La Revue de médecine interne
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Primary systemic vasculitides, mainly of the small and medium-sized vessels, are frequently associated with peripheral neuropathies. When the disease is already known, the appearance of a neuropathy should suggest a specific injury, especially when associated with other systemic manifestations. ⋯ Several elements orient the etiological diagnosis and allow to eliminate the main differential diagnosis: non systemic vasculitic neuropathy. The existence of associated systemic manifestations (glomerular or vascular nephropathy, interstitial lung disease, intra-alveolar hemorrhage, ENT involvement…), biological markers (ANCA, cryoglobulinemia, rheumatoid factor), and invasive examinations allowing histological analysis (neuromuscular biopsy) are all useful tools for.
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Review
[Human immunodeficiency virus and venous thromboembolism: Role of direct oral anticoagulants].
Nowadays, thanks to highly active antiretroviral therapy (HAART), human immunodeficiency virus (HIV) infection is transforming into a chronic disease. The life expectancy of people living with HIV (PWH) has increased, as well as their risk of developing several co-morbidities, in particular cardiovascular diseases. In addition, the incidence of venous thromboembolism (VTE) is increased in PWH with a 2 to 10 times higher incidence when compared to the general population. ⋯ DOACs are substrates of the transport protein P-glycoprotein and/or of isoforms of cytochromes P450 pathway, which can be affected by some antiretroviral drugs. Limited guidelines are available to assist physicians with the complexity of those drug-drug interactions. The aim of this paper is to provide an updated review on the evidence of the high risk of VTE in PWH and the place of DOAC therapy in this population.
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Case Reports
[A vertebral polymicrobial osteomyelitis with atypicial microorganisms: A case report].
Vertebral Osteomyelitis (VO) is a rare disease, which has seen a gradual increase in its incidence over the past years. Here, we report a case, showing how difficult it can be to diagnose and manage a therapy in case of atypical microorganism. ⋯ In the face of this multi-microbial VO with atypicals microorganisms, a first PNB could have been discussed despite the positive blood cultures. This case report illustrates the complexity of management of VO, and its evolution according to the latest recommendations (interest of RMI during the follow-up, place of the TEP-scan, terms and conditions of immobilization, antibiotic administration methods).
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Case Reports
[Severe cytomegalovirus-associated protein losing gastropathy in an immunocompetent adult].
Clinical expression of cytomegalovirus (CMV) infection is numerous and depends on the immune status of the host. In immunocompromised patients, CMV disease corresponds to reactivation of the virus with tissue damage responsible for significant morbidity and mortality. In immunocompetent adults, primary CMV infection is usually asymptomatic but may rarely result in severe organ damage. ⋯ Severe CMV organ involvement in the immunocompetent patient is very rare but potentially serious. Digestive involvement complicated by exudative enteropathy is possible. Evolution is usually favorable without the need for antiviral treatment.