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9. Analyse des signes cliniques des malades atteints de pemphigoïde en fonction des antigènes reconnus par leur sérum en immunotransfert

Author

Gary, A., Carvalho, P., Louison, J.-B., Helot, M.-F., Gilbert, D., Bernard, P., Roujeau, J.-C., Bedane, C., Delaporte, E., Vaillant, L., Dreno, B., Saiag, P., Tancrede-Bohin, E., Plantin, P., D’Incan, M., Sassolas, B., Lok, C., Labeille, B., Pauwels, C., Chosidow, O., Picard, C., Loche, F., Guillaume, J.-C., and Joly, P.

Published
2004
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14. [Severe tularaemia mimicking glandular tuberculosis during adalimumab therapy]

Author

Konstantinou, M.-P., Abecassis-Cotta, S., Valeyrie-Allanore, L., Ortonne, N., Maurin, M., Roujeau, J.-C., Revuz, J., Bagot, M., Laboratoire Adaptation et pathogénie des micro-organismes [Grenoble] (LAPM), and Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)

Subjects
Male, MESH: Antirheumatic Agents, MESH: Tularemia, MESH: Humans, MESH: Middle Aged, [SDV.BID.EVO]Life Sciences [q-bio]/Biodiversity/Populations and Evolution [q-bio.PE], Adalimumab, Antibodies, Monoclonal, Middle Aged, Tuberculosis, Lymph Node, Antibodies, Monoclonal, Humanized, MESH: Tuberculosis, Lymph Node, Severity of Illness Index, MESH: Male, MESH: Antibodies, Monoclonal, Diagnosis, Differential, MESH: Antibodies, Monoclonal, Humanized, MESH: Diagnosis, Differential, MESH: Severity of Illness Index, Antirheumatic Agents, Humans, Tularemia
Abstract

International audience; BACKGROUND: Tularaemia is an anthropozoonosis, transmitted by small mammals (hares) and arthropods (ticks, horseflies). The causative agent is Francisella tularensis, a facultatively intracellular Gram-negative bacillus. We report a case of tularaemia in its ulceroglandular form occurring during methotrexate and adalimumab treatment (Humira) for rheumatoid arthritis. PATIENTS AND METHODS: A 58-year-old man with a history of primary tuberculosis receiving adalimumab in combination with methotrexate for rheumatoid arthritis for almost 1 year consulted for a febrile inflammatory plaque on the left leg with a small central necrotic area. An enlarged left inguinal lymph node was present. Doxycycline has previously been prescribed for a tick bite. The lymphadenopathy gradually became enlarged resulting in skin fistulisation. After surgical excision, histopathology revealed epithelioid granulomas accompanied by giant cells and central necrosis. Mycobacterial cultures were negative. Positive tularaemia serology at significant titres suggested a diagnosis of tularaemia, with probable transmission via a tick bite. The diagnosis was confirmed by F. tularensis DNA amplification using PCR on a lymph node biopsy. Doxycycline was continued for a further 6 weeks. One year later, no relapse had occurred. DISCUSSION: A febrile adenopathy presenting the histological features of necrotic granulomas in a patient receiving anti-TNF alpha treatment initially suggested reactivation of tuberculosis. However, the history of tick bite and failure to isolate mycobacteria from different tissue specimens prompted screening for a tick-borne disease, finally leading to a diagnosis of tularaemia. We discuss the possible relationship between immunosuppression and the clinical course of this rare infection.

Published
2008
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18. Les Auteurs

Author

Boles, J.-M., Bollaert, P.-E., Mercat, A., Mira, J.-P., Offenstadt, G., Saulnier, F., Wolff, M., Zéni, F., Aboab, J., Abou-Ayache, R., Abroug, F., Abtan, J., Adam, N., Aissaoui, N., Ait Hssain, A., Ait-Oufella, H., Aloy, B., Alves, M., Amour, J., Amstutz, P., Andréjak, C., Anglicheau, D., Annane, D., Anxionnat, R., Arab, K., Argaud, L., Arich, C., Arrivé, L., Aubron, C., Auneau, J.-C., Azabou, E., Azoulay, É., Bailly, P., Bakhos, D., Baldolli, A., Barbier, C., Barbier, F., Barbut, F., Bardon, J., Bargues, L., Barraud, D., Barreda, T., Barrot, L., Barry, B., Basille-Fantinato, A., Bastien, O., Baud, F., Baudel, J.-L., Bauwens, M., Bazire, A., Beaussier, M., Bedos, J.-P., Bédry, R., Beduneau, G., Begot, E., Belhadj-Tahar, N., Beloncle, F., Beltramini, A., Ben Hadj Salem, O., Benyamina, M., Benzidi, Y., Bernardin, G., Bertoletti, L., Beuret, P., Beydon, L., Bialais, É., Bilbault, P., Binoche, A., Biour, M., Birgand, G., Bitker, L., Blatteau, J.-E., Blivet, S., Blot, F., Boels, D., Bohé, J., Boisramé-Helms, J., Boissier, F., Boiteau, R., Boivin, A., Bonadona, A., Bonmarchand, G., Bonnot, B., Bouadma, L., Bouchet, M.-F., Bouffandeau, B., Bouglé, A., Boulain, T., Boulanger, D., Boulard, G., Bourcier, S., Boyer, A., Bracard, S., Bréchot, N., †Bricca, G., Bridoux, F., Brivet, F.-G., Brochard, L., Bruder, N., Brun-Buisson, C., Bruneel, F., Brunet, J., Brun-Vézinet, F., Bumsel, F., Burgel, P.-R., Cabasson, S., Cadranel, J., Calvet, L., Camus, C., Camus, Y., Canaud, B., Canellas, A., Canet, E., Capaldo, L., Capellier, G., Carbonell, N., Cariou, A., Carli, P., Carpentier, D., Carpentier, F., Carrat, F., Carteaux, G., Castanares-Zapatero, D., Castelain, V., Cavaillon, J.-M., Cecchini, J., Cha, O., Chaize, M., Champigneulle, B., Chanard, J., Charbonneau, P., Charles, P.-E., Charpentier, J., Chastre, J., Chemla, D., Chemouni, F., Chenine, L., Chiche, J.-D., Cholley, B., Chopin, C., Chosidow, O., Choukroun, M.-L., Chrétien, F., Clair, B., Claude, F., Clément, É., Clément-Rigolet, M., Cochereau, I., Cohen, Y., Combe, C., Combes, A., Commandeur, D., Coppo, P., Coquerel, D., Cordonnier, C., Coriat, P., Costedoat-Chalumeau, N., Cottin, V., Cour, M., Crozier, S., Danel, V., Danin, P.-E., Darmaun, D., Darmon, M., Darnal, E., Daubin, C., David, S., De Backer, D., De Cagny, B., De Jong, A., De Montalembert, M., De Prost, N., De Schryver, N., Decavele, M., Decousus, H., Degos, V., Delabranche, X., Delahaye, A., Delarue, J., Delclaux, C., Delile, E., Delisle, S., Dellamonica, J., Delluc, A., Demondion, P., Demoule, A., Dequatre-Ponchelle, N., Deray, G., Derelle, A.-L., Deriaz, H., Desrousseaux, J., Dewitte, A., Deye, N., Dhainaut, J.-F., Diehl, J.-L., Djibré, M., Dolz, M., Dorent, R., Dres, M., Dreyfuss, D., Dromer, C., Du Cheyron, D., Dubée, V., Ducloy-Bouthors, A.-S., Dugernier, J., Duguet, A., Durand, A., Durand, F., Duranteau, J., Durocher, A., Dussaule, J.-C., Eberhardt, N., Eckert, C., Égreteau, P.-Y., Ehrmann, S., El Esper, N., El Gharbi, F., Embriaco, N., Essig, M., Fagon, J.-Y., Faisy, C., Fangio, P., Fartoukh, M., Faugeras, F., Favory, R., Ferry, A., Ferry, T., Fialon, P., Flamant, M., Flamens, C., Flesch, F., Folscheid, D., Fontaine, E., Forel, J.-M., Fourel, D., Fournier, A., Fourrier, F., Francoz, C., Frat, J.-P., Friedlander, G., Friedman, D., Fromentin, M., Fulgencio, J.-P., Gainnier, M., Garçon, P., Garo, B., Garrouste-Orgeas, M., Gebel, H., Geeraerts, T., †Gehanno, P., Gempp, E., Genestal, M., Georges, H., Germain, A., Giacardi, C., Gibot, S., Girardot, T., Girault, C., Giura, G., Godard, A., Godeau, B., Goffinet, F., Goldgran-Toledano, D., Gonzalez, F., Gonzalez-Bermejo, J., Goulenok, C., Goutagny, S., Graftieaux, J.-P., Grangé, S., Grimaldi, D., Gros, A., Gruson-Vescovali, D., Guérin, C., Guérin, J.-M., Guérot, E., Guervilly, C., Guettrot-Imbert, G., Guglielminotti, J., Guidet, B., Guillot, M., Guitton, C., Haddad, L., Halimi, C., Hallynck, C., Hamada, S., Hammoudi, K., Hansmann, Y., Harlay, M.-L., Harrois, A., Harry, P., Hasselmann, M., Hauw-Berlemont, C., Hébuterne, X., Herbrecht, J.-E., Hertig, A., Heshmati, F., Hickmann, C., Hilbert, G., Houfflin-Debarge, V., Houhou, N., Houillier, P., Houzé, S., Hullin, T., Humbert, M., Hurel, D., Ichaï, P., Ioos, V., Isnard Bagnis, C., Jaber, S., Jacobs, F., †Jaeger, A., Jaffal, K., Jaïs, X., Janus, N., Jardin, F., Jars-Guincestre, M.-C., Jolliet, P., Joly, L.-M., Joly-Guillou, M.-L., Jonquet, O., Joseph, T., Jouffroy, R., Jougon, J., Jounieaux, V., Jourdain, M., Jozwiak, M., Jung, B., Kanfer, A., Karie-Guigues, S., Karila, L., Karoubi, P., Kentish-Barnes, N., Kerlan, V., Khalil, A., Khouri, T., Kim, S., Kimmoun, A., Koffel, J.-C., Kopferschmitt, J., Kummerlen, C., L'Her, E., Laaban, J.-P., Labbé, V., Labrousse, J., Lachâtre, M., Lacroix, D., Lamhaut, L., Lanceleur, A., Landman, C., Langeron, O., Lanternier, F., Lapostolle, F., Larmignat, P., Lascarrou, J.-B., Laterre, P.-F., Laudenbach, V., Launay-Vacher, V., Laurent, V., Lautrette, A., Lavaux, T., Lavillegrand, J.-R., Law-ye, B., Laxenaire, M.-C., Le Conte, P., Le Corre, B., Le Gall, G., Le Gall, J.-R., Le Gouez, A., Le Roux, G., Le Tulzo, Y., Lebas, B., Lebranchu, Y., Lebreton, G., Leclerc, F., Leclercq, D., Leclercq, R., Lecuyer, L., Lefaucheur, J.-P., Lefèvre, J., Lefèvre, M., Leflon-Guibout, V., Léger, P., Legrand, M., Leguay, T., Lellouche, F., Lemaire, F., Lemaitre, C., Lemarié, J., Lemiale, V., Lemonnier, M.-P., Léon, A., Lepape, A., Leprince, P., Leray-Moragues, H., Lerolle, N., Leroy, O., Lescot, T., †Leverve, X., Levy, B., Lévy, P., Leys, D., Lienhart, A., Lofaso, F., Lortholary, O., Losser, M.-R., Lothe, M.-N., Lotthé, A., Loubières, Y., Louge, P., Lucet, J.-C., Lutun, P., Luyt, C.-E., Lyazidi, A., Maamar, A., Magalhaes, E., Maillet, J.-M., Mainardi, J.-L., Maitre, B., Maizel, J., Mancebo, J., Manzo-Silberman, S., Marchalot, A., Marek, A., Marit, G., Markowicz, P., Marqué, S., Mattéi, M., Maurel, V., Maury, E., Maxime, V., Mazeraud, A., Mazighi, M., Mégarbane, B., Mekontso Dessap, A., Mentec, H., Mercier, F.-J., Mertes, P.-M., Meyer, G., Meynard, J.-L., Meziani, F., Miatello, J., Michelet, C., Mignon, A., Mismetti, P., Misset, B., Mohty, M., Monchi, M., Monéger, G., Monneret, G., Monnet, X., Monnier-Cholley, L., Montani, D., Morinière, P., Moritz, F., Mortaza, S., Mossé, P., Mottier, D., Mourvillier, B., Naccache, L., Nace, L., Naeije, R., Neuville, M., Nevière, R., †Nicolas, F., Nitenberg, A., Nousbaum, J.-B., Novy, E., Nuss, P., Obadia, E., Oger, E., Oliva-Labadie, M., Onimus, T., Orlikowski, D., Osman, D., Ouanes, I., Ouanes-Besbes, L., Outin, H., Oziel, J., Ozier, Y., †Paillard, M., Pajot, O., Papazian, L., Parer, S., Parquin, F., Parrilla, F.-J., Parrot, A., Pasquet, A., Pateron, D., Paugam-Burtz, C., Pavie, A., Peigné, M., Peineau, S., Pène, F., Perrigault, P.-F., Perrotin, D., Pessey, F., Pham, T., Philit, F., Pichené, C., Pierrot, M., Piette, J.-C., Pillet, O., Pilmis, B., Pioche, P.-A., Piquilloud, L., Piton, G., Plantefève, G., Pochard, F., Pocidalo, M.-A., Podglajen, I., Poidevin, A., Pottecher, J., Pottecher, T., Potton, L., Pourrat, O., Prat, G., Préau, S., Pruvo, J.-P., Pujol, S., Puntous, M., Quevrain, E., Rabaud, C., Rabbat, A., Rameix, S., †Raphaël, J.-C., Rapp, C., Raynard, B., Regard, L., Régnier, B., Reignier, J., Réminiac, F., Renault, A., Revelly, J.-P., Revest, M., Ribaud, P., Ricard, J.-D., Richalet, J.-P., Richard, C., Richard, J.-C., Ricôme, J.-L., Ridel, C., Rigolet, A., Rigollot, M., Rimmelé, T., Rineau, E., Robert, R., Robert, T., Roch, A., Roeseler, J., Roger, I., Roger, P.-A., Rohaut, B., Rouche, J., Roujeau, J.-C., Rozé, H., Rudler, M., Rugeri, L., Ruiz, J., Ruppé, É., Sab, J.-M., Saïkhali, E., Saliba, F., Samuel, D., †Santré, C., Sauder, P., Saumon, G., Sauvanet, A., Savale, L., Savoye, G., Scemla, A., Schlemmer, B., Schlemmer, F., Schmidt, M., Schneider, F., Schneider, S.-M., Schortgen, F., Schuby, M., Schwan, R., Schwebel, C., Seguin, T., Seksik, P., Senneville, É., Seronde, M.-F., Sharshar, T., Sigaut, S., Silva, S., Simonneau, G., Sitbon, O., Slama, M., Sollet, J.-P., Somme, D., Sonneville, R., Souday, V., Soufir, L., Soussi, S., Souweine, B., Spaulding, C., Squara, P., Steg, P.-G., Sterkers, G., Stiel, L., Sublon, C., Sudre, E., Surgers, L., Tabah, A., Tacquard, C., Tadié, J.-M., Talvard, O., Tamburini, J., Tamion, F., Tardy, B., Tardy-Poncet, B., Taright, N., Tasseau, F., Tattevin, P., Tauzin-Fin, P., Tazarourte, K., Teboul, J.-L., Tenaillon, A., Terzi, N., Tesnière, A., Thabut, D., Thaler, F., Thellier, D., Théodore, J., Thervet, E., Thierry, A., Thille, A.W., Thirion, M., Thomas, G., Thumerel, M., Thuong, M., Timsit, J.-F., Tissières, P., Tonnelet, R., Touchard, G., Tournoud, C., Tournoys, A., Tourtier, J.-P., Tourtier, Y., Tran Van Nhieu, J., Troché, G., Tromeur, C., Trouillet, J.-L., Tubiana, J., Ubeaud-Séquier, G., Uhel, F., Vachon, F., Valeyrie-Allanore, L., Van de Louw, A., Vargas, F., Velly, J.-F., Velly, L., Verdon, R., Vesin, A., Veyradier, A., Vieillard-Baron, A., Vignon, P., Vigué, B., Villers, D., Vincent, F., Vinsonneau, C., Voiriot, G., Voisin, B., Wattel, F., Wiel, E., Wittebole, X., Woerther, P.-L., Woimant, F., Wysocki, M., Xhaard, A., Yazdanpanah, Y., Yéni, P., Zarrouk, V., Zerbib, P., Zieleskiewicz, L., and Zuber, B.

Published
2016
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32. Liste des auteurs

Author

Abadie, Y., Abou-Ayache, R., Adhoum, A., Adib-Conquy, M., Adnet, F., Ait Hssain, A., Albanese, J., Alquier, P., Amstutz, P., Anglicheau, D., Annane, D., Annat, G., Ansart, S., Antoun, S., Anxionnat, R., Appéré de Vecchi, C., Argaud, L., Arich, C., Arrault, X., Arrivé, L., Asfar, P., Attaix, D., Aumeran, C., Auneau, J.-C., Ayem, M.-L., Azoulay, E., Barbar, S., Barnoud, D., Baron, D., Barouk, D., Barraud, D., Barry, B., Barthélémy, A., Bastien, O., Baud, F., Baudin, F., Bauwens, M., Bazin, C., Beague, S., †Beaufrère, B., Bedock, B., Bedon-Carte, S., Bédos, J.-P., Bédry, R., Bégueret, H., Belaouchi, F., Belle, E., Benali, A., Bengler, C., Benyamina, M., Bernardin, G., Berré, J., Bertrand, J.-C., Bilbault, P., Binoche, A., Biour, M., Bismuth, C., Blackwell, F., Blanc, P.-L., Blanchard, E., Bleichner, G., Blettery, B., Blivet, S., Blot, F., Bobin, S., Boccheciampe, N., Bohé, J., Boiteau, R., Boncompain-Gérard, M., Bonmarchand, G., Bonnaud, I., Bonnet, N., Bouadma, L., Bouchet, M.-F., Bouffandeau, B., Boulain, T., Boulard, G., Boulétreau, P., Boulo, M., Bourgoin, A., Boussat, S., Boussuges, A., Boyer, A., Bracard, S., Briand, E., Bridoux, F., Brivet, F., Brocas, E., Brochard, L., Bruder, N., Bruel, C., Brun-Buisson, C., Bruneel, F., Brun-Vézinet, F., Bumsel, F., Camou, F., Camus, C., Camus, Y., Canaud, B., Cannesson, M., Capellier, G., Capron, F., Carbonell, N., Cariou, A., Carlet, J., Carpentier, F., Carrat, F., Carrat, X., Cartier, F., Cary, E., Castaing, Y., Castelain, V., Cavaillon, J.-M., Cha, O., Chambrier, C., Chambrin, M.-C., Chanard, J., Chapplain, J.-M., Charbonneau, P., Chastre, J., Chaumoitre, K., Chemla, D., Chenine, L., Chevrolet, J.-C., Chiche, J.-D., Chiras, J., Chopin, C., Chouchane, N., Choukroun, M.-L., Clair, B., Clavier, B., Clec'h, C., Cluzel, P., Cochereau, I., Cohadon, F., Cohen, Y., Combe, C., Combes, A., Cordonnier, C., Coriat, P., Corne, P., Coulange, M., Cros, A.-M., Crozier, S., Dailland, P., Danel, V., Darmon, M., Darnal, E., David, S., de Cagny, B., De Deyne, C., De Jonghe, B., Decousus, H., Deklunder, G., Delabranche, X., Delafosse, B., Delahaye, A., Delarue, J., de Montalembert, M., Demoule, A., Dequin, P.-F., Deray, G., Deriaz, H., Descamps, J.-M., Devictor, D., Deye, N., Dhainaut, J.-F., di Costanzo, J., Diehl, J.-L., Dingemans, G., Djibré, M., Doise, J.-M., Dolz, M., Donati, S.Y., Dreyfuss, D., Drizenko, A., Du Cheyron, D., Ducloy-Bouthors, A.-S., Dugernier, T., Duguet, A., Durand, F., Duranteau, J., Durocher, A., Dussaule, J.-C., Eckert, Ph., Edouard, D., El Esper, N., Essig, M., Esteban, C., Eurin, B., Fagon, J.-Y., Faisy, C., Fangio, P., Fartoukh, M., Faurisson, F., Favarel-Garrigues, J.-C., Feihl, F., Ferrand, E., Ferry, T., Fialon, P., Fischer, E., Flamant, M., Flamens, C., Flesch, F., Folscheid, D., Forget, A.-P., Fourel, D., Fournier, A., Fournier, G., Fourrier, F., François, B., Francoz, C., Frat, J.-P., Frederic, M., Friedlander, G., Frossard, J.-L., Gabinski, C., Gainnier, M., Gajdos, P., Gamelin, L., Garo, B., Garot, J., Garré, M., Garrouste-Orgeas, M., Gastinne, H., Gbikpi-Benissan, G., †Gehanno, P., Gelas, P., Genestal, M., Gerbeaux, P., †Gibert, C., Gibot, S., Girault, C., Girot, M., Goarin, J.-P., Godeau, B., Goetghebeur, D., Goldgran-Toledano, D., Gonzalez, F., Goulenok, C., †Goulon, M., Grimaldi, D., Grosdidier, G., Gruson, D., Guenoun, T., Guérin, C., Guérin, J.-M., Guérot, E., Guervilly, C., Gueye, P., Guglielminotti, J., Guiavarch, M., Guidet, B., Guyomarc'h, S., Hallynck, C., Hamzaoui, O., Haniez, F., Harlay, M.-L., Harrois, A., Harry, P., Hasselmann, M., Hattab, A., Hébuterne, X., Heng, A.-É., Hertig, A., Hervé, P., Hilbert, G., Himbert, D., Holzapfel, L., Hommel, S., Houhou, N., Houillier, P., Hours, S., Hurel, D., Ichaï, P., Isnard-Bagnis, C., Jacobs, F., Jaffrelot, M., Jaffuel, S., Janvier, G., Jardel, B., Jardin, F., Jarrin, I., Jars-Guincestre, M.-C., Joly, L.-M., Joly-Guillou, M.-L., Jonquet, O., Joseph, T., Jourdain, M., Journois, D., Jung, B., Kahn, D., Kanfer, A., Karie-Guigues, S., Kerlan, V., Khalil, A., Koffel, J.-C., Kopferschmitt, J., Korach, J.-M., Kummerlen, C., L'Her, E., Laaban, J.-P., Laarbaui, F., Labrousse, J., Lacroix, D., Lachérade, J.-C., Lambert, H., Lanceleur, A., Langeron, O., Langevin, B., Lannes, B., Lapostolle, F., Larmignat, P., Laterre, P.-F., Laurent, C.h., Lautrette, A., Lavaux, T., Laxenaire, M.-C., Le Conte, P., Le Corre, B., Le Gall, C., Le Gall, G., Le Gall, J.-R., Le Prado, D., Le Tulzo, Y., Lebranchu, Y., Leclerc, F., Leclerc, X., Leclercq, R., Lefevre, M., Legendre, C., Leger, P., Legras, A., Lellouche, F., Lemaire, F., Lemiale, V., Lemonnier, M.-P., Léon, A., Léone, M., Leprince, P., Leray-Moragues, H., Lerebours, E., Leverve, X., Lévy, B., Lévy, Ph., Leys, D., Lheureux, P., Lienhart, A., Lissac, J., Loirat, P., Loubières, Y., Lucet, J.-C., Lutun, P., Luyt, C.-E., Maillet, J.-M., Mainardi, J.-L., Mancebo, J., Manel, J., Mangiapan, G., Manier, G., Manzon, C., Manzo-Silberman, S., Marek, A., Marit, G., Markowicz, P., Marqué, S., Marquette, C.-H., Marthan, R., Martin, C., Martin, O., Mathien, C., Mathieu, D., Mattéi, M., Maury, E., Maxime, V., Mayaud, C., Mayeur, C., Mazighi, M., Mégarbane, B., Melchior, J.-C., Mélot, C., Mentec, H., Mercat, A., Mertes, P.-M., Meyer, G., Meziani, F., Michelet, C., Micheletti, G., Mignon, A., Mira, J.-P., Mira, L., Mismetti, P., Misset, B., Monchi, M., Monnet, X., Monnier-Cholley, L., Moriconi, M., Morinière, P., Moritz, F., Mortier, E., Mottier, D., Mourvillier, B., Nace, L., Naeije, R., Nicolas, F., Nicolas-Chanoine, M.-H., Nitenberg, A., Nitenberg, G., Nousbaum, J.-B., Noyon, V., Obadia, E., Oger, E., Onimus, Th., Orizet, C., Ould Ahmed, M., Outin, H., Ozier, Y., Page, Y., Paillard, M., Pairault, M., Pajot, O., Papazian, L., Parer, S., Parquin, F., Parrot, A., Pavie, A., Pène, F., Penouil, F., Peraldi, M.-N., Perrin-Gachadoat, D., Perrotin, D., Petitjean, T., Philippart, F., Philit, F., Picard, L., Picart-Jacq, J.-Y., Pichené, C., Pillet, O., Pinsard, M., Plantefeve, G., Pochard, F., Pocidalo, M.-A., Podglajen, I., Pointet, P., Pourrat, O., Prat, G., Préveraud de Vaumas, C., Pruvo, J.-P., Puntous, M., Rabaud, C., Rabbat, A., Rackelboom, T., Racy, E., Raherison, C., Ralec, B., Ramakers, M., Rambaud, L., Rameix, S., Raphaël, J.-C., Ramon, P., Raynard, B., Régnier, B., Renault, A., Revest, M., Reynaert, M.-S., Reynaud, J., Ribaud, P., Ricard, J.-D., Richalet, J.-P., Richard, C., Richard, J.-C.M., Ricome, J.-L., Ricot, J., Ridel, C., Rigolet, A., Robert, D., Robert, R., Roger, I., Rondeau, E., Roques, S., Rossert, J., Roujeau, J.-C., Rozenberg, A., Rugeri, L., Rusterholtz, T., Sab, J.-M., Safran, D., Saïkhali, E., †Sainty, J.-M., Saissy, J.-M., Saliba, F., Samuel, D., Sauder, P., Saumon, G., Savineau, J.-P., Savoye, G., Schabanel, J.-C., Schaeffer, A., Schaller, M.-D., Schiano, P., Schlemmer, B., Schlossmacher, P., Schneider, F., Schneider, S.-M., Schortgen, F., Schwartz, A., Segouin, C., Seguin, Th., Seknadji, P., Serre-Sapin, A.-F., Sharshar, T., Silleran-Chassany, J., Similowski, T., Simonneau, G., Sitbon, O., Slama, M., Sollet, J.-P., Somme, D., Sonneville, R., Soubrier, S., Soufir, L., Souweine, B., Spaulding, C., Squara, P., Steg, P.-G., Stéphanazzi, J., Sterkers, G., Straus, C., Subtil, D., Sztrymf, B., Tabah, A., Taboulet, P., Tamion, F., Tardy, B., Tardy-Poncet, B., Taright, N., Tasseau, F., Tattevin, P., Tauzin-Fin, P., Teboul, J.-L., Tempé, J.-D., Tenaillon, A., Terzi, N., Tesnière, A., Textoris, J., Thabut, D., Thaler, F., Théodore, J., Thierry, A., Thille, A.W., Thirion, M., Thomas, R., Thuong, M., Timsit, J.-F., Tissières, P., Touchard, G., Tournoud, C., Tournoys, A., Tourtier, Y., Tranchant, C., Troché, G., Trouillet, J.-L., Trzeciak, M.-C., Tunon de Lara, J.-M., Ubeaud-Séquier, G., Vachon, F., Valatx, J.-L., Valentin, J.-M., Vallée, F., Vallet, B., Van de Louw, A., Vargas, F., Venet, C., Verdon, R., Vergier, B., Vésin, A., Vial, A., Viale, J.-P., Viau, F., Vieillard-Baron, A., Vignon, P., Villers, D., Vinatier, I., Vincent, B., Vinsonneau, C., Wassermann, D., Wattel, F., Willems, V., Woimant, F., Wysocki, M., Yéni, P., Zahar, J.-R., and Zelter, M.

Published
2009
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40. [Requests for emergency appointments with dermatologists in private practice in France: the ETude Urgences en DErmatologie libérale (ET.U.DE) study].

Author

Penso-Assathiany D, Bourdon-Lanoy E, Derancourt C, Roujeau JC, and Bastuji-Garin S

Subjects
Adult, Female, France, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Appointments and Schedules, Dermatology statistics & numerical data, Emergency Treatment statistics & numerical data, Private Practice, Skin Diseases diagnosis, Skin Diseases therapy
Abstract

Background: Requests for emergency appointments are fairly common in private dermatologic practice in France. To our knowledge the frequency and reasons for such requests have not yet been evaluated. The primary objective of our study was to provide a quantitative and qualitative evaluation of such requests and to assess the underlying reasons. The secondary aim was to investigate for an association between emergency requests where response was justified within 48 hours and the symptoms reported by patients in order to establish a predictive score for the validity of requests., Methods: The study took place during one week in April 2004. Forty French dermatologists took part on a voluntary basis. They deliberately reduced their ongoing schedule to accommodate patients seeking an urgent appointment. We collected data regarding the normal professional activity of each dermatologist, reasons for appointments, symptoms, diagnosis and evaluation of the degree of emergency by the attending dermatologist. Univariate and multivariate analyses were performed and a score was attributed based on the results for the variables used in the logistic regression model., Results: The mean number of patients seen at emergency appointments during the study week doubled in comparison with a normal period. During the week, 613 patients phoned and all questionnaires were completed for 538 (88%) patients. The most common reasons for requesting an appointment were: rash, eczema, pruritus, tumour modification, localized lesion and allergy. The most frequent diagnoses were: eczema, bacterial and viral infection, atopic dermatitis, mycosis and naevus. The dermatologists considered that the consultations were justified within 48 hours for one third of patients. In the multivariate analysis, factors significantly associated with a justified request were of a general medical rather than a dermatological nature: enlarged cysts, blisters, insomnia, impaired activity, onset or aggravation within the previous 7 days, inability to work. The score showed good specificity but poor sensitivity and discriminative value., Discussion: These results suggest that requests for emergency appointments are more frequent than previously suspected (14% of all requests). Physicians considered that emergency appointments within 48 hours were justified for one third of patients. The reasons for consultation and the resulting diagnoses were similar to those seen in emergency hospital consultations. The criteria on which the need for emergency consultation was based were not for the most part dermatologic. The scoring system we established was not sensitive enough to allow reliable pre-selection of patients requiring emergency consultation by telephone.

Published
2007
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41. [Severe necrotic and haemorrhagic edema of the upper limbs revealing remitting seronegative symmetrical synovitis with pitting edema].

Author

Guégan S, Poszepczynska-Guigné E, Wechsler J, Laloux L, Roujeau JC, and Revuz J

Subjects
Humans, Male, Middle Aged, Necrosis, Severity of Illness Index, Arm pathology, Edema complications, Hemorrhage complications, Synovitis complications
Abstract

Background: RS3PE (Remitting Seronegative Symmetrical Synovitis with Pitting Edema) syndrome is characterized by bilateral and symmetrical tenosynovitis of the distal extremities. It occurs with acute onset in older patients aged over 50 years. This heterogeneous entity can be isolated or can reveal various rheumatic diseases and neoplastic conditions. We report a case of RS3PE syndrome associated with unusually severe cutaneous necrotic and haemorrhagic lesions, and revealing malignant monoclonal IgM proliferation., Case Report: A 62-year-old man was admitted for acute and symmetrical synovitis of both hands and forearms associated with fever and increased acute phase reactants. Severe necrotic and haemorrhagic edema developed simultaneously. Laboratory tests ruled out infectious disease and collagen vascular disorder. Clinical symptoms responded promptly to corticosteroids to reveal severe erosive arthropathy of both wrists. The monoclonal IgM proliferation discovered during the acute phase evolved into a malignant medullary plasmocytosis. After adequate treatment of this proliferation, no haematological, cutaneous or articular relapse occurred during the two-year follow-up period., Discussion: This type of cutaneous symptoms has never been reported during the course of RS3PE syndrome. It may be supposed that the severity of the initial clinical picture was linked in this patient to the paraneoplastic nature of this.

Published
2006
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43. [Bullous pemphigoid in young patients: a retrospective study of 74 cases].

Author

Bourdon-Lanoy E, Roujeau JC, Joly P, Guillaume JC, Bernard P, Prost C, Tancrède-Bohin E, Delaporte E, Picard-Dahan C, Albes B, Bedane C, Doutre MS, Chosidow O, Lok C, Pauwels C, Chevrand-Breton J, Sassolas B, and Richard MA

Subjects
Adult, Age of Onset, Female, Humans, Male, Middle Aged, Pemphigoid, Bullous therapy, Prognosis, Retrospective Studies, Severity of Illness Index, Skin Neoplasms etiology, Autoantibodies analysis, Pemphigoid, Bullous pathology
Abstract

Introduction: Bullous pemphigoid usually affects elderly people. Only a few isolated cases among people younger than 65 years have been reported., Objectives: Describe the clinical and biological characteristics of patients younger than 60 years suffering from bullous pemphigoid, compare them with the usual characteristics known among elderly people and search for potential pathological associations., Patients and Methods: Retrospective, national, multicenter study. Clinical, biological and histological characteristics were recorded with a standardised questionnaire as well as treatments and associated pathologies., Results: Seventy-four cases of bullous pemphigoid diagnosed between June 1970 and March 2002 were analyzed. Mean age at the beginning of the disease was 46 +/- 11.6 years. Further explorations by indirect immunofluorescence of separated skin and/or immuno-electron microscopy and/or immunoblotting were performed for 42 patients (56.8 p. 100). Clinical characteristics among this restricted population were comparable to those found among the 32 other cases. Compared to usual data on bullous pemphigoid in elderly people, we observed a greater proportion of extensive form of disease (75 p. 100), a more frequent head and neck involvement (39.2 p. 100) and an overexpression of anti-BP180 autoantibodies (48 p. 100). Neoplasm was notified for 7 patients (9.5 p. 100), 18 (24.3 p. 100) suffered from a pathology of the basement membrane zone (6 psoriasis, 6 atopic dermatitis and 6 lichen) and 13 from neurological disease, among which 4 were bedridden. Fourty-six patients (62.2 p. 100) received drugs for the long term (mean 2.12 +/- 2.43), 4 patients were treated by PUVAtherapy and 2 by radiotherapy., Discussion: Our results suggest that bullous pemphigoid among young people is more severe and more active than the usual form in the elderly. This particular form could be the result of a higher expression of anti-BP180 autoantibodies, which are considered as a marker of poor prognosis in this disease. We also found a high frequency of pathological associations and physical treatment, all responsible for damage to the basement membrane zone, which can involve auto-immunization against hemidesmosome components.

Published
2005
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46. [Relationship between clinical findings of patients with bullous pemphigoid and antigens recognized by their circulating antibasement membrane zone antibodies].

Author

Gary A, Carvalho P, Louison JB, Helot MF, Gilbert D, Bernard P, Roujeau JC, Bedane C, Delaporte E, Vaillant L, Dreno B, Saiag P, Tancrede-Bohin E, Plantin P, D'Incan M, Sassolas B, Lok C, Labeille B, Pauwels C, Chosidow O, Picard C, Loche F, Guillaume JC, and Joly P

Subjects
Aged, Aged, 80 and over, Female, Humans, Male, Prospective Studies, Autoantibodies blood, Autoantigens blood, Basement Membrane immunology, Pemphigoid, Bullous blood, Pemphigoid, Bullous immunology
Abstract

Introduction: Clinical features and extent of bullous pemphigoid lesions differed widely among patients. The pathogenic role of anti-BPAG2 antibodies has been recently demonstrated. The aim of this study was to analyze the relationship between clinical features of bullous pemphigoid patients and the antigens recognized by their serum., Patients and Methods: One hundred and twelve bullous pemphigoid patients were included in this prospective multicenter study. Inclusion criteria were the following: 1) diagnosis of bullous pemphigoid established on the presence of 3 of the 4 clinical features of bullous pemphigoid, histological picture of bullous pemphigoid and positive direct immunofluorescence; 2) serum available for immunoblotting studies. The clinical and biological findings were prospectively recorded on standard forms. Sera were collected and analyzed using indirect immunofluorescence and immunoblotting on human epidermal extracts., Results: Analysis of patient's clinical features depending on the antigens recognized by their serum showed that patients whose serum contained anti-BPAG1 antibodies had more frequently pruritus, blisters on the lower limbs and a positive indirect immunofluorescence. Patients whose serum contained anti-BPAG2 antibodies had blisters more frequently localized on the head, and a more frequently negative indirect immunofluorescence. Patients whose serum was negative by immunoblotting had less frequently urticarial and/or eczematous lesions, bullae less frequently localized on the lower part of the trunk, abdomen and lower limbs, lower eosinophilia and a more frequently negative indirect immunofluorescence., Conclusion: Patients with circulating anti-BPAG1 antibodies exhibited the most typical, clinical and biological features of bullous pemphigoid.

Published
2004
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48. [Mycobacterium fortuitum skin infection occurring after a facelift].

Author

Angeli K, Lacour JP, Mantoux F, Roujeau JC, André P, Truffot-Pernot C, and Ortonne JP

Subjects
Aged, Female, Humans, Mycobacterium Infections, Nontuberculous etiology, Mycobacterium fortuitum, Rhytidoplasty adverse effects, Skin Diseases, Bacterial etiology
Abstract

Introduction: Mycobacterium fortuitum skin infections are rare and usually iatrogenic. We report a case with cervical involvement following a facelift., Observation: A 65 year-old woman, without past history, underwent bilateral surgical facelift, complicated by cutaneous necrosis and treated with directed healing at home. Six weeks later, an abscessed nodule appeared under the left maxillary and was drained surgically. Then other pre-auricular and left cervical inflammatory nodules appeared without adenopathy or fever. M. fortuitum was isolated in bacteriological samples. The initially probabilistic antibiotherapy with carithromycin, subsequently adapted with amikacine and cirprofloxacine and then imipeneme for a total duration of 3 months, led to the clinical cure., Discussion: Mycobacterium fortuitum is a rapidly growing, ubiquitous, mycobacteria responsible for nosocomial infections in immunocompetent patients, notably following plastic surgery. Contamination occurs where there has been a rupture in the skin barrier through contact with a vector (water, surgical material, antiseptic.). Treatment, which is not codified, consists in the association of surgery and antibiotics for several months.

Published
2004
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49. [Medical activity in a emergency outpatient department dermatology].

Author

Murr D, Bocquet H, Bachot N, Bagot M, Revuz J, and Roujeau JC

Subjects
Community Health Services, Humans, Outpatients, Referral and Consultation, Skin Diseases epidemiology, Dermatology statistics & numerical data, Emergency Service, Hospital, Health Services Needs and Demand statistics & numerical data, Private Practice, Skin Diseases therapy
Abstract

Background: The aim of this study was to characterize the medical activity of a dermatology emergency room and to compare it with 1) outpatients, scheduled visits to the same department and 2) visits to community dermatologists in private practice., Methods: All the 500 patients who attended the emergency room in one month and all the 411 patients with scheduled appointments during one week within the same period were included prospectively. The clinical diagnoses were recorded and compared between the two groups using chi square and linear correlation tests. Data on the diagnoses made by community dermatologists in private practice were obtained from another study., Results: In the emergency room, 4 diagnoses accounted for 71.4 of all visits: infections (29 p. 100), dermatitis (23.8 p. 100), rashes (11 p. 100) and urticaria (7.6 p. 100). In scheduled visits the 4 leading diagnosis were cancer and precancerous lesions (28.7 p. 100), dermatitis (11.7 p. 100), fungal infections (8.3 p. 100) and acne (7.1 p. 100). There was no correlation (r=0.14; p=0.6) between the 16 more prevalent diagnoses in the emergency room and the prevalence of the same diagnoses in scheduled visits in the hospital department. The emergency diagnosis were also not correlated with those seen in private practice (r=0.21; p=0.4). Seven percent of emergency room consultants were hospitalized., Comments: Skin disorders encountered in the dermatology emergency room differ from those seen both in the outpatient hospital department and in community private practice.

Published
2003

50. [Treatment of pemphigus vulgaris by azathioprine and low doses of prednisone (Lever scheme)].

Author

Benoit Corven C, Carvalho P, Prost C, Verret JL, Saiag P, Noblesse I, Bedane C, Chosidow O, Young P, Roujeau JC, and Joly P

Subjects
Adult, Aged, Aged, 80 and over, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Retrospective Studies, Azathioprine administration & dosage, Glucocorticoids administration & dosage, Immunosuppressive Agents administration & dosage, Pemphigus drug therapy, Prednisone administration & dosage
Abstract

Introduction: The so-called "Lever scheme" therapeutic regimen has been proposed in the borderline forms of pemphigus to reduce the side effects of systemic corticosteroids., Patients and Methods: A retrospective study was conducted in 8 hospital centers. The criteria for inclusion were the clinical diagnosis of pemphigus, confirmed by histological examination and direct immunofluorescence and first line therapy using the "Lever scheme" protocol, combining 40 mg of prednisone on alternate days and 100 mg/day of azathioprine., Results: Twenty-two patients, seen between January 1990 and December 2000 were included in the study. Eighteen patients (82 p. 100) exhibited complete healing of their cutaneous-buccal lesions after a mean delay of 4.3 months. The lesions of 4 patients did not heal. Three of these patients died: a bed-ridden patient, a patient exhibiting a metastatic bronchial carcinoma and a hypertensive patient who died following a hemorrhagic cerebral vascular accident. Twelve patients (54 p. 100) were weaned off treatment after a mean duration of 2.9 years. Five severe adverse events were observed: one pneumonia, 2 unbalanced diabetes, one hepatitis and one pulmonary embolism., Discussion: This study showed that the healing of the cutaneous-buccal lesions was obtained using the "Lever scheme" in 18 cases out of 22 (82 p. 100). The delay to healing was relatively long in view of the delayed effect of azathioprine. This limits the use of the "Lever scheme" protocol to non-extensive and/or early stage pemphigus. The severe adverse events occurred in low-weight patients in whom the dose related to weight was the highest. Hence the doses of azathioprine and prednisone should be adapted to patients' body weight.

Published
2003

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