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1. Performance and impact of rapid multiplex PCR on diagnosis and treatment of ventilated hospital-acquired pneumonia in patients with extended-spectrum β-lactamase-producing Enterobacterales rectal carriage

Author

Pierre Bay, Vincent Fihman, Paul-Louis Woerther, Bastien Peiffer, Ségolène Gendreau, Romain Arrestier, Pascale Labedade, Elsa Moncomble, Antoine Gaillet, Guillaume Carteaux, Nicolas de Prost, Armand Mekontso Dessap, and Keyvan Razazi

Subjects
Ventilator-associated pneumonia, Multiplex PCR, Antimicrobial stewardship, ESBL, Nosocomial pneumonia, Carbapenem, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Antimicrobial stewardship (AMS) for ventilator-associated pneumonia (VAP) or ventilated hospital-acquired pneumonia (vHAP) in extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) carriers is challenging. BioFire® FilmArray® Pneumonia plus Panel (mPCR) can detect bacteria and antibiotic resistance genes, including bla CTX-M, the most common ESBL-encoding gene. Methods This monocentric, prospective study was conducted on a group of ESBL-E carriers from March 2020 to August 2022. The primary objective was to evaluate the concordance between the results of mPCR and conventional culture performed on respiratory samples of ESBL-E carriers to investigate suspected VAP/vHAP. The secondary objective was to appraise the impact of performing or not mPCR on initial antibiotic therapy adequacy in ESBL-E carriers with confirmed VAP/vHAP. Results Over the study period, 294 patients with ESBL-E carriage were admitted to the ICU, of who 168 (57%) were mechanically ventilated. (i) Diagnostic performance of mPCR was evaluated in suspected 41 episodes of VAP/vHAP: bla CTX-M gene was detected in 15/41 (37%) episodes, where 9/15 (60%) were confirmed ESBL-E-induced pneumonia. The culture and bla CTX-M were concordant in 35/41 (85%) episodes, and in all episodes where bla CTX-M was negative (n = 26), the culture never detected ESBL-E. (ii) The impact of mPCR on initial antibiotic therapy adequacy was assessed in 95 episodes of confirmed VAP/vHAP (22 episodes were tested with mPCR and 73 without); 47 (49%) episodes were ESBL-E-induced, and 24 (25%) were carbapenem-resistant bacteria-induced. The use of mPCR was significantly associated with higher prescription of adequate empirical antibiotic therapy in the multivariable logistic regression (adjusted odds ratio (aOR) (95% CI) of 7.5 (2.1–35.9), p = 0.004), propensity-weighting (aOR of 5.9 (1.6–22.1), p = 0.008), and matching-cohort models (aOR of 5.8 (1.5–22.1), p = 0.01). Conclusion mPCR bla CTX-M showed an excellent diagnostic value to rule out the diagnosis of ESBL-E related pneumonia in ESBL-E carriers with suspected VAP/vHAP. In addition, in patients with confirmed VAP/vHAP, a mPCR-based antibiotic therapy was associated with an increased prescription of adequate empirical antibiotic therapy. Performing mPCR on respiratory samples seems to be a promising tool in ESBL-E carriers with suspected vHAP/VAP. However, if mPCR is used in very low pre-test clinical probability of pneumonia, due to the high sensitivity and the rate of overdiagnosed pneumonia, the risk of overconsumption of carbapenem may prevail. Further studies are warranted.

Published
2024
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2. Adverse Events and Infectious Complications in the Critically Ill Treated by Plasma Exchange: A Five-Year Multicenter Cohort Study

Author

Mickael François, MD, Delphine Daubin, MD, Dehbia Menouche, MD, Antoine Gaillet, MD, Judith Provoost, MD, Remi Trusson, MD, Romain Arrestier, MD, Olivier Hequet, MD, Jean‑Christophe Richard, MD, PhD, Olivier Moranne, MD, PhD, Romaric Larcher, MD, and Kada Klouche, MD, PhD

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

OBJECTIVES:. The aim of this study was to determine, in critically ill patients treated with therapeutic plasma exchange (TPE), the incidence of adverse events as well as the incidence of secondary infections and its predictive factors. DESIGN:. A multicenter retrospective cohort study of an intensive care population treated with TPE to collect adverse events and infectious complications. The characteristics of patients who developed an infection after plasma exchange were compared with those of patients who did not. SETTING:. Four ICUs of French university hospitals. PATIENTS:. All adults admitted between January 1, 2015, and December 31, 2019, who received at least one plasma exchange session were included. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. A total of 711 TPE sessions were performed on 124 patients. The most frequent TPE indications were thrombotic microangiopathies (n = 32, 26%), myasthenia gravis (n = 25, 20%), and acute polyradiculoneuropathy (n = 12, 10%). Among the 124 patients, 22 (21%) developed arterial hypotension, 12 (12%) fever, and 9 (9%) electrolyte disturbance during TPE. Moreover, 60 (48%) presented at least one infectious complication: ventilator-associated pneumonia 42, pneumonia 13, bacteremia 18 (of which 6 catheter-related infections) viral reactivation 14. Independent risk factors for ICU-acquired infection were the ICU length of stay (24 vs. 7 d; hazard ratio [HR]: 1.09 [1.04–1.15], p < 0.001) and invasive mechanical ventilation (92% vs. 35%; HR: 16.2 [5.0–53.0], p < 0.001). CONCLUSIONS:. In critically ill patients treated with TPE, adverse events occurring during the procedure remain moderately frequent and are mostly not life-threatening. Infectious complications, mainly ventilation-associated pneumonia, are frequent in this population. The need of mechanical ventilation and longer ICU stay is associated with an increased risk of infection.

Published
2023
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3. Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort

Author

Antoine Gaillet, Elie Azoulay, Etienne de Montmollin, Maité Garrouste-Orgeas, Yves Cohen, Claire Dupuis, Carole Schwebel, Jean Reignier, Shidasp Siami, Laurent Argaud, Christophe Adrie, Bruno Mourvillier, Stéphane Ruckly, Jean-Marie Forel, and Jean-Francois Timsit

Subjects
Human immunodeficiency virus (HIV), Acquired immune deficiency syndrome (AIDS), Antiretroviral therapy (ART), Intensive care unit (ICU), Outcome assessment, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Purpose Despite antiviral therapy (ART), 800,000 deaths still occur yearly and globally due to HIV infection. In parallel with the good virological control and the aging of this population, multiple comorbidities [HIV-associated-non-AIDS (HANA) conditions] may now be observed. Methods HIV adult patients hospitalized in intensive care unit (ICU) from all the French region from university and non-university hospital who participate to the OutcomeRea™ database on a voluntary basis over a 24-year period. Results Of the 24,298 stays registered, 630 (2.6%) were a first ICU stay for HIV patients. Over time, the mean age and number of comorbidities (diabetes, renal and respiratory history, solid neoplasia) of patients increased. The proportion of HIV diagnosed on ICU admission decreased significantly, while the median duration of HIV disease as well as the percentage of ART-treated patients increased. The distribution of main reasons for admission remained stable over time (acute respiratory distress > shock > coma). We observed a significant drop in the rate of active opportunistic infection on admission, while the rate of active hemopathy (newly diagnosed or relapsed within the last 6 months prior to admission to ICU) qualifying for AIDS increased—nonsignificantly—with a significant increase in the anticancer chemotherapy administration in ICU. Admissions for HANA or non-HIV reasons were stable over time. In multivariate analysis, predictors of 60-day mortality were advanced age, chronic liver disease, past chemotherapy, sepsis-related organ failure assessment score > 4 at admission, hospitalization duration before ICU admission > 24 h, AIDS status, but not the period of admission. Conclusion Whereas the profile of ICU-admitted HIV patients has evolved over time (HIV better controlled but more associated comorbidities), mortality risk factors remain stable, including AIDS status.

Published
2023
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4. Venous thrombosis and predictors of relapse in eosinophil-related diseases

Author

Valériane Réau, Alexandre Vallée, Benjamin Terrier, Aurélie Plessier, Noémie Abisror, Félix Ackermann, Ruben Benainous, Gérôme Bohelay, Marie-Laure Chabi-Charvillat, Divi Cornec, Anne-Claire Desbois, Stanislas Faguer, Nathalie Freymond, Antoine Gaillet, Mohamed Hamidou, Martin Killian, Sylvain Le Jeune, Anne Marchetti, Guy Meyer, Francisco Osorio-Perez, Kewin Panel, Pierre-Emmanuel Rautou, Julien Rohmer, Nicolas Simon, Colas Tcherakian, Marc Vasse, Elina Zuelgaray, Guillaume Lefevre, Jean-Emmanuel Kahn, and Matthieu Groh

Subjects
Medicine, Science
Abstract

Abstract Eosinophils have widespread procoagulant effects. Eosinophilic cardiovascular toxicity mostly consists of endomyocardial damage or eosinophilic vasculitis, while reported cases of venous thrombosis (VT) are scarce. We aimed to report on the clinical features and treatment outcomes of patients with unexplained VT and eosinophilia, and to identify predictors of relapse. This retrospective, multicenter, observational study included patients aged over 15 years with VT, concomitant blood eosinophilia ≥ 1G/L and without any other moderate-to-strong contributing factors for VT. Fifty-four patients were included. VT was the initial manifestation of eosinophil-related disease in 29 (54%) patients and included pulmonary embolism (52%), deep venous thrombosis (37%), hepatic (11%) and portal vein (9%) thromboses. The median [IQR] absolute eosinophil count at VT onset was 3.3G/L [1.6–7.4]. Underlying eosinophil-related diseases included FIP1L1-PDGFRA-associated chronic myeloid neoplasm (n = 4), Eosinophilic Granulomatosis with Polyangiitis (n = 9), lymphocytic (n = 1) and idiopathic (n = 29) variants of hypereosinophilic syndrome. After a median [IQR] follow-up of 24 [10–62] months, 7 (13%) patients had a recurrence of VT. In multivariate analysis, persistent eosinophilia was the sole variable associated with a shorter time to VT relapse (HR 7.48; CI95% [1.94–29.47]; p = 0.015). Long-term normalization of eosinophil count could prevent the recurrence of VT in a subset of patients with unexplained VT and eosinophilia ≥ 1G/L.

Published
2021
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5. Multiple myeloma with clivus involvement, neurological symptoms, and 45 g/L proteinorachia

Author

Yannick Chantran, Jean‐Rémi Lavillegrand, Bertrand Lefrere, Antoine Gaillet, Pierre Aucouturier, and Laurent Garderet

Subjects
central nervous system, cerebrospinal fluid, hyperproteinorachia, multiple myeloma, Medicine, Medicine (General), R5-920
Abstract

Abstract The mechanical obstruction of cerebrospinal fluid (CSF) flow can lead to very high hyperproteinorachia. In myeloma, tumoral clivus obstruction can cause such high proteinorachia, associated with paraprotein detection in the CSF in absence of intrathecal synthesis.

Published
2020
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6. Epidemiology, clinical presentation, and outcomes of 620 patients with eosinophilia in the intensive care unit

Author

Antoine Gaillet, Pierre Bay, Edwige Péju, Hafid Ait-Oufella, Elie Azoulay, Nacime Benchabane, Charles Cerf, Yves Cohen, Nicolas de Prost, Stanislas Faguer, Guillaume Geri, Steven Grangé, Jean-Emmanuel Kahn, Louis Kreitmann, Romaric Larcher, Guillaume Lefèvre, Asma Mabrouki, Armand Mekonsto-Dessap, Kewin Panel, Frédéric Pène, Marc Pineton de Chambrun, Jean-Pierre Quenot, Yacine Tandjaoui-Lambiotte, Jean-Francois Timsit, Antoine Vieillard-Baron, Auguste Dargent, Antoine Herault, and Matthieu Groh

Subjects
Critical Care and Intensive Care Medicine
Published
2023

7. High-Dose Steroids for Nonresolving Acute Respiratory Distress Syndrome in Critically Ill COVID-19 Patients Treated With Dexamethasone: A Multicenter Cohort Study

Author

Julien Lopinto, Romain Arrestier, Bastien Peiffer, Antoine Gaillet, Guillaume Voiriot, Tomas Urbina, Charles-Edouard Luyt, Raphaël Bellaïche, Tái Pham, Zakaria Ait-Hamou, Damien Roux, Raphaël Clere-Jehl, Elie Azoulay, Stéphane Gaudry, Julien Mayaux, Armand Mekontso Dessap, Florence Canoui-Poitrine, and Nicolas de Prost

Subjects
Critical Care and Intensive Care Medicine
Published
2023

8. Toxidermies graves en réanimation

Author

Antoine GAILLET, Saskia Ingen-Housz-Oro, Olivier Chosidow, and Nicolas De Prost

Subjects
Emergency Medicine, Emergency Nursing
Abstract

Les toxidermies graves (nécrolyse épidermique, drug reaction with eosinophilia and systemic symptoms (DRESS) et pustulose exanthémathique aiguë généralisée (PEAG)) sont des situations complexes, tant dans leur approche diagnostique que thérapeutique, justifiant une prise en charge multidisciplinaire en centre spécialisé. En plus de l’atteinte cutanéo-muqueuse, des complications viscérales peuvent advenir, engageant le pronostic vital à court terme. La prise en charge initiale, essentiellement symptomatique, a, par ailleurs, pour but de prévenir d’éventuelles séquelles à long-terme. Les médecins doivent être conscients du rôle potentiel des médicaments à haut risque dans le déclenchement de toxidermies graves, en particulier lorsque des facteurs prédisposants sont présents. Toutes les toxidermies graves doivent être déclarées en pharmacovigilance. A distance, les tests allergologiques peuvent aider à confirmer le médicament coupable et à décider des alternatives possibles.

Published
2023

9. Outcomes in Critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort

Author

Antoine Gaillet, Elie Azoulay, Etienne de Montmollin, Maité Garrouste-Orgeas, Yves Cohen, Claire Dupuis, Carole Schwebel, Jean Reignier, Shidasp Siami, Laurent Argaud, Christophe Adrie, Bruno Mourvillier, Stéphane Ruckly, Jean-Marie Forel, and Jean-Francois Timsit

Subjects
Critical Care and Intensive Care Medicine
Abstract

Purpose Despite antiviral therapy (ART), 800,000 deaths still occur yearly and globally due to HIV infection. In parallel with the good virological control and the aging of this population, multiple comorbidities [HIV-associated-non-AIDS (HANA) conditions] may now be observed. Methods HIV adult patients hospitalized in intensive care unit (ICU) from all the French region from university and non-university hospital who participate to the OutcomeRea™ database on a voluntary basis over a 24-year period. Results Of the 24,298 stays registered, 630 (2.6%) were a first ICU stay for HIV patients. Over time, the mean age and number of comorbidities (diabetes, renal and respiratory history, solid neoplasia) of patients increased. The proportion of HIV diagnosed on ICU admission decreased significantly, while the median duration of HIV disease as well as the percentage of ART-treated patients increased. The distribution of main reasons for admission remained stable over time (acute respiratory distress > shock > coma). We observed a significant drop in the rate of active opportunistic infection on admission, while the rate of active hemopathy (newly diagnosed or relapsed within the last 6 months prior to admission to ICU) qualifying for AIDS increased—nonsignificantly—with a significant increase in the anticancer chemotherapy administration in ICU. Admissions for HANA or non-HIV reasons were stable over time. In multivariate analysis, predictors of 60-day mortality were advanced age, chronic liver disease, past chemotherapy, sepsis-related organ failure assessment score > 4 at admission, hospitalization duration before ICU admission > 24 h, AIDS status, but not the period of admission. Conclusion Whereas the profile of ICU-admitted HIV patients has evolved over time (HIV better controlled but more associated comorbidities), mortality risk factors remain stable, including AIDS status.

Published
2022

11. Characteristics and risk factors for poor outcome in patients with systemic vasculitis involving the gastrointestinal tract

Author

Romain Paule, François Maurier, Laurent Perard, Julien Charpentier, Françoise Sarrot-Reynauld, Cécile-Audrey Durel, Ségolène Gendreau, Pierre-Louis Carron, Jean-Emmanuel Kahn, Maxime Samson, Tiphaine Goulenok, Arsène Mekinian, Charlotte Bernigaud, Loïc Guillevin, Jean-Christophe Lega, Benjamin Terrier, Thomas Pires, Raphaël Porcher, Wendy Jourde, Adrien Mirouse, Romain Sonneville, Alexandra Audemard-Verger, L. Frumholtz, Jean-Benoît Arlet, Xavier Puéchal, Nathalie Tieulie, Antoine Gaillet, Eric Hachulla, Elisabeth Diot, B. Thoreau, Saskia Ingen-Housz-Oro, Aurélie Hummel, Service de médecine interne et centre de référence des maladies rares [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Equipe 5 : METHODS - Méthodes de l’évaluation thérapeutique des maladies chroniques (CRESS - U1153), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), Centre d'épidémiologie Clinique [Hôtel-Dieu], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Hôtel Dieu, Hôpital Foch [Suresnes], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Service de Dermatologie [AP-HP Hôpital Saint-Louis], Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre hospitalier Saint Joseph - Saint Luc [Lyon], Service de Médecine Interne (SOC 1 et SOC 2) [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital Ambroise Paré [AP-HP], Hôpital Cochin [AP-HP], Hôpital Claude Huriez [Lille], CHU Lille, CHU Necker - Enfants Malades [AP-HP], CHU Bordeaux [Bordeaux], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), CHU Grenoble, CHU Nice [Cimiez], and Hôpital Cimiez [Nice] (CHU)

Subjects
medicine.medical_specialty, Gastrointestinal Diseases, law.invention, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Risk Factors, Melena, law, Internal medicine, Necrotizing Vasculitis, medicine, Clinical endpoint, Humans, 030212 general & internal medicine, Retrospective Studies, 030203 arthritis & rheumatology, Polyarteritis nodosa, business.industry, Systemic Vasculitis, medicine.disease, Intensive care unit, Polyarteritis Nodosa, Gastrointestinal Tract, Anesthesiology and Pain Medicine, IgA vasculitis, medicine.symptom, business, Vasculitis, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Systemic vasculitis
Abstract

Background Gastrointestinal (GI) involvement was described to be a poor prognostic factor in systemic necrotizing vasculitis. Its prognostic significance may vary according to clinical presentation and vasculitis subtype. Aims This study investigated risk-factors associated to poor outcome in GI-involvement of vasculitis. Methods Patients with systemic vasculitis as defined by the 2012 Chapel Hill Consensus Conference and presenting with GI involvement were retrospectively included. Baseline characteristics, treatments and outcome were recorded. Primary endpoint was a composite of admission to intensive care unit (ICU), emergency surgical procedure, or death. Results Two hundred and thirteen patients were included. Vasculitis were distributed as follows: 41% IgA vasculitis, 27% ANCA-associated vasculitis, 17% polyarteritis nodosa (PAN), and 15% other vasculitis. Eighty-three (39%) patients fulfilled the composite primary endpoint within 6 months. Predictive factors associated with the primary endpoint included PAN subtype (OR 3.08, 95% CI 1.29–7.34), performance status (OR 1.40, 1.05–1.87), use of morphine (OR 2.51, 0.87–7.24), abdominal guarding (OR 3.08, 1.01–9.37), ileus (OR 2.29, 0.98–5.32), melena (OR 2.74, 1.17–6.42), increased leukocytes (per G/L, OR 1.05, 1.00–1.10), low hemoglobin (per g/dL, OR 0.80, 0.71–0.91) and increased CRP (log mg/L, OR 1.21, 0.94–1.56). A risk prediction model for the achievement of primary endpoint had a very good performance [C-statistics 0.853 (0.810 to 0.895], and for overall survival as well. Conclusions Vasculitis presenting with GI involvement have a poor outcome in more than one third of cases. An easy-to-use risk prediction model had a very good performance to predict the admission to ICU, emergency surgical procedure, or death.

Published
2021

12. Correction: Epidemiology, clinical presentation, and outcomes of 620 patients with eosinophilia in the intensive care unit

Author

Antoine Gaillet, Pierre Bay, Edwige Péju, Hafid Ait-Oufella, Elie Azoulay, Nacime Benchabane, Charles Cerf, Yves Cohen, Nicolas de Prost, Stanislas Faguer, Guillaume Geri, Steven Grangé, Jean-Emmanuel Kahn, Louis Kreitmann, Romaric Larcher, Guillaume Lefèvre, Asma Mabrouki, Armand Mekonsto-Dessap, Kewin Panel, Frédéric Pène, Marc Pineton de Chambrun, Jean-Pierre Quenot, Yacine Tandjaoui-Lambiotte, Jean-Francois Timsit, Antoine Vieillard-Baron, Auguste Dargent, Antoine Herault, and Matthieu Groh

Subjects
Critical Care and Intensive Care Medicine
Published
2023

13. Multiple myeloma with clivus involvement, neurological symptoms, and 45 g/L proteinorachia

Author

Laurent Garderet, Bertrand Lefrere, Jean-Rémi Lavillegrand, Pierre Aucouturier, Antoine Gaillet, and Yannick Chantran

Subjects
Pathology, medicine.medical_specialty, Central nervous system, lcsh:Medicine, Case Report, Case Reports, 030204 cardiovascular system & hematology, urologic and male genital diseases, Intrathecal, cerebrospinal fluid, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, Clivus, immune system diseases, hemic and lymphatic diseases, medicine, Multiple myeloma, lcsh:R5-920, business.industry, lcsh:R, fungi, food and beverages, General Medicine, central nervous system, medicine.disease, hyperproteinorachia, multiple myeloma, medicine.anatomical_structure, 030220 oncology & carcinogenesis, lcsh:Medicine (General), business
Abstract

The mechanical obstruction of cerebrospinal fluid (CSF) flow can lead to very high hyperproteinorachia. In myeloma, tumoral clivus obstruction can cause such high proteinorachia, associated with paraprotein detection in the CSF in absence of intrathecal synthesis.

Published
2019

14. Venous thrombosis and predictors of relapse in eosinophil-related diseases

Author

Matthieu Groh, Francisco Osorio-Perez, Benjamin Terrier, Aurélie Plessier, Divi Cornec, Julien Rohmer, Marc Vasse, Nathalie Freymond, Mohamed Hamidou, Ruben Benainous, Stanislas Faguer, Alexandre Vallée, Marie-Laure Chabi-Charvillat, Elina Zuelgaray, Felix Ackermann, Jean-Emmanuel Kahn, Guy Meyer, A.C. Desbois, Martin Killian, Valériane Réau, Nicolas Simon, G. Bohelay, Noémie Abisror, Sylvain Le Jeune, Guillaume Lefèvre, Colas Tcherakian, Pierre-Emmanuel Rautou, Kewin Panel, Antoine Gaillet, Anne Marchetti, Centre d'Investigation Clinique Henri Mondor (CIC Henri Mondor), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre de Référence National des Syndromes Hyperéosinophiliques (CEREO), Hôpital Foch [Suresnes], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d’Hépatologie [Hôpital Beaujon], Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de rhumatologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Avicenne [AP-HP], Lymphocytes B, Autoimmunité et Immunothérapies (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-LabEX IGO Immunothérapie Grand Ouest, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Service de médecine interne [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Toulouse [Toulouse], CIC CHU Lyon (inserm), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier de Dax, Centre Hospitalier Universitaire [Grenoble] (CHU), Hémostase, Inflammation, Thrombose (HITH - U1176 Inserm - CHU Bicêtre), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)-Université Paris-Saclay, Hopital Saint-Louis [AP-HP] (AP-HP), CHU Lille, Hôpital Ambroise Paré [AP-HP], Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and HAL-SU, Gestionnaire

Subjects
Male, 0301 basic medicine, Churg-Strauss Syndrome, 030204 cardiovascular system & hematology, Gastroenterology, 0302 clinical medicine, Recurrence, Hypereosinophilic Syndrome, Eosinophilic, Eosinophilia, Venous Thrombosis, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Leukemia, Multidisciplinary, Portal Vein, Hypereosinophilic syndrome, Middle Aged, 3. Good health, Pulmonary embolism, Venous thrombosis, Treatment Outcome, medicine.anatomical_structure, Medicine, Female, medicine.symptom, Eosinophilic vasculitis, Granulomatosis with polyangiitis, Adult, medicine.medical_specialty, Science, Article, 03 medical and health sciences, Medical research, Internal medicine, medicine, Humans, Aged, Retrospective Studies, mRNA Cleavage and Polyadenylation Factors, business.industry, Eosinophil, medicine.disease, Eosinophils, 030104 developmental biology, Risk factors, Pulmonary Embolism, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Eosinophils have widespread procoagulant effects. Eosinophilic cardiovascular toxicity mostly consists of endomyocardial damage or eosinophilic vasculitis, while reported cases of venous thrombosis (VT) are scarce. We aimed to report on the clinical features and treatment outcomes of patients with unexplained VT and eosinophilia, and to identify predictors of relapse. This retrospective, multicenter, observational study included patients aged over 15 years with VT, concomitant blood eosinophilia ≥ 1G/L and without any other moderate-to-strong contributing factors for VT. Fifty-four patients were included. VT was the initial manifestation of eosinophil-related disease in 29 (54%) patients and included pulmonary embolism (52%), deep venous thrombosis (37%), hepatic (11%) and portal vein (9%) thromboses. The median [IQR] absolute eosinophil count at VT onset was 3.3G/L [1.6–7.4]. Underlying eosinophil-related diseases included FIP1L1-PDGFRA-associated chronic myeloid neoplasm (n = 4), Eosinophilic Granulomatosis with Polyangiitis (n = 9), lymphocytic (n = 1) and idiopathic (n = 29) variants of hypereosinophilic syndrome. After a median [IQR] follow-up of 24 [10–62] months, 7 (13%) patients had a recurrence of VT. In multivariate analysis, persistent eosinophilia was the sole variable associated with a shorter time to VT relapse (HR 7.48; CI95% [1.94–29.47]; p = 0.015). Long-term normalization of eosinophil count could prevent the recurrence of VT in a subset of patients with unexplained VT and eosinophilia ≥ 1G/L.

Published
2021

15. Penile Calciphylaxis

Author

Antoine Gaillet, Yosu Luque, Service d'Urgences néphrologiques et transplantation rénale [CHU Tenon], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Des Maladies Rénales Rares aux Maladies Fréquentes, Remodelage et Réparation, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CCSD, Accord Elsevier, Urgences néphrologiques et transplantation rénale [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
[SDV] Life Sciences [q-bio], Male, 03 medical and health sciences, 0302 clinical medicine, Penile Diseases, [SDV]Life Sciences [q-bio], 030220 oncology & carcinogenesis, Urology, Calciphylaxis, Humans, 030211 gastroenterology & hepatology, 3. Good health, Aged
Abstract

International audience; The proposed image reports the case of penile calciphylaxis. Calciphylaxis is a rare obliterative small vessel vasculopathy associated with diabetes mellitus, end-stage renal disease. Penile involvement is even rarer with only 50 cases reported, and agreement on appropriate diagnosis and management is unclear. This rarity exposes, as in our situation, to misdiagnosis, with possible iatrogeny (dermocorticoides in the case of balanitis). As the biopsy of the glans is not recommended, the clinical diagnosis is essential. Diffuse calcifications appearance on the reported ultrasound could support the diagnosis.

Published
2020

16. Distinct paradoxical inflammatory reaction followed by postantiretroviral therapy immune reconstitution syndrome in cryptococcal meningitis

Author

Sébastien Imbert, H. Guillot, Arnaud Fekkar, Valérie Pourcher, Morgan Ollivier, Ruxandra Calin, and Antoine Gaillet

Subjects
medicine.diagnostic_test, business.industry, Immunology, Magnetic resonance imaging, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Immune system, medicine, Immunology and Allergy, 030212 general & internal medicine, Young adult, business, Cryptococcal meningitis, Meningitis
Published
2018

17. Intravenous immunoglobulin efficacy for primary Sjögren's Syndrome associated small fiber neuropathy

Author

Antoine Gaillet, Damien Sène, Karine Champion, Jean-François Bergmann, Jean-Pascal Lefaucheur, and Hervé Trout

Subjects
Adult, Male, medicine.medical_specialty, biology, business.industry, Small Fiber Neuropathy, Immunology, Immunoglobulins, Intravenous, Retrospective cohort study, Middle Aged, Gastroenterology, Sjogren's Syndrome, Internal medicine, biology.protein, Humans, Immunology and Allergy, Medicine, Female, Sjogren s, Antibody, business, Retrospective Studies
Published
2019

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