Le théorème de Pythagore face au lit

International audienc

Dermatomyosites (DM) à anticorps anti-Mi2 revisitées : DM pure avec nécrose musculaire et haut risque de malignité associée

International audienc

Anti-Mi2 dermatomyositis revisited: pure DM phenotype with muscle fiber necrosis and high risk of malignancy

IF 2.969International audienceAnti-Mi2 are dermatomyositis-specific autoantibodies (Aabs) that have been associated, in small cohorts, with a good prognosis possibly related to a lower malignancy risk. Our objective was to describe the phenotype of anti-Mi-2 dermatomyositis (DM) in a larger cohort. A national multicenter retrospective cohort study was performed including all patients with a clinical phenotype suggestive of DM (cutaneous manifestations and/or muscle involvement) and a positive anti-Mi2 Aabs. Medical records were retrospectively reviewed to assess clinical and histological features, and presence of cancer occurring ± 3 years of diagnosing myositis (CAM)

Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs

International audiencePurpose: To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone.Methods: LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes.Results: The 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations.Conclusions: Severe leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis