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Resume Les reactions d’hypersensibilite retardee (HSR) sont definies comme celles qui surviennent plus de six heures apres une exposition aux allergenes et font intervenir l’immunite a mediation cellulaire. La peau est l’organe le plus souvent atteint dans les HSR aux produits naturels ou de synthese ainsi qu’aux medicaments. La plupart des eruptions cutanees sont benignes et spontanement resolutives, mais certaines sont graves, entrainant un risque eleve de morbidite et de mortalite. Elles doivent etre reconnues tot et gerees rapidement. La demarche diagnostique repose sur une anamnese exhaustive, des tests in vivo tels que l’intradermoreaction retardee, le patch-test ou le test de provocation orale et des tests biologiques in vitro explorant l’activite de lymphocytes T specifiques. Les performances de ces tests varient selon les manifestations cliniques. Les avancees concernant l’immunopathogenese ont permis d’identifier des alleles HLA associes aux manifestations cliniques et ainsi de determiner des facteurs de predisposition. Cet article decrit les caracteristiques et la place actuelle de ces tests selon les phenotypes d’HSR.

Resume Les lymphocytes T a recepteur antigenique chimerique (CAR-T cells) representent une innovation majeure offrant aux patients une nouvelle possibilite therapeutique pour des maladies graves. L’injection des CAR-T cells s’accompagne d’un passage de ces cellules dans la circulation sanguine. Cet article rapporte une observation de detection morphologique et de suivi cytometrique de ces cellules.

SUMMARYLittle is known about the time-dependent immune responses in severe COVID-19. Data of 15 consecutive patients were sequentially recorded from intensive care unit admission. Lymphocyte subsets and total monocyte and subsets counts were monitored as well as the expression of HLA-DR. For 5 patients, SARS-CoV-2-specific T-cell polyfunctionality was assessed against Spike and Nucleoprotein SARS-CoV-2 peptides. Non-specific inflammation markers were increased in all patients. Median monocyte HLA-DR expression was below the 8,000 AB/C threshold defining acquired immunodepression. A “V” trend curve for lymphopenia, monocyte numbers, and HLA-DR expression was observed with a nadir between days 11-14 after symptoms’ onset. Intermediate CD14++CD16+monocytes increased early with a reduction in classic CD14++CD16-monocytes. Polyfunctional SARS-Cov-2-specific CD4 T-cells were present and functional, whereas virus-specific CD8 T-cells were less frequent and not efficient. We report a temporal variation of both innate and adaptive immunity in severe COVID-19 patients, helpful in guiding therapeutic decisions (e.g. anti-inflammatoryvs. immunostimulatory ones). We describe a defect in virus-specific CD8 T-cells, a potential biomarker of clinical severity. These combined data also provide helpful knowledge for vaccine design.Trial registration numberNCT04386395

Pericarditis is the most commonly recognized cardiac complication in systemic lupus erythematosus (SLE). However, myocarditis with cardiac shock as the initial manifestation of SLE is uncommon. We describe a case of a 28-year-old man who presented cardiogenic shock revealing SLE. A 28-year-old man, white, with a history of smoking, presented to the emergency department in December 2016 with dyspnea. Blood pressure was 165/75 mm Hg, pulse rate 113 beats per minute, body temperature 36°C, and oxygen saturation 100%. Cardiovascular examination was remarkable for signs of congestion with edemas of lower limbs. Skin examination revealed livedo on both feet (Figure 1). Initial laboratory data on admission showed the following: Troponin I 0.053 μg/L (N