Pascal Brochot

Tuberculose lors d'un traitement par agents inhibiteurs du TNF alpha

Key points The clinical forms of tuberculosis that occur during anti-TNFα treatment are frequently extrapulmonary or even disseminated and life-threatening. The paradoxical reactions that can occur under appropriate treatment after stopping TNFα inhibitors raise the question of an immune restoration phenomenon. Adverse drug reaction reporting and epidemiologic studies, despite their methodological limitations, appear to show an excess risk of tuberculosis. Experimental studies reinforce these data. The French drug agency (Afssaps) has issued guidelines for the prevention and management of tuberculosis occurring under anti-TNFα treatment. Analogous guidelines in Spain led to a reduction in the incidence of these cases.The clinical forms of tuberculosis that occur during anti-TNFalpha treatment are frequently extrapulmonary or even disseminated and life-threatening. The paradoxical reactions that can occur under appropriate treatment after stopping TNFalpha inhibitors raise the question of an immune restoration phenomenon. Adverse drug reaction reporting and epidemiologic studies, despite their methodological limitations, appear to show an excess risk of tuberculosis. Experimental studies reinforce these data. The French drug agency (Afssaps) has issued guidelines for the prevention and management of tuberculosis occurring under anti-TNFalpha treatment. Analogous guidelines in Spain led to a reduction in the incidence of these cases.

A case of arthritis under pembrolizumab

Joint Bone Spine - In Press.Proof corrected by the author Available online since lundi 25 avril 2016

Neurogenic muscle hypertrophy

We report the case of a 48-year-old man who presented with left calf hypertrophy 6 years after an episode of left S1 sciatica related to a herniated disk. Magnetic resonance imaging disclosed muscle hypertrophy. Electromyography showed left S1 radiculopathy with abnormal spontaneous muscle activity. Neurogenic muscle hypertrophy is a rare phenomenon that is chiefly seen when denervation occurs slowly and gradually. The typical patient is a middle-aged man who has a history of S1 radiculopathy. The soleus muscle is the main site of involvement. The pathophysiology is unclear but may involve type I fiber hypertrophy in response to the complex repetitive discharges recorded by electromyography. The natural history of neurogenic muscle hypertrophy is incompletely understood.

Sarcoïdose vertébrale. Évolution spontanément favorable : une observation et revue de la littérature

INTRODUCTIONnThe prevalence of vertebral sarcoidosis is highly variable (1 to 36% of reported case series). Because of limited clinical expression, its frequency is probably underestimated. Its proper management is not clearly defined.nnnCASE REPORTnA 42-year-old woman who had a past medical history of cutaneous and pulmonary sarcoidosis presented with low back pain that was refractory to usual medical treatment. A diagnosis of vertebral localisation of sarcoidosis was considered on the history of proven sarcoidosis, radiological features, and the absence of evidence of an alternative diagnosis. In the absence of other clinical or biological evidence of active sarcoidosis, a simple follow-up was planned. MRI control at 1xa0year showed the resolution of vertebral sarcoidosis lesions.nnnCONCLUSIONnSpontaneous regression is a possible outcome of vertebral sarcoidosis. Initiation of a specific treatment should be discussed in the absence of other visceral involvement.

Discitis and sacroiliitis diagnosed 15 years after iatrogenic Mycobacterium xenopi inoculation.

A patient was diagnosed with discitis and sacroiliitis due to Mycobacterium xenopi. He had a history of percutaneous nucleotomy performed 15 years earlier (in 1992) at the Clinique du Sport, Paris, France, during an outbreak of nosocomial M. xenopi infection at that institution. In 1997, magnetic resonance imaging performed as part of the routine follow-up program for patients who had surgery at the Clinique du Sport during the outbreak was not interpreted as indicating discitis; this assessment was confirmed by our review of the images. Bone and joint infections due to atypical mycobacteria are rare and can develop very slowly. To our knowledge, this is the first reported case of M. xenopi discitis with secondary extension to the sacroiliac joint in an immunocompetent patient.

First two cases of alopecia areata during golimumab therapy

Joint Bone Spine - In Press.Proof corrected by the author Available online since jeudi 8 octobre 2015