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Resume L’embolie pulmonaire est une maladie grave et potentiellement mortelle. Son incidence chez les enfants drepanocytaires est probablement sous-estimee et les cas rapportes dans la litterature, notamment en pediatrie, sont rares. Par ailleurs, les symptomes cliniques peuvent mimer un syndrome thoracique aigu. Nous rapportons le cas d’un adolescent drepanocytaire de 17 ans admis pour une douleur thoracique avec dyspnee et tachycardie. L’angioscanner pulmonaire a revele une embolie pulmonaire bilaterale partiellement obstructive. Le bilan etiologique n’a pas mis en evidence de thrombus veineux profond ni de thrombophilie. L’evolution a ete rapidement favorable sous traitement anticoagulant. Nous preconisons la realisation d’un angioscanner pulmonaire devant toute douleur thoracique n’evoluant pas favorablement chez un enfant drepanocytaire. Le recensement d’autres cas pediatriques sera utile afin d’etablir des recommandations diagnostiques et therapeutiques.

Background Childhood recurrent wheezing and consequently asthma corresponds to various phenotypes. Our aim was to link genetic variants of asthma candidate genes to the phenotypes of early onset wheezing. Study design We included very young consecutive children presenting with recurrent wheezing who had been evaluated for the severity of wheezing, associated atopic comorbidities, and tested for biomarkers of atopy and inflammation. All were genotyped for 16 single nucleotide polymorphisms (SNPs) linked with asthma or atopy. An unsupervised hierarchical bottom-up method was used for clustering the phenotypes and a multinomial logistic regression was performed for each individual SNP. Results We replicated the three phenotypes previously described Trousseau Asthma Program in 317 children aged 21.5 ± 7.9 months: cluster 1 (nonatopic uncontrolled severe wheeze), n = 207, a severe viral-induced wheeze, cluster 2 (atopic multiple trigger wheeze), n = 61, with multiple allergic comorbidities, and cluster 3 (episodic viral wheeze), n = 49, a mild viral-induced wheeze. The TT-genotype of the IL-4 rs2070874 polymorphism was significantly associated with the nonatopic uncontrolled severe wheeze compared to the episodic viral wheeze (OR 7.9; CI95% [2.5-25.3]; P = 0.001). Conclusion Association between the TT-genotype of IL-4 rs2070874 polymorphism and a severe phenotype of viral-induced wheeze further underlines the role IL-4 plays in the inflammation pathway leading to viral respiratory infections.

International audience; At present, it is still difficult to distinguish a priori different phenotypes of early-onset asthma in infants, especially to be able to differentiate infants with asthma who are at risk of persistence and severity from those with transient wheezing. It is thus essential to improve the prediction of the prognosis of early-onset asthma because of its high frequency, about 10%, in the pediatric general population. The pulmonary epithelium secretes into the serum a variety of proteins, including some known as pneumoproteins, and these proteins can now be assayed in the serum. Some of them might represent an interesting way in the search of new biomarkers associated with particular asthma phenotypes.; Il reste difficile actuellement de distinguer a priori les différents phénotypes d’asthme du nourrisson, et notamment de distinguer l’asthme à risque de persistance et de sévérité de l’asthme transitoire. Il est essentiel d’améliorer la prédiction du pronostic de l’asthme au cours de l’enfance, car l’asthme à début précoce concerne une proportion non négligeable, environ 10 %, de la population générale pédiatrique. L’épithélium pulmonaire sécrète différentes protéines, dont certaines, appelées pneumoprotéines, sont dorénavant dosables dans le sérum. Certaines d’entre elles pourraient constituer une piste intéressante dans la recherche de biomarqueurs associés aux phénotypes de l’asthme.