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International audience; Rationale:Whether severe coronavirus disease (COVID-19) is a significant risk factor for the development of invasive fungal superinfections is of great medical interest and remains, for now, an open question.Objectives: We aim to assess the occurrence of invasive fungal respiratory superinfections in patients with severe COVID-19.Methods: We conducted the study on patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related pneumonia admitted to five ICUs in France who had respiratory and serum sampling performed for specific screening of fungal complications.Measurements and Main Results: The study population included a total of 145 patients; the median age was 55 years old. Most of them were male (n = 104; 72%), were overweight (n = 99; 68%), and had hypertension (n = 83; 57%) and diabetes (n = 46; 32%). Few patients presented preexisting host risk factors for invasive fungal infection (n = 20; 14%). Their global severity was high; all patients were on invasive mechanical ventilation, and half (n = 73, 54%) were on extracorporeal membrane oxygenation support. Mycological analysis included 2,815 mycological tests (culture, galactomannan, β-glucan, and PCR) performed on 475 respiratory samples and 532 sera. A probable/putative invasive pulmonary mold infection was diagnosed in 7 (4.8%) patients and linked to high mortality. Multivariate analysis indicates a significantly higher risk for solid organ transplant recipients (odds ratio, = 4.66; interquartile range, 1.98–7.34; P = 0.004). False-positive fungal test and clinically irrelevant colonization, which did not require the initiation of antifungal treatment, was observed in 25 patients (17.2%).Conclusions: In patients with no underlying immunosuppression, severe SARS-CoV-2–related pneumonia seems at low risk of invasive fungal secondary infection, especially aspergillosis.

Introduction Syphilis is reemerging in certain populations, such as in men who have sex with men in particular. Oral manifestations are not uncommon and can render diagnosis difficult, particularly if occurring in isolation. Materials and methods We recovered clinical data for all patients receiving a diagnosis of secondary syphilis who were referred to the National Reference Center for Syphilis in Paris, France, from January 2000 to July 2019. We selected patients presenting oral symptoms only and analyzed their general characteristics, time to diagnosis, and clinical presentations. Results Secondary syphilis was diagnosed in 206 patients, 38 of whom (18%) presented oral manifestations, which were isolated in 14 patients (37%). The main oral manifestations were subacute erosive or ulcerative lesions (55%), mucous patches on the tongue (53%), and nodular (10%) and leukokeratotic lesions (5%). Mean time to diagnosis was 4.5 months, but was significantly longer for patients with isolated oral symptoms (8.8 vs 1.8 months; P = .02). Conclusion Oral presentations of secondary syphilis are frequent and challenging for diagnosis, even in patients with epidemiologic risk factors. Clinicians confronted with subacute oral lesions in such patients should bear in mind the possibility of this contagious, curable, and sometimes severe disease.

International audience

Resume Les histiocytoses sont un groupe heterogene de maladies caracterisees par l’accumulation d’histiocytes dans des organes varies. La mise en evidence d’anomalies moleculaires somatiques dans certaines d’entre elles a conduit a une nouvelle classification. Nous detaillons dans cette revue les atteintes osseuses des histiocytoses du groupe L (histiocytose Langerhansienne (HL) et maladie d’Erdheim-Chester (MEC)) et de la maladie de Destombes-Rosai-Dorfman (DRD). Les atteintes osseuses de l’HL sont constituees essentiellement d’atteintes lytiques, uni ou multifocales, hypermetaboliques sur la scintigraphie ou la tomodensitometrie par emission de positons (TEP) au 18 fluorodeoxyglucose (FDG), touchant principalement les os plats et les vertebres et plus rarement les membres, avec un risque fracturaire. La MEC est caracterisee par une atteinte metaphyso-diaphysaire des os longs, presente dans plus de 90 % des cas, et constituant une atteinte iconique de la maladie. Les douleurs osseuses peuvent etre revelatrices de la MEC. La maladie de DRD est caracterisee par une atteinte osseuse multifocale des membres ou du rachis, associee dans les formes typiques a des atteintes ganglionnaires. Les traitements different dans ces 3 types d’histiocytoses et vont d’une abstention therapeutique a des chimiotherapies dans l’HL, de traitements immunomodulateurs a des therapies ciblees dans la MEC et d’une corticotherapie a des chimiotherapies dans la maladie de DRD.

Invasive pulmonary aspergillosis is a complication in critically ill patients with acute respiratory distress syndrome, especially those with severe influenza pneumonia. We report a fatal case of invasive pulmonary aspergillosis in an immunocompetent patient in France who had severe coronavirus disease–associated pneumonia.

Background Fever is a deceptive feature of autoimmune disorders. Although cases of MOG-IgG associated disorders (MOGAD) were rarely associated with fever, this association was not specifically described. Methods We report a case of MOGAD revealed by weeks of fever and meningitis. We reviewed the current literature to describe the association between fever and MOGAD. Results We analyzed 146 cases from the literature including ours. Fever was associated with 39% of MOGAD attacks and lasted more than a week in 74%. Fever was strongly associated with brain and spinal cord attacks, and with meningitis. Conclusion Among the various features of MOGAD, fever is a highly prevalent associated symptom that should be kept in mind.