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Résumé L’hémorragie intra-alvéolaire (HIA) est une maladie rare et grave. Le diagnostic est évoqué devant la triade hémoptysie, anémie et infiltrat radiologique. Il est confirmé par la réalisation d’une tomodensitométrie thoracique et d’une fibroscopie bronchique avec lavage broncho-alvéolaire révélant des sécrétions uniformément hémorragiques. Les étiologies en sont nombreuses. Elles sont classiquement différenciées en cause « immune » (vascularites liées aux anticorps anti-cytoplasme des polynucléaires neutrophiles (ANCA), les connectivites/lupus érythémateux systémique (LES) et le syndrome de Goodpasture) et « non immune » (cardiopathie, toxique, infection…). Un bilan étiologique avec la recherche de signes cliniques extrathoraciques, d’auto-anticorps (anticorps anti-nucléaires et anti-membrane basale glomérulaire [ANCA]), la réalisation d’une échographie cardiaque et la recherche d’une imputabilité iatrogénique ou d’un contexte septique évident est urgent. Le LES et le syndrome des antiphopholipides sont les causes immunes les plus fréquentes en rhumatologie avec les vascularites à ANCA. Les autres connectivites sont rarement directement impliquées dans le mécanisme d’HIA, hormis en cas de formes associées à une vascularite et la présence d’ANCA. Une telle situation doit donc faire rechercher une cause « non immune » en priorité. Alveolar hemorrhage (AH) is a rare and serious disease. Diagnosis is suspected with the three following symptoms: hemoptysis, anemia and radiological infiltrate. It is confirmed by performing a thoracic CT scan and bronchoscopy with bronchoalveolar lavage revealing uniformly hemorrhagic secretions. Etiologies are numerous. They are classically differentiated into “immune” causes (vasculitis related to anti-cytoplasmic neutrophil antibodies (ANCA), connective tissue diseases/systemic lupus erythematous (SLE) and Goodpasture's syndrome) and “non-immune” causes (heart disease, toxic, infection…). Etiological assessment with the search for extrathoracic clinical signs, dosage of autoantibodies (ANCA, anti-nuclear antibodies and anti-glomerular basement membrane), the realization of a cardiac ultrasound, elimination of a iatrogenic cause or an obvious septic condition is urgent. SLE and antiphopholipid syndrome are the most common immune causes in rheumatology with ANCA-related vasculitis. Other connective tissue diseases are rarely directly involved in the AH mechanism, except in cases of vasculitis-associated forms and the presence of ANCA. In such a situation, a “non-immune” cause must be sought in priority. [ABSTRACT FROM AUTHOR]

Cancer patients are thought to have an increased risk of developing severe Coronavirus Disease 2019 (COVID-19) infection and of dying from the disease. In this work, predictive factors for COVID-19 severity and mortality in cancer patients were investigated. In this large nationwide retro-prospective cohort study, we collected data on patients with solid tumours and COVID-19 diagnosed between March 1 and 11th June 2020. The primary end-point was all-cause mortality and COVID-19 severity, defined as admission to an intensive care unit (ICU) and/or mechanical ventilation and/or death, was one of the secondary end-points. From April 4 to 11th June 2020, 1289 patients were analysed. The most frequent cancers were digestive and thoracic. Altogether, 424 (33%) patients had a severe form of COVID-19 and 370 (29%) patients died. In multivariate analysis, independent factors associated with death were male sex (odds ratio 1.73, 95%CI: 1.18–2.52), The Eastern Cooperative Oncology Group Performance Scale (ECOG PS) ≥ 2 (OR 3.23, 95%CI: 2.27–4.61), updated Charlson comorbidity index (OR 1.08, 95%CI: 1.01–1.16) and admission to ICU (OR 3.62, 95%CI 2.14–6.11). The same factors, age along with corticosteroids before COVID-19 diagnosis, and thoracic primary tumour site were independently associated with COVID-19 severity. None of the anticancer treatments administered within the previous 3 months had any effect on mortality or COVID-19 severity, except for cytotoxic chemotherapy in the subgroup of patients with detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction (RT-PCR), which was associated with a slight increase of the risk of death (OR 1.53; 95%CI: 1.00–2.34; p = 0.05). A total of 431 (39%) patients had their systemic anticancer treatment (such as chemotherapy, targeted or immune therapy) interrupted or stopped following diagnosis of COVID-19. Mortality and COVID-19 severity in cancer patients are high and are associated with general characteristics of patients. We found no deleterious effects of recent anticancer treatments, except for cytotoxic chemotherapy in the RT-PCR-confirmed subgroup of patients. In almost 40% of patients, the systemic anticancer therapy was interrupted or stopped after COVID-19 diagnosis. • A total of 1289 patients with solid tumours and COVID-19 were analysed. • Mortality and COVID-19 severity were mainly driven by patients′ general characteristics. • Overall, we found no deleterious effects of recent anticancer treatments on mortality. • Systemic anticancer treatment was interrupted or stopped in 39% of patients. [ABSTRACT FROM AUTHOR]