Streptococcus pyogenes necrotizing soft tissue infection following glucose monitoring with FreeStyle Libre device

International audienc

[Retroperitoneal fibrosis in adults: Main characteristics and relevance of the diagnostic procedures based on a retrospective multicenter study on 77 cases]

INTRODUCTION: Retroperitoneal fibrosis (RPF) is a rare disorder characterized by the sheathing of retroperitoneal structures by fibro-inflammatory process. It can be either isolated or associated with an underlying disease or condition. In the absence of consistent and consensual approach, the objective of this study was to assess the relevance of diagnostic tests performed during the diagnostic work-up of RPF. METHODS: Seventy-seven patients were included in this retrospective multicenter study. The diagnosis of RPF was defined by the presence of a thickened circumferential homogeneous tissue unsheathing the infrarenal aorta, excluding peri-aneurysmal fibrosis and a clear evidence of a cancer. RESULTS: In 62 cases (80.5%), the RPF was considered as being primary or "idiopathic". Surgical (n=31) or CT-guided (n=9) biopsies of the RPF were performed in half of the patients showing some fibrotic or non-specific inflammatory lesions in 98% of cases. A bone marrow biopsy was performed in 23 patients leading to diagnosis of low grade B cell non-Hodgkin lymphoma in a single patient who also had a monoclonal gammopathy IgM. The systematic search for autoantibodies or serum tumor markers was of no diagnostic value. CONCLUSIONS: Although the diagnostic procedure was heterogeneous, no cause or associated disease was found in the majority of cases of FRP in this series. In the absence of any clinical or paraclinical evidence suggesting an underlying disease or any atypical features at presentation, a number of non-invasive tests (autoantibodies, tumor markers, bone scintigraphy) and also more invasive diagnostic tests (bone marrow and RPF biopsies) seem of little relevance

Rituximab associated vasculitis flare: incidence, predictors and outcome

International audienceTo report the incidence, predictor, and outcome of rituximab-associated autoimmune disease flare.METHODS: We conducted a retrospective study in a tertiary referral centre from 2005 to 2015. Disease flare was defined as the onset of a new organ involvement or worsening of autoimmune disease, within 4 weeks following rituximab.RESULTS: Among the 185 patients, we identified 7 (3.4%) disease flares. All were due to type II mixed cryoglobulinemia vasculitis. Vasculitis flare occurred after a median time of 8 [2; 16] days following rituximab infusion and included acute kidney insufficiency (n=7), purpura (n=7), gastrointestinal tract involvement (n=4), and myocarditis (n=1). Patients with rituximab-associated cryoglobulinemia vasculitis flare had more frequently renal involvement (p=0.008), B cell-lymphoproliferation (p=0.015), higher level of cryoglobulin (2.1 vs 0.4 g/l, p=0.004) and lower level of C4 level (0.02 vs 0.05, p=0.023) as compared to patients without flare after rituximab (n=43). Four patients (57%) died after a median time of 3.3 months. The 1-year survival rate was poorer in patients with vasculitis flare after rituximab as compared to their negative counterpart [43% (95% CI: 18-100) vs 97% (95% CI: 92-100), p<0.001]. Immunofluorescence analysis of kidney biopsy in patients with rituximab associated vasculitis worsening highlighted the presence of rituximab, IgM, and IgG1 positive staining of endomembranous deposits and thrombi within kidney lesions.CONCLUSION: Rituximab-associated involves cryoglobulinemia vasculitis and is associated with high mortality rate. We provided evidence that kidney lesions are due to immune complex deposition and to glomerular obstruction by cryoglobulinemia and rituximab

Des hommes et des bêtes

De la création d'une race chevaline à l'alimentation carnée, en passant par les combats de coq ou les "mémères à chats" du Père-Lachaise, sont ici réunies une série d'analyses sur l'importance et la signification de pratiques liées au monde animal, en milieu rural comme en milieu urbain