology, Guadeloupe University Hospital, Pointe-à-Pitre, Guadeloupe.,Normandie University, UNIROUEN, IRIB, Inserm, U1234, Rouen, France
| | - B Bensaid
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHU Edouard Herriot, Lyon, France
| | - C Fargeas
- Dermatology Department, AP-HP, CHU Necker-Enfants Malades, Paris Centre University, Paris, France
| | - M Tauber
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHU Larrey, Toulouse, France
| | - S Renolleau
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Intensive Care Unit, CHU Necker-Enfants Malades, Paris, France
| | - F Boralevi
- Dermatology Department, CHU Pellegrin-Enfants, Bordeaux, France
| | - S Ingen-Housz-Oro
- Dermatology Department, AP-HP, CHU Henri Mondor, Créteil, France.,Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Univ Paris Est Creteil EpidermE, Créteil, France
| | - C Bodemer
- Dermatology Department, AP-HP, CHU Necker-Enfants Malades, Paris Centre University, Paris, France.,Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
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7
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Bensaid B, Jullien D. Évaluation des sequelles dans les DRESS : une série de 79 patients. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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8
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Bensaid B, Bourdenet V, Jullien D. DRESS induit par la ceftaroline avec atteinte pulmonaire. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Lesort C, Kanitakis J, Villani A, Ducroux E, Bouschon P, Fattouh K, Bensaid B, Danset M, Jullien D. COVID-19 and outbreak of chilblains: are they related? J Eur Acad Dermatol Venereol 2020; 34:e757-e758. [PMID: 32594575 PMCID: PMC7361424 DOI: 10.1111/jdv.16779] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- C Lesort
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | - J Kanitakis
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | - A Villani
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | - E Ducroux
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | - P Bouschon
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | - K Fattouh
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | - B Bensaid
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | - M Danset
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | - D Jullien
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
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10
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Ingen-Housz-Oro S, Assier H, Gener G, Milpied B, Soria A, Bernier C, Descamps V, Tetart F, Staumont-Sallé D, Valeyrie-Allanore L, Valois A, Sassolas B, Bensaid B, Lebrun-Vignes B, Barbaud A. [Delayed hypersensitivity to anti-tuberculosis drugs. Proposed practical management plan for exanthema: when to stop, which allergological investigations to perform, and how to restart treatment]. Ann Dermatol Venereol 2019; 146:313-318. [PMID: 30904277 DOI: 10.1016/j.annder.2019.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/06/2018] [Accepted: 01/15/2019] [Indexed: 12/20/2022]
Affiliation(s)
- S Ingen-Housz-Oro
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France.
| | - H Assier
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - G Gener
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - B Milpied
- Service de dermatologie, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - A Soria
- Service de dermatologie et allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - C Bernier
- Service de dermatologie, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - V Descamps
- Service de dermatologie, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - F Tetart
- Service de dermatologie, CHU Charles-Nicolle, 1, rue De Germont, 76100 Rouen, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - D Staumont-Sallé
- Service de dermatologie, CHRU Claude-Huriez, rue Michel-Polonovski, 59000 Lille, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - L Valeyrie-Allanore
- Cabinet de dermatologie, 18, avenue Quihou, 94160 Saint-Mandé, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - A Valois
- Service de dermatologie, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - B Sassolas
- Service de médecine interne, hôpital Cavale-Blanche, CHRU de Brest, boulevard Tanguy Prigent, 29600 Brest, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - B Bensaid
- Service de dermatologie, hôpital Edouard-Herriot, 5, place D'Arsonval, 69003 Lyon, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - B Lebrun-Vignes
- Département de pharmacovigilance, hôpital La Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - A Barbaud
- Service de dermatologie et allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | -
- Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
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11
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Garel B, Ingen-Housz-Oro S, Afriat D, Prost-Squarcioni C, Tétart F, Bensaid B, Bara Passot C, Beylot-Barry M, Descamps V, Duvert-Lehembre S, Grootenboer-Mignot S, Jeudy G, Soria A, Valnet-Rabier MB, Barbaud A, Caux F, Lebrun-Vignes B. Drug-induced linear immunoglobulin A bullous dermatosis: A French retrospective pharmacovigilance study of 69 cases. Br J Clin Pharmacol 2019; 85:570-579. [PMID: 30511379 DOI: 10.1111/bcp.13827] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/08/2018] [Accepted: 11/23/2018] [Indexed: 11/27/2022] Open
Abstract
AIMS Linear immunoglobin A (IgA) bullous dermatosis is a rare autoimmune dermatosis considered spontaneous or drug-induced (DILAD). We assessed all DILAD cases, determined the imputability score of drugs and highlighted suspected drugs. METHODS Data for patients with DILAD were collected retrospectively from the French Pharmacovigilance network (from 1985 to 2017) and from physicians involved in the Bullous Diseases French Study Group and the French Investigators for Skin Adverse Reactions to Drugs. Drug causality was systematically determined by the French imputability method. RESULTS Of the 69 patients, 42% had mucous membrane involvement, 20% lesions mimicking toxic epidermal necrolysis (TEN), 21% eosinophil infiltrates and 10% keratinocytes necrosis. Direct immunofluorescence, in 80%, showed isolated linear IgA deposits. Vancomycin (VCM) was suspected in 39 cases (57%), 11 had TEN-like lesions, as compared with three without VCM suspected. Among the 33 patients with a single suspected drug, 85% had an intrinsic imputability score of I4. Among them, enoxaparin, minocycline and vibramycin were previously unpublished. For all patients, the suspect drug was withdrawn; 15 did not receive any treatment. First-line therapy for 31 patients was topical steroids. Among the 60 patients with available follow-up, 52 achieved remission, 10 without treatment. Four patients experienced relapse, four died and five had positive accidental rechallenges. CONCLUSIONS There is no major clinical difference between DILAD and idiopathic linear IgA bullous dermatosis, but the former features a higher prevalence of patients mimicking TEN. VCM, suspected in more than half of the cases, might be responsible for more severe clinical presentations. We report three new putative drugs.
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Affiliation(s)
- Bethsabée Garel
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (APHP), Henri-Mondor Hospital, 94010, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (APHP), Henri-Mondor Hospital, 94010, Créteil, France.,EA 7379 EpiDermE, Université Paris Est Créteil Val de Marne UPEC, Créteil, France.,Reference Center for toxic bullous diseases and severe drug reactions, Créteil, France
| | - Daniele Afriat
- Regional Center of Pharmacovigilance, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Catherine Prost-Squarcioni
- Dermatology Department, APHP, Avicenne Hospital, Bobigny, France.,Pathology Department, APHP, Avicenne Hospital, Bobigny, France.,Université Paris 13, Bobigny, France
| | - Florence Tétart
- Department of Dermatology, Rouen University Hospital, Rouen, France
| | - Benoit Bensaid
- Drug Allergy Unit-CCR2A, Department of Allergy and Clinical Immunology, CHU Lyon-Sud, Pierre Benite, France
| | | | - Marie Beylot-Barry
- Department of Dermatology, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Descamps
- Department of Dermatology, APHP, Bichat Claude Bernard Hospital, Paris Diderot University
| | | | | | - Géraldine Jeudy
- Department of Dermatology, Dijon University Hospital, Dijon, France
| | - Angèle Soria
- Department of Dermatology and Allergology, APHP, Tenon Hospital, Paris, France.,Sorbonne Université, Faculté de Médecine Sorbonne Université, Paris, France.,Inserm, UMR 1135, Paris, France
| | | | - Annick Barbaud
- Reference Center for toxic bullous diseases and severe drug reactions, Créteil, France.,Department of Dermatology and Allergology, APHP, Tenon Hospital, Paris, France.,Sorbonne Université, Faculté de Médecine Sorbonne Université, Paris, France
| | - Frédéric Caux
- Dermatology Department, APHP, Avicenne Hospital, Bobigny, France.,Université Paris 13, Bobigny, France
| | - Bénédicte Lebrun-Vignes
- EA 7379 EpiDermE, Université Paris Est Créteil Val de Marne UPEC, Créteil, France.,Reference Center for toxic bullous diseases and severe drug reactions, Créteil, France.,Regional Center of Pharmacovigilance, APHP, Pitié-Salpêtrière Hospital, Paris, France
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12
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Ingen-Housz-Oro S, Duong TA, Bensaid B, Bellon N, de Prost N, Lu D, Lebrun-Vignes B, Gueudry J, Bequignon E, Zaghbib K, Royer G, Colin A, Do-Pham G, Bodemer C, Ortonne N, Barbaud A, Fardet L, Chosidow O, Wolkenstein P. Epidermal necrolysis French national diagnosis and care protocol (PNDS; protocole national de diagnostic et de soins). Orphanet J Rare Dis 2018; 13:56. [PMID: 29636107 PMCID: PMC5894129 DOI: 10.1186/s13023-018-0793-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/22/2018] [Indexed: 12/18/2022] Open
Abstract
Epidermal necrolysis (EN) encompasses Stevens-Johnson syndrome (SJS, < 10% of the skin affected), Lyell syndrome (toxic epidermal necrolysis, TEN, with ≥30% of the skin affected) and an overlap syndrome (10 to 29% of the skin affected). These rare diseases are caused, in 85% of cases, by pharmacological treatments, with symptoms occurring 4 to 28 days after treatment initiation. Mortality is 20 to 25% during the acute phase, and almost all patients display disabling sequelae (mostly ocular impairment and psychological distress). The objective of this French national diagnosis and care protocol (protocole national de diagnostic et de soins; PNDS), based on a critical literature review and on a multidisciplinary expert consensus, is to provide health professionals with an explanation of the optimal management and care of patients with EN. This PNDS, written by the French National Reference Center for Toxic Bullous Dermatoses was updated in 2017 (https://www.has-sante.fr/portail/jcms/c_1012735/fr/necrolyse-epidermique-syndromes-de-stevens-johnson-et-de-lyell). The cornerstone of the management of these patients during the acute phase is an immediate withdrawal of the responsible drug, patient management in a dermatology department, intensive care or burn units used to dealing with this disease, supportive care and close monitoring, the prevention and treatment of infections, and a multidisciplinary approach to sequelae. Based on published data, it is not currently possible to recommend any specific immunomodulatory treatment. Only the culprit drug and chemically similar molecules must be lifelong contraindicated.
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Affiliation(s)
- Saskia Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France. .,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France. .,EA7379 EpiDermE (Epidemiologie en Dermatologie et Evaluation des Thérapeutiques), Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.
| | - Tu-Anh Duong
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France.,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France
| | - Benoit Bensaid
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Dermatology Department, Edouard Herriot Hospital, Lyon, France
| | - Nathalia Bellon
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Dermatology Department, AP-HP, Necker Hospital, Paris, France
| | - Nicolas de Prost
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Intensive Care Unit, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Dévy Lu
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France.,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France
| | - Bénédicte Lebrun-Vignes
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Pharmacovigilance Department, AP-HP, La Pitié Salpêtrière Hospital, Paris, France
| | - Julie Gueudry
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Ophthalmology Department, Charles Nicolle Hospital, Rouen, France
| | - Emilie Bequignon
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Ear Nose and Throat Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Karim Zaghbib
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Psychiatry Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Gérard Royer
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Ophthalmology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Audrey Colin
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France.,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France
| | - Giao Do-Pham
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Dermatology Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Christine Bodemer
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Dermatology Department, AP-HP, Necker Hospital, Paris, France
| | - Nicolas Ortonne
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Pathology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Annick Barbaud
- French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,Dermatology Department, AP-HP, Tenon Hospital, Paris, France
| | - Laurence Fardet
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France.,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,EA7379 EpiDermE (Epidemiologie en Dermatologie et Evaluation des Thérapeutiques), Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Olivier Chosidow
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France.,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,EA7379 EpiDermE (Epidemiologie en Dermatologie et Evaluation des Thérapeutiques), Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Pierre Wolkenstein
- Dermatology Department, AP-HP, Henri Mondor Hospital, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France.,French National Reference Center for Toxic Bullous Dermatoses, Créteil, France.,EA7379 EpiDermE (Epidemiologie en Dermatologie et Evaluation des Thérapeutiques), Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
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13
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Zoulati M, Bakkali T, Aghoutane N, Bensaid B, Lyazidi Y, Ouharakat Y, Chtata H, Taberkant M. [Claude Bernard-Horner syndrome revealing spontaneous aneurysm of the vertebral artery]. J Med Vasc 2017; 42:244-247. [PMID: 28705344 DOI: 10.1016/j.jdmv.2017.04.005] [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] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/08/2017] [Indexed: 06/07/2023]
Abstract
False aneurysms of the extracranial vertebral artery (FAVA) are rare because of the path of the artery at the level of the transverse holes. They can be secondary to penetrating cervical trauma, spontaneous in the course of an angiopathy such as Ehlers-Danlos syndrome, or iatrogenic. We report the case of a 31-year-old woman who presented a syndrome of Claude Bernard-Horner related to a spontaneous FAVA. The angioscanner confirmed the diagnosis and the patient underwent successful surgical treatment of the false aneurysm with ligature of the vertebral artery. Outcome was favorable.
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Affiliation(s)
- M Zoulati
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc.
| | - T Bakkali
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - N Aghoutane
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - B Bensaid
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - Y Lyazidi
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - Y Ouharakat
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - H Chtata
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - M Taberkant
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
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14
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Skowron F, Bensaid B, Balme B, Depaepe L, Kanitakis J, Nosbaum A, Maucort-Boulch D, Bérard F, D'Incan M, Kardaun S, Nicolas JF. Comparative histological analysis of drug-induced maculopapular exanthema and DRESS. J Eur Acad Dermatol Venereol 2016; 30:2085-2090. [DOI: 10.1111/jdv.13832] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- F. Skowron
- Department of Dermatology; CH de Valence; Valence France
| | - B. Bensaid
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; CHU Lyon-Sud; Pierre-Bénite France
| | - B. Balme
- Department of Dermatopathology; CHU Lyon-Sud; Pierre-Bénite France
| | - L. Depaepe
- Department of Dermatopathology; CHU Lyon-Sud; Pierre-Bénite France
| | - J. Kanitakis
- Department of Dermatology; Groupement Hospitalier Edouard Herriot; Lyon France
| | - A. Nosbaum
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; CHU Lyon-Sud; Pierre-Bénite France
- INSERM U1111 - CIRI; av T Garnier; Lyon France
| | | | - F. Bérard
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; CHU Lyon-Sud; Pierre-Bénite France
- INSERM U1111 - CIRI; av T Garnier; Lyon France
| | - M. D'Incan
- Department of Dermatology; CHU Estaing; Clermont-Ferrand France
| | - S.H. Kardaun
- Department of Dermatology; Reference center for cutaneous adverse reactions; University Medical Center of Groningen; Groningen the Netherlands
| | - J.-F. Nicolas
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; CHU Lyon-Sud; Pierre-Bénite France
- INSERM U1111 - CIRI; av T Garnier; Lyon France
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Valeyrie-Allanore L, Lebrun-Vignes B, Bensaid B, Sassolas B, Barbaub A. Érythème pigmenté fixe : épidémiologie, physiopathologie, clinique, diagnostic différentiel et modalités de prise en charge. Ann Dermatol Venereol 2015; 142:701-6. [DOI: 10.1016/j.annder.2015.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 07/06/2015] [Accepted: 07/24/2015] [Indexed: 11/25/2022]
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Skowron F, Bensaid B, Balme B, Depaepe L, Kanitakis J, Nosbaum A, Maucort-Boulch D, Bérard F, D'Incan M, Kardaun S, Nicolas J. Drug reaction with eosinophilia and systemic symptoms (DRESS): clinicopathological study of 45 cases. J Eur Acad Dermatol Venereol 2015; 29:2199-205. [DOI: 10.1111/jdv.13212] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/22/2015] [Indexed: 01/25/2023]
Affiliation(s)
- F. Skowron
- Departement of Dermatology; Centre Hospitalier de Valence; Valence France
| | - B. Bensaid
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - B. Balme
- Departement of Dermatopathology; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - L. Depaepe
- Departement of Dermatopathology; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - J. Kanitakis
- Departement of Dermatology; Groupement Hospitalier Edouard Herriot; Lyon Cedex 03 France
| | - A. Nosbaum
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - D. Maucort-Boulch
- Department of Biostatistics; Hospices Civils de Lyon; Lyon France
- CNRS UMR 5558; Equipe Biostatistique Santé; Pierre-Bénite France
- Université Lyon I; Villeurbanne France
| | - F. Bérard
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; Centre Hospitalier Lyon Sud; Pierre Bénite France
- INSERM U1111 - CIRI; Lyon France
| | - M. D'Incan
- Departement of Dermatology; CHU Estaing; Clermont-Ferrand France
| | - S.H. Kardaun
- Department of Dermatology; Reference center for cutaneous adverse reactions; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - J.F. Nicolas
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; Centre Hospitalier Lyon Sud; Pierre Bénite France
- INSERM U1111 - CIRI; Lyon France
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Hacard F, Nosbaum A, Bensaid B, Nicolas JF, Augey F, Goujon C, Bérard F. [Histaminergic angioedema and chronic urticaria]. Presse Med 2014; 44:37-42. [PMID: 25535159 DOI: 10.1016/j.lpm.2014.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 11/26/2022] Open
Abstract
Most angioedemas are histaminergic and correspond to deep urticarial swelling. Recurrent histaminergic angioedema led to the diagnosis of chronic urticaria, even when there are no superficial associated hives. Chronic urticaria is a benign disease, and autoimmune in 40 % of cases. The occurrence of angioedema in chronic urticaria is not a sign of severity. The occurrence of angioedema in chronic urticaria is associated with a longer duration of urticarial disease. NSAIDs and/or systemic corticotherapy are classic triggers of angioedema in chronic urticaria. In the absence of clinical endpoints, there is no need to make further assessment in chronic urticaria good responders to antihistamines.
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Affiliation(s)
- Florence Hacard
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France; Université Claude-Bernard Lyon I, UFR médecine Lyon-Sud Charles-Mérieux, 69921 Oullins cedex, France
| | - Audrey Nosbaum
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France; Université Claude-Bernard Lyon I, UFR médecine Lyon-Sud Charles-Mérieux, 69921 Oullins cedex, France
| | - Benoit Bensaid
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France
| | - Jean-François Nicolas
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France; Université Claude-Bernard Lyon I, UFR médecine Lyon-Sud Charles-Mérieux, 69921 Oullins cedex, France
| | - Frédéric Augey
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France; Université Claude-Bernard Lyon I, UFR médecine Lyon-Sud Charles-Mérieux, 69921 Oullins cedex, France
| | - Catherine Goujon
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France; Université Claude-Bernard Lyon I, UFR médecine Lyon-Sud Charles-Mérieux, 69921 Oullins cedex, France
| | - Frédéric Bérard
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France; Université Claude-Bernard Lyon I, UFR médecine Lyon-Sud Charles-Mérieux, 69921 Oullins cedex, France.
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Skowron F, Bensaid B, Depaepe L, Balme B, Kanitakis J, Amarger S, Maucourt-Boulch D, D’Incan M, Bérard F, Nicolas JF. Analyse de la valeur pronostique des modifications histologiques cutanées lors d’un exanthème induit par les médicaments (forme simple, compliquée et DRESS). Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tardieu M, Rozières A, Bensaid B, Baysal T, Vocanson M, Nicolas JF. Caractérisation des lymphocytes T cytotoxiques dans les toxidermies. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Nour M, Zerhouni H, Bensaid B, Khaloufi S, Ouazzani L, Aqquaoui L, Elhami I, Oubejja H, Erraji M, Ettayebi F. [Axillary artery pseudo-aneurysm secondary to shoulder dislocation in children]. ACTA ACUST UNITED AC 2013; 38:377-80. [PMID: 24042011 DOI: 10.1016/j.jmv.2013.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 04/09/2013] [Accepted: 07/08/2013] [Indexed: 11/19/2022]
Abstract
Axillary artery injury following anterior dislocation of the shoulder in children is a rare complication often considered as iatrogenic. We report the case of a pseudo-aneurysm of the axillary artery in a 5-year-old boy that appeared four months after a shoulder dislocation that was reduced in an ambulatory setting. Although this is an uncommon vascular complication, we emphasize the need for short-term and long-term follow-up in these children to avoid missing a pseudo-aneurysm of the axillary artery.
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Affiliation(s)
- M Nour
- Service des urgences chirurgicales pédiatriques, hôpital d'Enfant-Rabat, Rabat, Maroc.
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Descamps V, Avenel-Audran M, Valeyrie-Allanore L, Bensaid B, Barbaud A, Al Jawhari M, Ranger-Rogez S. Saliva polymerase chain reaction assay for detection and follow-up of herpesvirus reactivation in patients with drug reaction with eosinophilia and systemic symptoms (DRESS). JAMA Dermatol 2013; 149:565-9. [PMID: 23426332 DOI: 10.1001/jamadermatol.2013.2018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Reactivations of human herpesviruses (HHVs) contribute to the development of drug reaction with eosinophilia and systemic symptoms (DRESS). Diagnosis of HHV reactivation is conventionally based on quantitative real-time polymerase chain reaction (PCR) analysis of blood samples, but these viruses are present in the oropharynx and are shed in saliva. OBJECTIVE To evaluate the use of a saliva PCR assay for demonstrating HHV shedding in patients with DRESS. DESIGN Shedding of HHV in saliva was prospectively studied in patients with DRESS. Reactivations of HHV, including HHV-6, HHV-7, cytomegalovirus (CMV), and Epstein-Barr virus (EBV), were studied by performing quantitative real-time PCR analysis of blood samples obtained at admission) and serial samples of saliva obtained within the first 2 weeks of DRESS; saliva samples from controls were compared. PARTICIPANTS The study included 5 patients who met definite criteria for DRESS and 15 controls (5 immunosuppressed patients and 10 healthy adults). MAIN OUTCOME MEASURES DNA viral loads of HHV, including HHV-6, HHV-7, CMV, and EBV as measured with real-time PCR in blood and saliva samples from patients with DRESS and saliva samples from immunosuppressed and healthy controls. RESULTS The PCR assay demonstrated shedding of HHV-7, EBV, HHV-6, and CMV, listed by order of magnitude. The DNA viral loads in blood and saliva samples, also measured with real-time PCR, were found to be close. In 1 patient, reactivations in saliva preceded clinical manifestations of CMV disease. Significant production of HHV-7 and EBV was demonstrated in saliva samples from the controls, but neither HHV-6 nor CMV were detected. CONCLUSIONS AND RELEVANCE The saliva PCR assay is a useful tool for demonstration and follow-up of HHV reactivation. The interpretation of HHV viral loads in saliva differs according to HHV type.
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Affiliation(s)
- Vincent Descamps
- Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique des Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France.
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Bensaid B, Rozieres A, Nosbaum A, Nicolas JF, Berard F. Amikacin-induced drug reaction with eosinophilia and systemic symptoms syndrome: Delayed skin test and ELISPOT assay results allow the identification of the culprit drug. J Allergy Clin Immunol 2012; 130:1413-4. [DOI: 10.1016/j.jaci.2012.05.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/14/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
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Combemale P, Mognetti T, Allanore L, Bensaid B, Giammarile F, Pinson S, Drouet A, Wolkeinstein P, Blay JY. Interest of tumor to liver ratio 18F-FDG uptake in positron emission tomography for detection of neurofibrosarcoma in neurofibromatosis 1 patients. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.10049] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10049 Background: Malignant peripheral nerve sheath tumors (MPNSTs) are difficult to detect in neurofibromatosis 1 (NF1) individuals. The 18F FDG positron emission tomoscintigraphy (FDG PET) is a useful tool. The Standard Uptake Value (SUV) is the gold standard but it is subject to individual variation among patients and medical centers. So we assessed the interest of FDG PET based on a specific tumor to liver uptake ratio (T/L) instead of SUV to find a reproducible and constant cut-off for detecting malignant tumors. Methods: From 2000 to 2010, we conduct a multi centric study: all patients with NF1 and presenting clinical signs of MPNST suspicion (increased tumor size, induration or pain) underwent a FDG PET. Preliminary study estimated a T/L ratio of 1.5 as cut-off for malignity. Based on semi-quantitative analysis of FDG PET images, patients were compared with this cut-off value. Results: 98 patients with 125 tumors were included. FDG PET evaluation identified 42/125 suspected lesions with T/L > 1.5; among these 30 MPNST and 12 benign lesions were found. 83/125 tumors were classified as non-suspicious and 82 were actually benign according to histology or long term follow up. The 1.5 T/L cut off corresponds to 99 % Negative Predictive Value (NPV) and 71% Positive (PPV). The positive likelihood ratio (LR) was thus equal to 7, 69 and the Negative LR to 0, with 97% sensitivity and 87% specificity. When T/L ratio is < 1.5, MPNST is eliminated with 99% NPV, thus avoiding useless surgery. When T/L ratio is above 1.5, there is a strong suspicion of malignancy. But there is a risk of false positivity, which requires discussion before any therapeutic decision. On the over hand we found no significant correlation between SUVmax and malignancy. Conclusions: This study confirms the FDG PET in the detection of NF1-associated MPNST. The tumor/liver ratio with a cut off 1.5 has a very sensitive and specific value to sort out malignant from benign tumors and thus provides adequate surgery. More this semi-quantitative analysis method is just as easy as SUV, more sensitive and more reproducible.
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Affiliation(s)
| | | | | | | | | | | | - Alain Drouet
- Desgenettes Hospital Department of Neurology, Lyon, France
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Affiliation(s)
- B Bensaid
- Service immunologie clinique et allergologie, Centre hospitalier Lyon-Sud, 69495 Pierre Bénite, France. benoid.ben-said@chu-lyon
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Bensaid B, Giammarile F, Mognetti T, Galoisy-Guibal L, Pinson S, Drouet A, Combemale P. Intérêt de la tomographie par émission de positons au fluorodéoxyglucose 18 dans la détection des neurofibrosarcomes au cours de la neurofibromatose de type 1. Ann Dermatol Venereol 2007; 134:735-41. [DOI: 10.1016/s0151-9638(07)92528-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bensaid B, Pavic M, Estival JL, Rabar D, Dupin M, Combemale P. Thrombose veineuse profonde révélée par une éruption cutanée au cours d’une primo-infection à cytomégalovirus. Ann Dermatol Venereol 2007; 134:779-80. [DOI: 10.1016/s0151-9638(07)92538-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Debourdeau P, Zammit C, Pavic M, Bensaid B, Farge-Bancel D. Thromboses sur cathéter central chez le patient cancéreux. Rev Med Interne 2007; 28:471-83. [PMID: 17561314 DOI: 10.1016/j.revmed.2007.03.002] [Citation(s) in RCA: 10] [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] [Received: 09/30/2006] [Accepted: 03/05/2007] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Increased incidence of cancers and the development of totally implanted venous access devices that contain their own port to deliver chemotherapy will lead to a greater than before numbers of central venous catheter related thrombosis (CVCT). Medical consequences include catheter dysfunction and pulmonary embolism. Compared with lower extremity deep venous thrombosis (DVT) (3 d) and with non CVC associated thrombosis (5 d), CVCT is associated with an increased duration of hospitalisation (9 d). CVCT oftentimes leads to the need to replace such ports at an average cost of 4500 euros. CURRENT KNOWLEDGE AND KEY POINTS Vessel injury caused by the procedure of CVC insertion is the most important risk factor for development of CVCT. This event could cause the formation of a fresh thrombus, which is reversible in the large majority of patients. The incidence of CVC-related DVT assessed by venography has been reported to vary from 30 to 60% but catheter-related DVT in adult patients is symptomatic in only 5% of cases. The majority of patients with CVC-related DVT is asymptomatic or has non-specific symptoms: arm or neck swelling or pain, distal paresthesias, headache, congestion of subcutaneous collateral veins. In the case of clinical suspicion of CVC-related DVT, compressive ultrasonography (US), especially with Doppler and color imaging, currently is first used to confirm the diagnosis. The main criteria of color-Doppler US are visualization of mural thrombi or incompressibility of the veins. Consequently, contrast venography is reserved for clinical trials and difficult diagnostic situations. There is no consensus on the optimal management of patients with CVC-related DVT. Treatment of CVC-related VTE requires a 5- to 7-day course of adjusted-dose unfractionated heparin or LMWH followed by oral anticoagulants. Long-term LMWH that has been shown to be more effective than oral anticoagulant in cancer patients with lower limb DVT could be used in these patients. The optimal duration of oral anticoagulation treatment for CVC-related DVT is unknown, but patients with active cancer should be treated for at least 6 months or indefinitely. FUTURE PROSPECTS AND PROJECTS The efficacy and safety of pharmacologic prophylaxis for CVC related thrombosis is not established. Additional studies performed in high risk populations are needed to define if LMWH or oral anticoagulation is indicated in this clinical setting.
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Affiliation(s)
- P Debourdeau
- Service de Médecine Interne Oncologique, Hôpital Desgenettes, 108, boulevard Pinel, 69003 Lyon, France.
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Bensaid B, Maitre S, Labeille B, Perrot J, Cambazard F. P117 - Un syndrome paranéoplasique original au cours d’un carcinome spinocellulaire. Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)79846-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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