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Abstract: We report a case of meningoencephalitis following influenza vaccine revealed by status epilepticus. The patient, an 82-year-old man who had been vaccinated against influenza two days before, had a favourable outcome after intensive care admission including mechanical ventilation. Neurologic side effects have been previously described after influenza vaccination. Although confirmation''s exams do not exist, diagnosis is based on imputability criteria, with a complete aetiologic check-up in particular microbiologic check-up. This case, illustrated by modern techniques of biology and imaging, completes the rare and old cases already described in the literature. [Copyright &y& Elsevier]

Résumé Introduction La vascularite à IgA est une vascularite des petits vaisseaux avec des atteintes habituellement cutanées, articulaires, rénales et digestives. Les complications abdominales sont surtout liées aux œdèmes et saignements dans la paroi de l’intestin grêle, mais rarement à une pancréatite aiguë. Observation Nous rapportons l’observation d’une femme de 53 ans présentant une pancréatite aiguë inaugurale suivie d’un purpura et d’arthrites développés au septième jour. La biologie et le scanner permettaient d’éliminer une autre cause de pancréatite et le diagnostic étiologique de vascularite à IgA était porté. L’évolution était favorable sans aucune rechute sous traitement symptomatique et glucocorticoïdes. Conclusion Les pancréatites représentent une complication rare mais potentiellement mortelle des vascularites à IgA au cours de laquelle la question des corticostéroïdes ou des immunosuppresseurs n’est pas résolue. Une élimination rapide des autres causes habituelles de pancréatite est nécessaire afin d’optimiser la prise en charge des patients. Introduction IgA vasculitis is a systemic small vessel leukocytoclastic vasculitis characterized by skin purpura, arthritis, abdominal pain and nephritis. Most of the abdominal complications are due to edema and hemorrhage in the small bowel wall, but rarely to acute secondary pancreatitis. Case report Here, we report a 53-year-old woman who presented with acute pancreatitis and, secondarily, developed skin purpura and arthritis at the seventh day of the clinical onset. Biological tests and computed tomographic scan allowed to rule out another cause of pancreatitis and IgA vasculitis was diagnosed as its etiology. The outcome was favorable without any relapse on glucocorticoids. Conclusion Despite its rarity, pancreatitis is a potential life-threatening complication of IgA vasculitis in which the role of glucocorticoids and immunosuppressive drugs remains uncertain. A prompt elimination of other usual pancreatitis etiologies is mandatory to improve the management of the patients. [ABSTRACT FROM AUTHOR]

Introduction: IgA vasculitis is a systemic small vessel leukocytoclastic vasculitis characterized by skin purpura, arthritis, abdominal pain and nephritis. Most of the abdominal complications are due to edema and hemorrhage in the small bowel wall, but rarely to acute secondary pancreatitis., Case Report: Here, we report a 53-year-old woman who presented with acute pancreatitis and, secondarily, developed skin purpura and arthritis at the seventh day of the clinical onset. Biological tests and computed tomographic scan allowed to rule out another cause of pancreatitis and IgA vasculitis was diagnosed as its etiology. The outcome was favorable without any relapse on glucocorticoids., Conclusion: Despite its rarity, pancreatitis is a potential life-threatening complication of IgA vasculitis in which the role of glucocorticoids and immunosuppressive drugs remains uncertain. A prompt elimination of other usual pancreatitis etiologies is mandatory to improve the management of the patients., (Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Acute kidney injury is frequently encountered in patients in intensive care units and is associated with higher risk of mortality and chronic renal failure. Even small increases in serum creatinine are associated with adverse outcomes. Many interventions have been proposed to prevent or treat acute kidney injury in patients in intensive care units. However, no intervention has proved its efficacy in large randomized control trials. This review presents the various attempts aiming at acute kidney injury improvement in patients in intensive care units published over the recent years: hemodynamic interventions, "usual" drugs used in intensive care units, modulation of inflammation and hemostasis, remote ischemic conditioning, drugs specifically dedicated for acute kidney injury, and stimulation of renal recovery., (Copyright © 2017 Association Société de néphrologie. Published by Elsevier Masson SAS. All rights reserved.)

Background: long-term outcomes of elderly patients after an intensive care unit (ICU) stay are not fully elucidated. The objective of the pre-Seniorea study was to examine the feasibility of comprehensive geriatric assessment (CGA) during and after the ICU stay., Methods: inpatients aged 75 years and over admitted to medical and surgical ICUs of Angers University Hospital, France, from june to september 2012, received a SGA (assessment of morbidities, frailty, cognition, anxiety, mood, nutrition, functional abilities, motor function, pain, caregiver burden and quality of life) at ICU admission (through a proxy interview), at the end of the ICU stay, and 3 month later in the place of life., Results: fifty-two patients were included (81 [78; 83] years (median [25(th); 75(th) percentile]); 35 males; SAPSII 47 [38; 56]; 80% ventilation). ICU survival was 73% (n=38), 58% (n=30) after three months, and 54% (n=28) after 12 months. The CGA at ICU admission was performed in all patients and lasted 10 [5; 10] minutes. The CGA at discharge was performed in all survivors and lasted 10 [5; 15] minutes. In all, 26 survivors received CGA in their place of life after 3 months. Travel time by evaluators was 42 minutes, and time on site 45 [45; 60] minutes. At 3 months, 85% of surviving patients were at home and felt happy, 80% had preserved autonomy. The only variable predictive of survival at three months was the SAPSII score., Conclusion: the follow-up of elderly inpatient admitted to ICU with repeated CGAs, including long-term evaluations in the place of life, was feasible and well-accepted. These results set the place for larger multicentric trials.

Background: Lipoatrophic panniculitis is generally considered to be a rare disease affecting children. We report a case involving this condition in an adult patient presenting with striking clinical features and responding to hydroxychloroquine therapy. We discuss the nosological relationship between lipoatrophic panniculitis and connective tissue panniculitis., Patients and Methods: A 62-year-old woman was referred to our institution with a six-month history of painful erythematous nodules and plaques on the calves, thighs, buttocks, breasts, abdomen and arms. With each outbreak of new lesions, she felt unwell and experienced fever, chills and sweating. After a few weeks, the lesions progressed circumferentially and led to large areas of subcutaneous atrophy showing a central depression covered with a yellowish, supple skin and surrounded by an annular, infiltrated, erythematous and tender inflammatory margin. Deep subcutaneous biopsy specimens showed typical features of lobular and septal lipophagic panniculitis, with a dense inflammatory infiltrate composed of large histiocytes, multinucleated giant cells and few neutrophils, without vasculitis. The patient was started on hydroxychloroquine 400 mg daily. Three weeks later, her pain and tenderness had completely resolved and the inflammatory margin of the lesions had clearly regressed., Discussion: This unique condition, with distinctive clinical and histological features, is similar to cases described under the term "lipophagic panniculitis", seen mostly in children, but also "connective tissue panniculitis". Their clinical resemblance and response to hydroxychloroquine therapy leads us to think that these two entities, previously subsumed under the eponym of Weber-Christian disease or Rothman-Makai syndrome, are closely related., Conclusion: Dermatologists and dermatopathologists should be made aware of this unusual entity, and of the fact that it can arise in adult patients, so that they may make an early diagnosis and thus prevent the unsightly consequences of lipoatrophy., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Human toxocarosis is a helminthozoonosis due to the migration of toxocara species larvae throughout the human body. Lung manifestations vary and range from asymptomatic infection to severe disease. Dry cough and chest discomfort are the most common respiratory symptoms. Clinical manifestations include a transient form of Loeffler's syndrome or an eosinophilic pneumonia. We report a case of bilateral pneumonia in an 80 year old caucasian man who developed very rapidly an acute respiratory distress syndrome, with a PaO2/FiO2 ratio of 55, requiring mechanical ventilation and adrenergic support. There was an increased eosinophilia in both blood and bronchoalveolar lavage fluid. Positive toxocara serology and the clinical picture confirmed the diagnosis of the "visceral larva migrans" syndrome. Intravenous corticosteroid therapy produced a rapid rise in PaO2/FiO2 before the administration of specific treatment. A few cases of acute pneumonia requiring mechanical ventilation due to toxocara have been published but this is, to our knowledge, is the first reported case of ARDS with multi-organ failure., (Copyright 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

We report a case of meningoencephalitis following influenza vaccine revealed by status epilepticus. The patient, an 82-year-old man who had been vaccinated against influenza two days before, had a favourable outcome after intensive care admission including mechanical ventilation. Neurologic side effects have been previously described after influenza vaccination. Although confirmation's exams do not exist, diagnosis is based on imputability criteria, with a complete aetiologic check-up in particular microbiologic check-up. This case, illustrated by modern techniques of biology and imaging, completes the rare and old cases already described in the literature.