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Background: The efficacy of raltegravir plus optimized background therapy (OBT) has been demonstrated for antiretroviral (ARV)-experienced HIV-1-infected patients in randomized clinical trials. We studied viro-immunological response, pharmacokinetic parameters and genotypic test results in an observational cohort of multiple ARV class-experienced patients starting a raltegravir-based regimen., Methods: Already enrolled ANRS CO3 Aquitaine Cohort patients with virological failure were included in this study after starting a raltegravir-based regimen (400 mg twice a day, week 0). Virological success was defined by the plasma HIV-1 RNA level [viral load (VL)] <2.7 log(10) copies/mL at week 12 and <1.7 log(10) copies/mL at week 24. One patient was excluded from further analysis (no follow-up after week 4)., Results: Fifty-one patients [male/female = 43/8, median age = 48 (interquartile range = 43, 55) years] were included. At week 0, median CD4 count was 244 (110; 310)/mm(3) and median VL was 4.2 (3.6, 4.7) log(10) copies/mL. At week 24, 39 (78%) patients experienced virological success: 4 (44%), 14 (82%) and 21 (87%) patients with a genotypic sensitivity score <1, > or =1 and <2 and > or =2 (P = 0.02), respectively. Raltegravir-related mutations emerged in 9 of 11 failing patients (82%): Q148H/R (n = 5), N155S/H (n = 3) and S230N (n = 1). Median CD4 increases from week 0 to week 4 and week 24 were 28 (-4, 85) and 57 (0, 156) cells/mm(3), respectively. A poor immune response was independently associated with a lower VL decline (week 0 to week 12) [odds ratio (OR): 3.5, 95% confidence interval (CI): 1.4, 8.4, for 1 log(10) less] and CD4+% at baseline (OR: 2.6, 95% CI: 0.97, 8.3, for 10% lower)., Conclusions: Raltegravir plus OBT provided a good virological success rate in highly pre-treated patients under clinical routine conditions.

Polyarteritis nodosa (PAN) is a systemic vasculitis whose severe forms are treated with glucocorticoids and cyclophosphamide. Refractory patients are exposed to many complications, notably accelerated atherosclerosis. We report a case report of 71-year-old man followed for polyarteritis nodosa refractory to glucocorticoids and cyclosphosphamide. Systemic vasculitis relapses are followed to accelerated atherosclerosis: severe ischemic lesions led to amputation of lower limbs. Remission of refractory PAN is obtained with rituximab. Disappearance of biological inflammatory is allowed to regression of ischemic lesions in upper limbs. In this situation, we recommend a systematic vascular work-up for patients suffered from refractory vasculitis. On the other hand, therapeutic trials are needed to determine the real efficacy and place of rituximab in the treatment of polyarteritis nodosa.

Giant cell arteritis, a large-sized vessel vasculitis, may be associated with musculoskeletal proximal (polymyalgia rheumatica) or distal manifestations. A 68-year-old woman, who had inflammatory pelvic girdle pain, was diagnosed with giant cell arteritis and was successfully treated with corticosteroids. The magnetic resonance imaging and ultrasonography revealed a bilateral bursitis and pelvic girdle enthesopathy. Bursitis is the main anatomic lesion occurring in polymyalgia rheumatica and can be underlined by ultrasonography.

Symptoms and signs that point to immunodeficiency are numerous and various. Recurrent history, unusual pathogens or severe course of infections should alert any physician to potential immunodeficiency state. If infections are the hallmark of immunodeficiency, other manifestations such as autoimmune diseases or particular malignancies can be a presenting feature of immunodeficiency. If many primary or secondary immunodeficiencies are well defined, it is important for the general practitioners to know that a large number of underlying conditions can lead to immunodeficiency states.

Introduction: Hypercalcemia frequently occurs in the course of Adult T-cell leukemia/lymphoma (ATLL). We report the first case of acute pancreatitis revealing ATLL., Exegesis: A 41-year-old woman, without medical history, presented with acute pancreatitis. Physical examination found recent loss of weight, hepatosplenomegaly and generalised lymphoadenopathy. Biochemical tests showed severe hypercalcemia and the peripheral white blood cell count revealed an atypical lymphocytosis. ATLL was diagnosed by immunophenotypic and morphological analysis of circulating lymphocytes, bone marrow and lymphatic node biopsy. Level of serum parathyroid hormone-related protein was not increased. We discuss the mechanism of hypercalcemia in this context., Conclusion: In spite of the high prevalence of hypercalcemia in ATLL, acute pancreatitis revealing this pathology is an exceptional condition.

Background: Severe community acquired pneumonia is a common cause of acute respiratory failure. The influenza virus itself can cause a severe pneumonia and non-respiratory illness., Case Report: A physician developed an acute respiratory failure associated with hemolytic anemia, acute renal failure, and myocarditis. Influenza A infection was diagnosed by screening for antibodies (complement fixation, ELISA Ig A)., Discussion: Fulminant influenza pneumonia is a rare clinical presentation of influenza infection and usually has a severe clinical course. Influenza infection is also associated with myositis, myocarditis, acute renal failure, encephalopathy, and hemolytic anemia. Rapid laboratary diagnosis can be made by PCR or immunofluorescence applied directly to respiratory specimens. Antiviral treatment did not prove its efficacy in fulminant Influenza. This case report is an opportunity to stress the importance of seroprophylaxis by parenteral vaccination in exposed occupations.

An Antopol-Goldman lesion or subepithelial pelvic hematoma of the kidney is a rare cause of hematuria. We described a 26 year-old man hospitalized for macroscopic hematuria associated with a subepithelial hematoma whose development might have been favored by arterial hypertension secondary to a renal artery stenosis.

Purpose: To describe the clinical and radiographic features of patients with primary localized amyloidosis of the urinary tract., Methods: We report a case of localized amyloidosis of the ureters and bladder. The medical records of four other cases from the French Register of localized amyloidosis were reviewed., Results: The mean age of three men and two women was 53 years. All patients presented with gross hematuria, four patients presented with renal colic, only one patient had irritative lower urinary tract symptoms. Ureter and bladder were involved in three patients, both ureters in two patients and the bladder only, in one patient. Clinical and radiographic presentations mimicked a neoplasia excluded by histologic analysis. Immunohistochemical study was performed in only two cases and revealed lambda light chain amyloidosis. The median follow-up was eight years. Various treatments were performed, and recurrences occurred in two cases. None of the five patients developed monoclonal gammapathy or systemic amyloidosis., Conclusion: Primary localized amyloidosis of the urinary tract is a rare disorder and can easily be confused with a neoplasm. The physiopathology is unknown, the prognosis is usually good. There is no specific treatment, and repeated work-up for systemic amyloidosis is unnecessary as local recurrences appear to be the main complication.