La Revue de medecine interne最新文献_第4页

[Diffuse radiological abnormality in 72-year-old man]. [72岁男性弥漫性影像学异常]。

La Revue de medecine interne Pub Date : 2026-09-03 DOI: 10.1016/j.revmed.2026.08.004

Abel Brion, Margaux Bordes, Romain Collot, Rodolphe Cougnaud, Alexia Michaut, Cédric Mathieu, Anne Moreau, Nowenn Le Lan, Guillaume Bonnard, Khawla Mellouki, Mathilde Notin, Guillemette Lafeuillade

引用次数: 0

[Neonatal lupus and congenital heart block]. [新生儿狼疮和先天性心脏传导阻滞]。

La Revue de medecine interne Pub Date : 2026-09-01 DOI: 10.1016/j.revmed.2026.08.006

Grégoire Martin de Frémont, Véronique Le Guern, Gaëlle Guettrot-Imbert, Marine Driessen, Chantal Brouzes, Bettina Bessières, Alice Maltret, Nathalie Costedoat-Chalumeau, Nathalie Morel

{"title":"[Neonatal lupus and congenital heart block].","authors":"Grégoire Martin de Frémont, Véronique Le Guern, Gaëlle Guettrot-Imbert, Marine Driessen, Chantal Brouzes, Bettina Bessières, Alice Maltret, Nathalie Costedoat-Chalumeau, Nathalie Morel","doi":"10.1016/j.revmed.2026.08.006","DOIUrl":"https://doi.org/10.1016/j.revmed.2026.08.006","url":null,"abstract":"Neonatal lupus (NL) is a rare syndrome resulting from the transplacental transfer of maternal anti-Ro/SSA autoantibodies, with or without anti-La/SSB antibodies, and is clinically characterized by cutaneous, hematological, hepatic, and especially cardiac manifestations. The most severe manifestation is congenital heart block (CHB), which occurs in structurally normal fetal hearts, is most often complete and irreversible, and is associated with substantial morbidity and mortality. Although anti-Ro/SSA antibodies are common in women with systemic lupus erythematosus and Sjögren disease, most cases of CHB occur in asymptomatic women, the fetal diagnosis leading to the discovery of the maternal autoantibodies. The pathophysiology of NL is multifactorial, involving autoantibodies, inflammation, and genetic and environmental factors, ultimately leading to fibrosis of the fetal cardiac conduction system. Cutaneous NL is more frequent but transient and generally associated with a favorable prognosis. CHB is usually diagnosed before 24 weeks of gestation and often requires pacemaker implantation during childhood. Screening strategies have evolved, with less emphasis on systematic echocardiographic surveillance. There is growing interest in identifying predictive factors for CHB in order to enable the development of a curative treatment, which to date remains undefined. Indeed, corticosteroid therapy has not demonstrated clear efficacy in this indication and may be associated with substantial adverse effects. In the absence of curative treatment, the management of cardiac NL relies on specialized obstetric and pediatric coordination and long-term cardiology follow-up. Hydroxychloroquine may reduce the risk of recurrence in women who had a first pregnancy complicated with CHB.","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Anti-LGI1 antibody encephalitis: A monocentric retrospective series of seven patients]. [抗lgi1抗体脑炎：7例患者的单中心回顾性研究]。

La Revue de medecine interne Pub Date : 2026-08-27 DOI: 10.1016/j.revmed.2026.07.014

Léa Wolff, Mathieu Zuber, Vincent Roubeau

{"title":"[Anti-LGI1 antibody encephalitis: A monocentric retrospective series of seven patients].","authors":"Léa Wolff, Mathieu Zuber, Vincent Roubeau","doi":"10.1016/j.revmed.2026.07.014","DOIUrl":"https://doi.org/10.1016/j.revmed.2026.07.014","url":null,"abstract":"Anti-leucine-rich glioma-inactivated 1 (LGI1) autoimmune encephalitis is a rare neurological disorder caused by autoantibodies targeting the LGI1 protein, leading to synaptic dysfunction predominantly affecting the temporal lobes and hippocampi. It is mainly characterized by cognitive impairment, focal seizures, and faciobrachial dystonic seizures. The aim of this study was to describe the clinical, paraclinical, therapeutic, and outcome characteristics of patients managed at our center. We conducted a retrospective study including seven patients diagnosed between 2016 and 2024. The median age at diagnosis was 71 years. Cognitive impairment, predominantly memory deficits, was the most common presenting feature. Brain magnetic resonance imaging (MRI) showed abnormalities in six of seven patients (85.7%). The diagnosis was confirmed by the detection of anti-LGI1 antibodies in serum and/or cerebrospinal fluid (CSF). First-line immunotherapy combining corticosteroids and intravenous immunoglobulins resulted in early clinical improvement in five patients (71.4%). However, several patients required second-line immunosuppressive therapy because of an insufficient response or disease relapse. Persistent neurocognitive deficits were observed in some patients during follow-up. This case series highlights the importance of early diagnosis and prompt initiation of immunotherapy to improve functional outcomes and reduce long-term cognitive impairment. Long-term follow-up is essential to detect relapses and optimize therapeutic management.","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Biophilic design: Could the healthcare environment become a therapeutic determinant?] 亲生物设计：医疗环境能否成为治疗的决定因素？］

La Revue de medecine interne Pub Date : 2026-08-24 DOI: 10.1016/j.revmed.2026.07.010

Thomas El Jammal, Pascal Sève, Yann Nguyen, Yvan Jamilloux

引用次数: 0

[Avacopan, trusting issues]. [Avacopan，信任问题]。

La Revue de medecine interne Pub Date : 2026-08-24 DOI: 10.1016/j.revmed.2026.07.012

Alexandre Terré, Marie-France Mamzer, Florian Naudet

引用次数: 0

[Uveitis diagnosis: Current approaches and future perspectives]. 葡萄膜炎的诊断：目前的方法和未来的展望。

La Revue de medecine interne Pub Date : 2026-08-12 DOI: 10.1016/j.revmed.2026.07.005

Robin Jacquot, Thomas El-Jammal, Yvan Jamilloux, François Frapart, Thibaud Mathis, Laurent Kodjikian, Pascal Seve

{"title":"[Uveitis diagnosis: Current approaches and future perspectives].","authors":"Robin Jacquot, Thomas El-Jammal, Yvan Jamilloux, François Frapart, Thibaud Mathis, Laurent Kodjikian, Pascal Seve","doi":"10.1016/j.revmed.2026.07.005","DOIUrl":"10.1016/j.revmed.2026.07.005","url":null,"abstract":"Uveitis encompasses a heterogeneous spectrum of etiologies, including systemic inflammatory diseases, infections, specific ophthalmologic entities, and pseudo-uveitis. The diagnostic approach relies on an algorithmic strategy aimed at the early identification of a curable etiology and/or an underlying condition suitable for targeted therapy, while taking into account the severity and relative frequency of the various causes. The prospective ULISSE study showed that a standardized diagnostic approach based on the anatomo-clinical classification of uveitis achieved a diagnostic yield comparable to unrestricted testing, while substantially reducing both the number and cost of investigations. Etiological diagnosis is primarily based on anatomo-clinical analysis of uveitis, integrating the site of inflammation, disease course, laterality, and specific ophthalmologic features. Subsequently, consideration of epidemiological and demographic factors, medical history, and extra-ophthalmologic clinical examination allows further refinement of the diagnostic workup. Complementary investigations should be prioritized and targeted, except for a minimal systematic baseline evaluation, as the diagnostic yield of non-directed testing is very low. Clinical decision-support tools based on artificial intelligence (AI) represent a major advancement. Machine learning models integrating clinical, ophthalmologic, laboratory, and imaging data available from the initial consultation achieve etiological prediction performances comparable to those of experts with access to a complete diagnostic workup. These multimodal AI models could transform diagnostic strategies by enabling a personalized etiological assessment based on the prioritization and dynamic adaptation of complementary investigations. However, their implementation in routine clinical practice will require prior medico-economic validation through controlled comparative studies.","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Anti-synthetase syndrome treatment]. 【抗合成酶综合征治疗】。

La Revue de medecine interne Pub Date : 2026-08-06 DOI: 10.1016/j.revmed.2026.07.008

Jean-Philippe Martellosio, Mickaël Martin, Florent Broca, Van Minh Nguyen, Mathieu Puyade, Clément Beuvon

{"title":"[Anti-synthetase syndrome treatment].","authors":"Jean-Philippe Martellosio, Mickaël Martin, Florent Broca, Van Minh Nguyen, Mathieu Puyade, Clément Beuvon","doi":"10.1016/j.revmed.2026.07.008","DOIUrl":"https://doi.org/10.1016/j.revmed.2026.07.008","url":null,"abstract":"Anti-synthetase syndrome (ASS) is a systemic autoimmune disease associated with the presence of anti-aminoacyl tRNA synthetase antibodies, primarily anti-Jo1, PL7, and PL12. It may be limited to a single organ and involves the lungs in approximately 75% of cases. Pulmonary involvement and its severity determine both prognosis and treatment. Management relies on high-dose corticosteroid therapy, which is effective in inducing remission. Nevertheless, relapses occur in roughly 50% of cases with monotherapy by corticosteroid. The early addition of an immunosuppressant has demonstrated benefits in terms of survival and relapse reduction. The most commonly used immunosuppressants are azathioprine (AZA), mycophenolate mofetil (MMF), methotrexate (MTX), tacrolimus (TAC), rituximab (RTX), and cyclophosphamide (CYC). Chimeric Antigen Receptor T (CAR-T) cells and bispecific antibodies are promising innovative therapies. Antifibrotic drugs can be used in cases of progressive pulmonary fibrosis. However, there are currently no dedicated treatment guidelines for ASS, as available data are mainly derived from retrospective studies or extrapolated from clinical trials including patients with inflammatory myopathy or connective tissue disease-associated interstitial lung disease. This review aims to synthesize existing data on the efficacy and safety of treatments in ASS and to present an updated treatment algorithm.","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Idiopathic and secondary recurrent aphthous stomatitis: A narrative review]. 特发性和继发性复发性口疮性口炎：述评。

La Revue de medecine interne Pub Date : 2026-08-06 DOI: 10.1016/j.revmed.2026.07.009

Alexandre Le Joncour, Adrien Mirouse, Patrice Cacoub, David Saadoun, Juliette Rochefort

{"title":"[Idiopathic and secondary recurrent aphthous stomatitis: A narrative review].","authors":"Alexandre Le Joncour, Adrien Mirouse, Patrice Cacoub, David Saadoun, Juliette Rochefort","doi":"10.1016/j.revmed.2026.07.009","DOIUrl":"https://doi.org/10.1016/j.revmed.2026.07.009","url":null,"abstract":"Recurrent aphthous stomatitis (RAS) is the most common cause of painful ulcers of the oral mucosa, affecting approximately 10 to 20% of the population. It is characterized by recurrent, well-demarcated superficial ulcers located on non-keratinized mucosa, which heal spontaneously within one to two weeks. Three clinical subtypes are classically described: minor aphthae (the most common form), major aphthae, and herpetiform aphthae. Diagnosis is primarily clinical, but it is essential to rule out other causes of oral ulcers (traumatic, infectious, autoimmune, neoplastic) and to identify secondary causes of RAS (e.g., Behçet's disease, inflammatory bowel disease) to avoid diagnostic delay, detect specific complications, and tailor management appropriately. The pathophysiology of RAS involves an inappropriate cell-mediated immune response in genetically predisposed individuals. Reported abnormalities affect both innate immunity (notably neutrophils) and adaptive immunity (CD8+ T lymphocytes, Th1/Th17 profile). Precipitating factors such as nutritional deficiencies, psychological stress, microtrauma, or food intolerances may trigger flare-ups. Management is based primarily on general measures and local treatments. Severe or refractory cases may require a short course of systemic corticosteroids or maintenance therapy (e.g., colchicine, apremilast). This narrative review provides an update on recurrent oral aphthosis.","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Skin first: when cervical swelling and subcutaneous nodules reveal Whipple's Disease. 首先是皮肤：当颈部肿胀和皮下结节提示惠普尔病时。

La Revue de medecine interne Pub Date : 2026-07-29 DOI: 10.1016/j.revmed.2026.07.002

E Le Dault, N Quiles, P Berniolles, M Eté, C Charpin, H Lepidi, B Demarez

引用次数: 0

[Sustained complete remission achieved with tofacitinib in a refractory T-cell large granular lymphocytic leukemia]. [托法替尼治疗难治性t细胞大颗粒淋巴细胞白血病的持续完全缓解]。

La Revue de medecine interne Pub Date : 2026-07-22 DOI: 10.1016/j.revmed.2026.07.001

Adèle Carré, Samuel Deshayes, Nicolas Martin-Silva, François Comoz, Lassina Sere, Hubert De Boysson, Achille Aouba

{"title":"[Sustained complete remission achieved with tofacitinib in a refractory T-cell large granular lymphocytic leukemia].","authors":"Adèle Carré, Samuel Deshayes, Nicolas Martin-Silva, François Comoz, Lassina Sere, Hubert De Boysson, Achille Aouba","doi":"10.1016/j.revmed.2026.07.001","DOIUrl":"https://doi.org/10.1016/j.revmed.2026.07.001","url":null,"abstract":"Introduction: Treatment of large granular lymphocytic leukemia, particularly T-cell leukemia (LGL-T), remains challenging. JAK inhibitors, although still scarcely evaluated, appear promising.Case report: An 85-year-old woman was treated for a refractory LGL-T associated with neutropenia, unclassified polyarthritis and vitiligo. During the 7-year course of the disease, she received alternatively cyclosporine, cyclophosphamide and methotrexate, associated with prednisone and/or filgrastim. During a severe relapse with agranulocytosis complicated by infectious pneumonia, no response was observed after 14 days of filgrastim. Ten days after initiation of tofacitinib, a marked increase of the neutrophil count (98G/L) occurred, associated with Sweet syndrome. Both resolved rapidly with filgrastim discontinuation. Tofacitinib allowed a rapid and complete remission of both hematological and clinical manifestations, which was maintained throughout 37 months of follow-up.Conclusion: This report adds to the limited evidence supporting tofacitinib in LGL-T and further highlights the potential of JAK-inhibition, particularly in refractory and systemic forms.","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0