Léiomyosarcome de la veine rénale gauche dans un contexte de polyarthrite rhumatoïde sous méthotrexate

RésuméLe léiomyosarcome de la veine rénale est une tumeur maligne exceptionnelle dont la détection est délicate, le traitement mal codifié et le pronostic sombre. Nous décrivons le cas d’une patiente de 68 ans atteinte de polyarthrite rhumatoïde et développant un léiomyosarcome de la veine rénale gauche avec une issue fatale en moins d’un an. L’association à une polyarthrite rhumatoïde traitée par méthotrexate pose donc la question d’une combinaison fortuite ou d’un terrain favorisant compte tenu des études récentes qui tendent à prouver l’association entre ce rhumatisme et certains cancers

Mise en place d’outils d’aide à la prescription des antibiotiques dans les établissements de santé (ES) des Pays de la Loire : création d’un thésaurus régional de protocoles d’antibiothérapie

Date du colloque&nbsp;: 2008</p

Venous thrombosis in immunocompetent patients with acute cytomegalovirus infection: a complication that may be underestimated

In the present study, we retrospectively studied clinical and laboratory findings associated with cytomegalovirus (CMV) infection in immunocompetent patients. We focused on severe CMV infection. Among 38 patients, five had a severe form of infection: one had meningitis, one had symptomatic thrombocytopenia and three had venous thromboses with pulmonary embolism, a rarely described complication. CMV-induced thrombosis has been reported in immunocompromised patients such as transplant recipients and patients with AIDS. Recent case reports have also described thrombotic phenomena in immunocompetent patients with CMV infection. Our study suggests that venous thrombosis during acute CMV infection is an underestimated complication

F-02: Antibiothérapies anti-SARM dans le traitement probabiliste des bactériémies à Staphylococcus aureus au CHU d&#039;Angers

Introduction – objectifs La résistance à la méticilline du Staphylococcus aureus (SA) ne cesse de diminuer en France. Nous avons évalué la prescription des antibiothérapies probabilistes dans les bactériémies à SA et leur impact clinique. Matériels et méthodes Il s’agit d’une étude rétrospective incluant les bactériémies à Staphylococcus aureus sur le CHU d’Angers entre novembre 2012 et septembre 2013 avec recueil de l’antibiothérapie prescrite au rendu « cocci gram (CG)+ », à J5, hospitalisation depuis plus de 5 jours ou dans les six derniers mois, signes de gravité clinique, mortalité à J5. Résultats Nous avons inclus 146 épisodes de bactériémies. A l’annonce de CG+, 10 patients étaient décédés, 38,2 % ont reçu un anti-SARM (n = 52), 54,4 % un anti-SASM (n = 74), 7,4 % aucun antibiotique (n = 10). Parmi les bactériémies à SARM (n = 23), 60,9 % (n = 14) ont reçu une antibiothérapie initiale à visée SARM contre 36,3 % (n = 41) pour les bactériémies à SASM (n = 113) (OR = 2,71, p = 0,03). Cette adaptation semble influencée par une hospitalisation récente (OR = 1,82 ; p = 0,33) et la présence de signes de gravité (OR = 1,87, p = 0,23). Dans 21,4 % (n = 6) des bactériémies à SASM, l’antibiothérapie anti-SARM n’a pas été désecaladée. La mortalité à J5 est 13 %. L’absence d’antibiothérapie dans les 24 premières heures (OR = 2,97 ; p = 0,046) et une prescription de C3G (OR = 5,2, p = 0,05) en monothérapie augmentent le risque de décès à J5. Conclusion L’antibiothérapie initale semble adaptée à l’histoire et la présentation des patients. L’initiation sans délai, la visée staphylococcique et la désescalade sont les éléments importants du traitement

A 59-Year-Old Woman With Chronic Skin Lesions of the Leg

Diagnosis: Acrodermatitis chronica atrophicans

Cytomegalovirus-associated splenic infarcts in a female patient with Factor V Leiden mutation: a case report

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Clinical aspects and prognostic factors of leptospirosis in adults. Retrospective study in France

BackgroundBecause early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of leptospirosis, and determine prognostic factors. Patients and methods This study included all patients treated at Angers University Hospital between January 1995 and December 2005 for leptospirosis – both probable (cases combining epidemiologically suggestive features with compatible clinical, laboratory, and radiographic findings, with no other diagnosis envisioned) and confirmed (by finding microorganism on direct examination or culture of blood, urine or CSF, or by seroconversion or by a significant increase in the antibody titer between two samples). Severe leptospirosis was defined by hospitalization in the critical care department or need for renal dialysis. The statistical analysis used SPSS software version 12. Results Of 97 records reviewed, we retained 62 cases that met the criteria above, including 35 confirmed cases, 27 probable and 15 severe. The sex ratio was nine men for every woman. The patients\u27 mean age was 45 ± 18 years [12–77]. The principal clinical signs observed were: fever (n = 59) with shivering (n = 42), diffuse myalgia (n = 41), headaches (n = 38), jaundice (n = 24), conjunctival suffusion (n = 10), rash (n = 11), herpes eruption (n = 7), renal damage (n = 33) that was sometimes severe (&gt;500 μmol/L) (n = 7), meningitis (n = 12), meningoencephalitis (n = 2), myocarditis or pericarditis (n = 6), and atypical radiographic lung disease (n = 16), sometimes with ARDS (n = 6). Blood tests showed thrombocytopenia (platelets &lt; 140 G/L) in 65.5% of patients (n = 40). Logistic regression modeling showed that two criteria remained independently predictive of development toward severe leptospirosis: clinical jaundice (p = 0.005) and cardiac damage seen either clinically or on ECG (p &lt; 0.02). These factors can be identified easily at the first clinical examination and during evolution, and should help to reduce mortality by allowing earlier management of patients with suspected leptospirosis

Small-bowel necrosis complicating a cytomegalovirus-induced superior mesenteric vein thrombosis in an immunocompetent patient: a case report

<p>Abstract</p> <p>Introduction</p> <p>Superior mesenteric venous thrombosis as a result of acute cytomegalovirus infection is rare, with only a few cases reported in the literature.</p> <p>Case presentation</p> <p>We present the case of a 40-year-old Caucasian man who was admitted to our hospital with a 5-day history of fever. His serological test and pp65 antigen detection of cytomegalovirus were positive, suggesting acute infection. On the sixth day after his admission, the patient complained of acute, progressive abdominal pain. Abdominal computed tomography revealed acute superior mesenteric venous thrombosis. An emergency laparotomy showed diffuse edema and ischemic lesions of the small bowel and its associated mesentery with a 50-cm-long segmental infarction of the proximal jejunum. An extensive enterectomy of about 100 cm of jejunum that included the necrotic segment was performed, followed by an end-to-end anastomosis. Anti-coagulation therapy was administered pre-operatively in the form of small-fractionated heparin and continued postoperatively. The patient had an uneventful recovery and was discharged on the 11th postoperative day.</p> <p>Conclusion</p> <p>Acute cytomegalovirus infection can contribute to the occurrence of mesenteric venous thrombosis in immunocompetent patients. It is important for physicians and internists to be aware of the possible thrombotic complications of cytomegalovirus infection. A high level of clinical suspicion is essential to successfully treat a potentially lethal condition such as superior mesenteric venous thrombosis.</p

The prognosis of streptococcal prosthetic bone and joint infections depends on surgical management-A multicenter retrospective study

BACKGROUND: The optimal treatment of streptococcal prosthetic joint infections (PJIs) is unclear. METHODS: A cohort of streptococcal PJIs was reviewed retrospectively in seven reference centers for the management of complex bone and joint infections, covering the period January 1, 2010 to December 31, 2012. RESULTS: Seventy patients with monomicrobial infections were included: 47 had infections of total hip arthroplasty and 23 had infections of total knee arthroplasty. The median age was 77 years (interquartile range (IQR) 69-83 years), the median Charlson comorbidity score was 4 (IQR 3-6), and 15.6% (n=11) had diabetes. The most commonly identified streptococcal species were Streptococcus agalactiae and Streptococcus dysgalactiae (38.6% (n=27) and 17.1% (n=12), respectively). Debridement, antibiotics and implant retention (DAIR) was performed after a median time of 7 days (IQR 3-8 days), with polyethylene exchange (PE) in 21% of cases. After a minimum follow-up of 2 years, 27% of patients had relapsed, corresponding to 51.4% of DAIR treatment cases and 0% of one-stage (n=15) or two-stage (n=17) exchange strategy cases. Rifampicin or levofloxacin in combination therapy was not associated with a better outcome (adjusted p= 0.99). S. agalactiae species and DAIR treatment were associated with a higher risk of failure. On multivariate analysis, only DAIR treatment and S. agalactiae were independent factors of relapse. Compared to DAIR without PE, DAIR with PE was only associated with a trend towards a benefit (odds ratio 0.33, 95% confidence interval 0.06-1.96; adjusted p= 0.44). CONCLUSIONS: Streptococcal PJIs managed with DAIR have a poor prognosis and S. agalactiae seems to be an independent factor of treatment failure

Acute partial Budd-Chiari syndrome and portal vein thrombosis in cytomegalovirus primary infection: a case report

BACKGROUND: Splanchnic vein thrombosis may complicate inherited thrombotic disorders. Acute cytomegalovirus infection is a rare cause of acquired venous thrombosis in the portal or mesenteric territory, but has never been described extending into a main hepatic vein. CASE PRESENTATION: A 36-year-old immunocompetent woman presented with acute primary cytomegalovirus infection in association with extensive thrombosis in the portal and splenic vein. In addition, a fresh thrombus was evident in the right hepatic vein. A thorough evaluation for a hypercoagulable state was negative. The clinical course, biological evolution, radiological and histological findings were consistent with cytomegalovirus hepatitis complicated by a partial acute Budd-Chiari syndrome and portal thrombosis. Therapeutic anticoagulation was associated with a slow clinical improvement and partial vascular recanalization. CONCLUSION: We described in details a new association between cytomegalovirus infection and acute venous thrombosis both in the portal vein and in the right hepatic vein, realizing a partial Budd-Chiari syndrome. One should be aware that this rare thrombotic event may be complicated by partial venous outflow block