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Resume La leucocidine Panton-Valentine est un facteur de virulence majeur produit par certaines souches de Staphylococcus aureus (SA-PVL). L’infection invasive la mieux decrite demeure la pneumonie necrosante hemorragique. L’epanchement pleural n’est pas rare mais toujours associe a une lesion parenchymateuse. Ici, nous rapportons une pleuresie hemorragique imputable a SA-PVL isolee.

Objectives To determine whether hydroxychloroquine decreases the risk of adverse outcome in patients with mild to moderate coronavirus disease 2019 (COVID-19) at high risk of worsening. Methods We conducted a multicentre randomized double-blind placebo-controlled trial evaluating hydroxychloroquine in COVID-19 patients with at least one of the following risk factors for worsening: need for supplemental oxygen, age ≥75 years, age between 60 and 74 years and presence of at least one co-morbidity. Severely ill patients requiring oxygen therapy >3 L/min or intensive care were excluded. Eligible patients were randomized in a 1:1 ratio to receive either 800 mg hydroxychloroquine on day 0 followed by 400 mg per day for 8 days or a placebo. The primary end point was a composite of death or start of invasive mechanical ventilation within 14 days following randomization. Secondary end points included mortality and clinical evolution at days 14 and 28, and viral shedding at days 5 and 10. Results The trial was stopped after 250 patients were included because of a slowing down of the pandemic in France. The intention-to-treat population comprised 123 and 124 patients in the placebo and hydroxychloroquine groups, respectively. The median age was 77 years (interquartile range 58–86 years) and 151/250 (60.4%) patients required oxygen therapy. The primary end point occurred in 9/124 (7.3%) patients in the hydroxychloroquine group and 8/123 (6.5%) patients in the placebo group (relative risk 1.12; 95% CI 0.45–2.80). The rates of positive SARS-CoV-2 RT-PCR tests at days 5 and 10 were 72.8% (75/103) and 57.1% (52/91) in the hydroxychloroquine group, versus 73.0% (73/100) and 56.6% (47/83) in the placebo group, respectively. No difference was observed between the two groups in any of the other secondary end points. Conclusion In this underpowered trial involving mainly older patients with mild to moderate COVID-19, patients treated with hydroxychloroquine did not experience better clinical or virological outcomes than those receiving the placebo. Trial registration ClinicalTrials.gov Identifier: NCT04325893 ( https://clinicaltrials.gov/ct2/show/NCT04325893 ).

Resume Introduction Les anomalies de l’hemostase chez le patient lupique sont majoritairement de nature thrombotique mais plus rarement hemorragique. Observation Nous rapportons le cas d’un homme de 25 ans presentant un syndrome d’activation macrophagique revelateur d’un lupus erythemateux systemique et complique secondairement d’un syndrome hemorragique avec un allongement du temps de thrombine et du temps de cephaline activee, corriges in vitro par l’ajout de protamine, confirmant ainsi la presence d’un anticoagulant « heparine-like ». Le bilan d’hemostase s’est normalise apres traitement specifique du lupus. Conclusion Cette anomalie rare du bilan d’hemostase est connue dans les hemopathies et cancers solides. Il s’agit de la premiere description au cours d’un lupus. Apres un an de recul, aucun diagnostic d’hemopathie ou de neoplasie solide n’a ete porte.

International audience; OBJECTIVES:To describe the features and outcomes of patients with giant cell arteritis who developed venous thrombosis.METHODS:Inception cohort study including 428 newly diagnosed patients of giant cell arteritis from 1976 to 2014. Clinical and biological data and outcomes were analysed by comparing patients with and without venous thrombosis.RESULTS:Twenty-six patients (6%) developed venous thrombosis, 12 of whom presented with pulmonary embolism. The mean time between the onset of giant cell arteritis symptoms and venous thrombosis occurrence was 248.8±215.0 days. No difference was observed between the two groups in clinical or laboratory data collected at diagnosis. The mean time from the start of prednisone to venous thrombosis diagnosis was 187.7±217.0 days. The average dose of prednisone at venous thrombosis onset was 21.5mg/day. The venous thrombosis group had a higher number of glucocorticoid-related adverse effects (mean, 3.1 vs 1.1; P

Background Campylobacter fetus infections usually occur in immunodepressed patients or patients presenting with diabetes mellitus or cancer. They rarely cause diarrhea but frequently cause bacteremia or vascular diseases. The therapeutic management is not well codified and fluoroquinolone resistance is continuously increasing. Methods We conducted a retrospective study of C. fetus infections from January 2007 to August 2013 at the Limoges teaching hospital. The infections were defined by at least 1 bacteriological sample positive for C. fetus. Results Twenty patients were included (15 men), with an average age of 73 years (43–91). Sixteen presented with cancer, 12 with solid cancer including 9 of the urinary tract, and 9 patients with hematologic diseases. Five patients presented with diabetes mellitus, 9 with isolated bacteremia, 3 with cellulitis, and 3 with septic arthritis. The diagnosis was made by blood cultures for 17 patients. Twenty percent of the isolates were resistant to amoxicillin and 30% to fluoroquinolones. The therapeutic regimens and the treatment duration were quite different. The outcome was unfavorable for 3 patients whose implanted port had not been removed and 1 with subdural hematoma infection. 1 patient died. Conclusions C. fetus infection occurs in case of underlying diseases, most frequently promoting urinary tract cancer. Fluoroquinolones must not be used without susceptibility testing and catheters should be removed.

International audience; Introduction. FibroScan, a non-invasive tool for measuring liver stiffness (LS), is not specific to liver fibrosis. Other extra-hepatic conditions may modify the LS value. Objectives. Our aim was to examine whether amyloid deposition in the liver may modify LS. Methods. LS was measured prospectively in 41 patients with systemic AL amyloidosis (AL) in the French AL Reference Center, comprising: 5 patients with liver involvement (LI) and no cardiac involvement (CI), 11 with CI and no LI, 12 with both LI and CI and 13 with neither (2005 consensus criteria); 26 negative controls, 50 patients infected with Hepatitis C virus (HCV)-infected and 18 AL-free patients with right-sided heart disease ('cardiac controls') were also examined. Results. Median LS was significantly higher in patients with AL with liver involvement [27.4 (10.3-75) kPa] than in negative controls [4.8 (2.8-11.9) kPa] (p 17.3 kPa is suggestive of AL hepatic disease in patients with non-fibrotic liver changes, and may have diagnostic value in patients with known AL.

Nous rapportons la seconde description endoscopique d’infection a Listeria mocoytogenes, chez un patient de 30 ans suivi pour une rectocolite hemorragique et traite par azathioprine. L’endoscopie montrait la presence d’ulcerations aphtoides. L’evolution fut favorable avec une antibiotherapie adaptee. Il s’agit d’une complication infectieuse rare mais devant etre connue des patients porteurs deMICI et traites par immunosuppresseurs, notamment l’azathioprine.

Background Prostatic abscesses are an uncommon disease usually caused by enterobacteria. They mostly occur in immunodeficient patients. It is thus extremely rare to have a Staphylococcal prostatic abscess in a young immunocompetent patient. Case presentation A 20-year-old patient was treated with ofloxacin for a suspicion of prostatitis. An ultrasonography was performed because of persisting symptoms and showed acute urinary retention and prostatic abscesses. So the empirical antibiotic therapy was modified with ceftriaxone/amikacin. The disease worsened to severe sepsis and the patient was admitted in ICU. CT-scan and MRI confirmed three abscesses with perirectal infiltration and the bacteriological samples (abscesses and blood cultures) were positive to methicillin-susceptible Staphylococcus aureus producing Panton-Valentine leukocidine. The treatment was changed with fosfomycin/ofloxacin which resulted in a general improvement and the regression of the abscesses. Conclusion Staphyloccocus aureus producing Panton-Valentine leukocidin are most commonly responsible for skin and soft tissue infections. To this day, no other case of prostatic abscess due to this strain but susceptible to methicillin has been described. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-466) contains supplementary material, which is available to authorized users.

Objectives Curbside consultation (CC) of infectious diseases specialists for advice is very frequent but the corresponding workload has rarely been assessed. This activity is mostly oral (phone or direct contact) and poorly quantifiable because it is not charged. We had for aim to evaluate this activity in a French teaching hospital. Methods We recorded all CCs given during a 2.5-year period, from mid-2011 to the end of 2013. Results During the study period, 6789 CCs were recorded (2715 per year), or slightly more than 10 per day. These CCs were divided in 676 travel recommendations and 6113 for other reasons. They were mostly given by phone (77.4%). Most demands came from our hospital (61.4%), followed by community family physicians and specialist (27.1%), other local hospitals (6.5%) and clinics (4.3%). All the departments in our hospital consulted us for advice at least once and answers were mainly given by phone (70.1%) and at bedside (30.5%). The answers were principally advice (50.8%), modification of antibiotic prescription (22.9%), initiation of antibiotic course (14.8%), maintaining the same treatment (6.2%), and stopping antibiotics (4.3%). CCs accounted for 20% of clinical work for 1 physician. If the CCs in our hospital had been paid, our department would have received an additional 77,000 € in revenue. Conclusion This curbside activity is very important and time-consuming for infectious diseases specialists, but it is currently not acknowledged or rewarded.

Although a glucocorticoid (GC)-sparing strategy is needed for patients with giant cell arteritis (GCA) suffering from refractory disease or serious treatment-related complications, evidence of efficacy in this setting of immunosuppressive drugs and biotherapies is lacking. Herein, we evaluated the GC-sparing effects and tolerability of addition of dapsone (DDS) to prednisone therapy in patients with GCA. We retrospectively assessed data on 18 GCA patients who received DDS as a first-line treatment (DDS-1 group) and 52 patients who received it as a second- or third-line treatment for refractory GCA, with or without excessive GC-related toxicity (DDS-2 group). Of these 70 patients, 63 belonged to an inception cohort of 478 patients, whereas the remaining 7 were referred to our department for resistant GCA. In all, 52 patients were assessable for DDS efficacy. The baseline characteristics of the DDS-1 patients were similar to those of 395 GCA patients (control group) who received prednisone alone. DDS-1 patients had a more sustained decrease in GC dose with a lower mean prednisone dose at 12 months, and they comprised higher proportions who achieved GC withdrawal within the first year, who stopped prednisone treatment, and who recovered from GCA (P

Background Cardiac tamponade is a rare but severe complication of pericardial effusion with a poor prognosis. Prompt diagnosis using transthoracic echocardiography allows guiding initial therapeutic management. Although etiologies are numerous, cardiac tamponade is more often due to a hemopericardium. Rarely, a coronary injury may result in such a hemopericardium with cardiac tamponade. Coronary artery aneurysm are the main etiologies but blunt, open chest trauma or complication of endovascular procedures have also been described. Case presentation A 83-year-old hypertensive man presented for dizziness and hypotension. The patient had oliguria and mottled skin. Transthoracic echocardiography disclosed a circumferential pericardial effusion with a compressed right atrium, confirmed by contrast-enhanced thoracic CT scan. A pig-tail catheter allowed to withdraw 500 mL of blood, resulting in a transient improvement of hemodynamics. Rapidly, recurrent hypotension prompted a reoperation. An active bleeding was identified at the level of the retroventricular coronary artery. The pericardium was thickened with several "sharping" calcified plaques in the vicinity of the bleeding areas. On day 2, vasopressors were stopped and the patient was successfully extubated. Final diagnosis was a spontaneous cardiac tamponade secondary to a coronary artery injury attributed to a "sharping"calcified pericardial plaque. Conclusion Cardiac tamponade secondary to the development of a hemopericardium may develop as the result of a myocardial and coronary artery injury induced by a calcified pericardial plaque.

Abstract 4894 Background Liver involvement is frequent in AL amyloidosis patients, and is found in 70% of cases in autopsy series. Histologic diagnosis of amyloid deposition is mandatory, preferably by biopsies of non-hepatic tissue, liver biopsy being associated with an increased risk of bleeding. FibroScan, a non invasive method for measuring liver stiffness, is used to measure liver fibrosis in patients with viral hepatitis. We postulated that amyloid liver deposition in AL could enhance liver stiffness and that may help for the diagnosis of liver amyloidosis. Methods 41 consecutive AL patients with systemic disease seen at the French Reference Center for AL amyloidosis were analyzed: 17 had liver AL, 23 cardiac AL, and 13 no liver or cardiac involvement according to the criteria defined by the Tours Consensus Opinion on Amyloidosis (2005). All had liver stiffness measured by FibroScan simultaneously with 76 controls: 16 healthy controls, 10 multiple myeloma and 50 consecutive patients chronically infected with hepatitis C virus (HCV). According to the manufacturer's criteria, liver stiffness was interpretable in 32 (78%) of AL patients and in 68 (89%) of the control group. The Mann Whitney test with Bonferroni correction for multiple comparisons was used to compare the interpretable liver stiffness values between the groups. Results The liver stiffness was not statistically different between the healthy (median 4,6 range 2,8-6,5 KPa) and the myeloma controls (median 5,4 range 3,3-11,9 KPa) and both were considered as the negative control group. The negative control group had a liver stiffness significantly different from the HCV group (median 6,8 range 2,9-69,1 KPa, p Conclusion FibroScan is a useful non invasive tool which may suggest that a patient with undefined signs (enlarged liver, asymptomatic cholestasis, isolated monoclonal gammopathy) has liver amyloidosis and may help to define liver involvement in patients with proven amyloidosis, especially when liver stiffness reaches the cut-off value of 17,5 KPa. Disclosures No relevant conflicts of interest to declare.

Objectif Notre etude a pour objectif d’evaluer notre prise en charge des RRC par CPA [1, 2] et de proposer une nouvelle echelle d’evaluation des lesions endoscopiques et sa correlation therapeutique afin d’optimiser la procedure. Patients et Methodes 34 patients ont ete inclus de facon retrospective entre 2002 et 2008 dans notre service d’endoscopie digestive. La CPA etait realisee en per endoscopique avec ou sans anesthesie apres preparation par voie haute de type PEG, puis un suivi clinique et endoscopique systematique etait mis en place. Resultats Le score clinique de Chutkan initial de 3,09 etait de 0,57 apres CPA, le taux d’hemoglobine a augmente de 1,7 g/dL et aucun patient n’a eu besoin de transfusion apres notre prise en charge. Le score endoscopique est ameliore de 2,3 points (p Discussion Nos resultats, conformes a la litterature, confirment l’efficacite de la CPA sur les lesions de RRC. Elle permet de traiter tous les stades de lesions de RRC par spotting ou par balayage, en vision directe ou retro bequillage. Nous n’avons pas retrouve de facteur predictif d’efficacite ou d’echec de la CPA, lie aux antecedents cardiovasculaires, a la prise d’un traitement anti-hemostatique, ni a la prise en charge princeps du cancer (radiotherapie, chirurgie, chimiotherapie ou hormonotherapie). Le risque de complications est augmente si D > 0,8 L/mn ou P > 50 W, sans modification d’efficacite. Conclusion L’utilisation prospective, a chaque seance, de cette nouvelle echelle des lesions endoscopiques de RRC pourrait permettre de juger, selon des criteres objectifs, du stade initial et de l’amelioration des lesions. L’application de la CPA se ferait en fonction du stade endoscopique trouve, minimisant ainsi la survenue de complications (ulcere, microrectie) en optimisant le traitement.