Ischémie digitale après injection d'un comprimé pilé de zolpidem, amélioration tardive par l'iloprost

L'injection intra artérielle de comprimés écrasés, puis dissous, peut entraîner de graves troubles de la vascularisation des extrémités, allant parfois jusqu'à la nécrose. Un homme de 35 ans est hospitalisé suite à l'injection involontaire dans l'artère radiale d'un comprimé de zolpidem pilé et solubilisé. Il s'ensuivra une ischémie des doigts de la main droite. Le traitement initial par héparine et vasodilatateurs s'avérant insuffisant, des cures d'iloprost seront entamées. Elles permettront une nette régression des troubles et seule la dernière phalange du majeur devra être amputée. Parmi les traitements disponibles, l'iloprost a déjà été utilisé avec succès pour traiter plusieurs cas d'ischémie après injection intra artérielle de divers produits d'abus. Il peut permettre de limiter l'ischémie, voire une guérison ad integrum des zones de nécroses et constitue une alternative thérapeutique à envisager

Anti-PD1 and Anti-PDL1-Induced Hypophysitis: A Cohort Study of 17 Patients with Longitudinal Follow-Up

International audienceHypophysitis, secondary to programmed cell death 1 protein (PD1) and programmed cell death 1 ligand 1 (PDL1) inhibitors, were thought to be rare, with only a few studies describing more than one case with long-term follow-up. The aim of the present study was to describe the clinical, laboratory, and morphological characteristics of PD1/PDL1 inhibitor-induced hypophysitis, and its long-term course. This cohort study was conducted at the University Hospital of Lyon, France, with longitudinal follow-up of patients. Seventeen cases of PD1/PDL1 inhibitor-induced hypophysitis were included. The median time to onset of hypophysitis was 28 weeks (range: 10-46). At diagnosis, 16 patients complained of fatigue, 12 of nausea or loss of appetite, while headache was rare. We found no imaging pituitary abnormality. All patients presented adrenocorticotropic hormone (ACTH) deficiency; other pituitary deficiencies were less common (n = 7). At last follow-up (median: 13 months), ACTH deficiency persisted in all but one patient and one patient recovered from gonadotropic deficiency. PD1/PDL1 inhibitor-induced hypophysitis is a clinical entity different from those associated to cytotoxic T-lymphocyte antigen-4 (CTLA4) inhibitors, with less obvious clinical and radiological signs, and probably a different mechanism. The paucity of symptoms demonstrates the need for systematic hormonal follow-up for patients receiving PD1/PDL1 inhibitors

Wire brushing wood furniture associated, granulomatosis and microscopic mineralogical analysis

There is increasing evidence that sarcoidosis can occur in workplaces in which there is exposure to inorganic triggers (1-3). Moreover, transmission electron microscopy (TEM) and energy dispersive X-ray (EDX) analysis may contribute to identifying micro and/or nanoparticles in granulomatous tissues (4-6) and, out of the workplace, hobby activities may also involve dangerous exposure. Our case shows the possibility of correlating abnormal exposure and inorganic particles identified in granuloma by TEM and EDX analysis (...)

Wire brushing wood furniture associated, granulomatosis and microscopic mineralogical analysis

There is increasing evidence that sarcoidosis can occur in workplaces in which there is exposure to inorganic triggers (1-3). Moreover, transmission electron microscopy (TEM) and energy dispersive X-ray (EDX) analysis may contribute to identifying micro and/or nanoparticles in granulomatous tissues (4-6) and, out of the workplace, hobby activities may also involve dangerous exposure. Our case shows the possibility of correlating abnormal exposure and inorganic particles identified in granuloma by TEM and EDX analysis (...)