La Revue de medecine interne最新文献

{"title":"[Sarcoidosis-associated uveitis: Current status and future prospects].","authors":"Pascal Sève, Thomas El Jammal, Yasmine Serrar, Yvan Jamilloux, Laurent Kodjikian, Robin Jacquot","doi":"10.1016/j.revmed.2026.05.006","DOIUrl":"https://doi.org/10.1016/j.revmed.2026.05.006","url":null,"abstract":"<p><p>Sarcoidosis-related uveitis is the most common manifestation of ocular sarcoidosis. It can occur at any age but preferentially affects adults aged 30 to 60 years, with a female predominance, especially in forms with late onset. Suggestive semiological features are: granulomatous anterior uveitis defined by thick retro-descemetal precipitates (so-called \"mutton-fat\" keratic precipitates) or iris nodules, anterior synechiae, vitreous inflammation (hyalitis), periphlebitis, choroidal granulomas, and macular edema. Diagnosis relies on a combination of these ophthalmological features and paraclinical tests, notably serum biomarkers and suggestive chest imaging. Management is guided by the anatomical characteristics of the uveitis - including laterality and the severity of inflammation - as well as associated extra-ophthalmic manifestations and the patient's background. Systemic treatment is offered in case of failure, contraindication or side effects of local corticosteroid therapy, or active bilateral posterior-segment involvement. Conventional immunosuppressive agents, particularly methotrexate, remain first-line therapy. Hydroxychloroquine appears to be a good option for anterior and intermediate uveitis. Biologic agents such as anti-TNFα drugs - especially adalimumab - are used for refractory cases because of their steroid-sparing effect demonstrated for chronic non-anterior non-infectious uveitis. Tocilizumab appears to be an alternative to anti-TNF agents, particularly in patients with macular edema. Multi-omics techniques and artificial intelligence offer prospects for diagnosis, refining prognosis and personalizing therapy for sarcoid uveitis.</p>","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":"148564265","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}

{"title":"[Etiological investigation of inflammatory orbital disease in patients seen in internal medicine].","authors":"Sébastien Abad","doi":"10.1016/j.revmed.2026.06.009","DOIUrl":"https://doi.org/10.1016/j.revmed.2026.06.009","url":null,"abstract":"<p><p>Inflammatory orbital diseases are characterized by inflammation that may involve any structure of the orbit including lacrimal gland, and may represent the manifestation of numerous disorders. Thereby, they are grouped under the term orbital inflammatory syndrome (OIS). A distinction is made between primary OIS of purely inflammatory etiology, whether identified or not - the latter being considered idiopathic orbital inflammatory syndrome (IOIS) - and secondary OIS resulting from a local or systemic cause such as infection, neoplasia, or even iatrogenic conditions. In this review, we describe the autoimmune/systemic diseases most frequently revealed or heralded by OIS, as well as the orbital manifestations that characterize them. Thus, in the presence of bilateral dacryoadenitis, IgG4-related disease and sarcoidosis should be investigated first as granulomatosis with polyangiitis in cases of intraorbital mass. Furthermore, we propose an update of our diagnostic algorithm based on topographic information provided by orbital imaging. When systemic investigations fail to identify an underlying disease (in more than 50% of cases), orbital biopsy should be considered in order to distinguish nonspecific inflammation from lymphoma. In cases of isolated myositis or posterior orbital masses for which biopsy may entail deleterious complications, diffusion-weighted MRI analysis of orbital lesions can help differentiate purely inflammatory lesions from lymphoma. When the diagnostic work-up fails, a therapeutic trial of corticosteroids may still be considered, while keeping in mind corticosteroids have sometimes a beneficial effect on lymphomas. In future, artificial intelligence-based analysis of biomarkers generated through omics technologies should contribute significantly to differentiating orbital lymphomas from IOIS.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551805","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}

{"title":"[Cardiorespiratory functional disorders: A transnosologic approach].","authors":"Brigitte Ranque, Pascal Cathebras","doi":"10.1016/j.revmed.2026.05.012","DOIUrl":"https://doi.org/10.1016/j.revmed.2026.05.012","url":null,"abstract":"<p><p>Functional disorders affecting the cardiorespiratory system are common. Non-cardiac chest pain affects more than 10% of the population. It can result from gastro-oesophageal reflux or chest wall disorders but is also very often associated with anxiodepressive disorders, particularly panic disorder. Postural orthostatic tachycardia syndrome (POTS), a rarer entity, is characterized by a sharp increase in heart rate without orthostatic hypotension when standing. The pathophysiological mechanisms of POTS include 'partial' autonomic neuropathy, hypovolaemia and noradrenergic dysregulation, but it is also closely linked to anxiety disorders and deconditioning to exertion. Functional respiratory disorders, particularly hyperventilation syndrome, are accompanied by various manifestations ranging from tetany to gastrointestinal symptoms. They are highly prevalent, especially among women and people suffering from anxiety, and particularly in the case of associated respiratory disease such as asthma. The diagnosis of hyperventilation syndrome is based on the Nijmegen questionnaire. The pathophysiology does not necessarily involve hypocapnia but is related to cerebral conditioning phenomena and vicious circles linked to anticipatory anxiety. Cardiorespiratory functional disorders are often linked to each other and to other functional somatic disorders and have in common a dysregulation of the autonomic nervous system. Psychological, cognitive and behavioural factors play a central role in their persistence. While each has its specificities, all have a complex circular causality. Their management currently relies primarily on physical rehabilitation, often associated with symptomatic treatments such as beta-blockers. The place of cognitive and behavioral therapies would be well worth exploring in these disorders.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321346","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}

{"title":"[Beyond burnout: Understanding moral injury in internal medicine].","authors":"Laurent Boyer, Mikael Ebbo","doi":"10.1016/j.revmed.2026.05.009","DOIUrl":"https://doi.org/10.1016/j.revmed.2026.05.009","url":null,"abstract":"","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177372","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}

{"title":"[Prolonged fever and imported brucellosis: Targeted diagnosis in a patient returning from endemic areas].","authors":"Elsie Madérou, Annick Bosseray, Yvan Caspar, Gautier Szymanski, Laurence Bouillet, Orlane Chol","doi":"10.1016/j.revmed.2026.05.002","DOIUrl":"https://doi.org/10.1016/j.revmed.2026.05.002","url":null,"abstract":"<p><strong>Introduction: </strong>Brucellosis is a bacterial zoonosis that remains endemic in many parts of the world but is now rare in France, where most cases are imported. Its clinical presentation is often nonspecific and may be limited to prolonged fever.</p><p><strong>Case report: </strong>We report the case of a 46-year-old man who presented with prolonged fever, fatigue, and night sweats following several stays in Algeria. Blood cultures grew a fastidious Gram-negative bacillus, initially difficult to identify. Brucella serology was positive, and Brucella melitensis was confirmed by species-specific PCR at the Nîmes National Reference Center. A six-week course of doxycycline and rifampicin led to rapid defervescence and clearance of the bacteremia.</p><p><strong>Conclusion: </strong>This case allows us to discuss the indications for brucellosis screening in patients presenting with prolonged fever in France, as well as the limitations of available diagnostic tools.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019579","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}

{"title":"[Management of domestic violence in internal medicine practice].","authors":"Emma Lafon, Sophie Tardieu, Clara Fontenaille","doi":"10.1016/j.revmed.2026.04.008","DOIUrl":"https://doi.org/10.1016/j.revmed.2026.04.008","url":null,"abstract":"<p><p>Intimate partner violence is a major public health issue, affecting around 10% of women each year in France. Its consequences extend beyond the psychological sphere, directly influencing the control of chronic diseases and the occurrence of psychosomatic disorders frequently encountered in internal medicine. Prolonged exposure to stress and partner coercion perpetuates a vicious cycle between chronic illnesses, diffuse pain, unexplained fatigue, and somatic decompensations. Internists, given the comprehensive nature of their practice and the regular follow-up of vulnerable patients, are often confronted with the challenge of identifying such situations. Screening relies on attentive history-taking, observation of suggestive signs (social isolation, anxiety, medical nomadism), and the use of validated tools such as the WAST or the Violentomètre. Management should be multidisciplinary, integrating psychological, social, and legal support, through referral to specialized structures such as Maisons des Femmes, and through the training of healthcare professionals to improve detection and help break the cycle of violence.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825280","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}

{"title":"French protocol for the diagnosis and management of juvenile idiopathic arthritis including pediatric-onset Still's disease.","authors":"Pierre Quartier, Alexandre Belot, Sylvain Breton, Aurélia Carbasse, Valérie Devauchelle, Bruno Fautrel, Sophie Georgin-Lavialle, Anne-Laure Jurquet, Isabelle Koné-Paut, Irène Lemelle, Ulrich Meinzer, Isabelle Melki, Pascal Pillet, Héloïse Reumaux, Linda Rossi-Semerano, Florence Uettwiller","doi":"10.1016/j.revmed.2025.06.001","DOIUrl":"10.1016/j.revmed.2025.06.001","url":null,"abstract":"<p><p>Juvenile idiopathic arthritis (JIA) is characterised by arthritis onset before the age of 16, persisting for at least 6weeks without a known cause. Symptoms include joint swelling, inflammatory pain (worse at night and in the morning), or also back, heel, or buttock pain. Timely diagnosis and referral to a paediatric rheumatologist are crucial to reduce errors, invasive procedures, and long-term complications. Around 5000 children under 16 are affected by JIA in France. The current international classification recognises 7 subgroups: the systemic form, oligoarthritis, polyarthritis without rheumatoid factor, polyarthritis with rheumatoid factor (juvenile rheumatoid arthritis), enthesitis associated with JIA (juvenile spondyloarthropathy), JIA associated with psoriasis and undifferentiated JIA. A new classification divides JIA into 5 groups: the systemic form, early-onset oligo- and polyarthritis with anti-nuclear antibodies (associated with a risk of chronic anterior uveitis), polyarthritis with rheumatoid factor, juvenile spondyloarthropathy and non-groupable forms. JIA management involves a multidisciplinary team led by a paediatric rheumatologist, using targeted therapies (biologics, small molecules) and numerous health professionals (physiotherapist, occupational therapist, etc.), improving overall outcomes. Physicians (paediatricians or general practitioners) play a vital role in overall management, ensuring treatment compliance, monitoring effectiveness, and managing infection risks. This includes updating vaccination schedules and addressing febrile episodes. We present recent international recommendations including the \"treat-to-target\" approach, consisting in setting precise objectives at the beginning and during the evolution, which involves regularly assessing the patient's situation to adapt treatments, control inflammation and disease complications, limit the toxicity of treatments. This strategy aims to achieve, ideally in a few months an inactive disease or complete remission. Regarding systemic JIA (or pediatric Still's disease), we pay attention to particularly severe clinical forms in very young children, which may be life-threatening by major activation of the immune system (macrophage activation syndrome) or secondary pulmonary involvement. For non-systemic forms, i.e. oligoarthritis, polyarthritis, enthesitis related JIA (or juvenile spondylarthropathies) and JIA associated with psoriasis, we specify the state of current knowledge and uncertainties regarding prognosis and therapeutic choices.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":"449-481"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340717","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}

{"title":"[Internal medicine: A core discipline in healthcare establishments for the care of complex patients].","authors":"Quitterie Reynaud, Mathias Gernez, Natacha Grienay-Poletto, Pascal Sève, Arnaud Hot, Mael Richard, Yoann Roubertou, Yvan Jamilloux, Thomas Barba, Céline Piegay, Isabelle Durieu","doi":"10.1016/j.revmed.2025.04.024","DOIUrl":"10.1016/j.revmed.2025.04.024","url":null,"abstract":"<p><strong>Introduction: </strong>The role of internal medicine departments in the management of chronic diseases in older patients with more comorbidities is a topical issue.</p><p><strong>Methods: </strong>For each internal medicine department of the Lyon University Hospital (North, Centre and South Hospices Civils de Lyon Hospital Group), Programme de médicalisation des systèmes d'information (PMSI) activity report data were used, with the number of medical unit summary (RUM) and standardised discharge summary (RSS) stays for 4 consecutive years from 2018 to 2022.</p><p><strong>Results: </strong>Activity increased in the three internal medicine departments in outpatient day hospital activity, the rest of the activity remained stable. The rate of admissions via emergency units was multiplied by 3, with an increase in discharges to rehabilitation services. The death rate doubled. The average age increased to 68, with an increase in the Charlson score comorbidity index to 2, independently of age, and in the percentage of stays with severity 3 and 4.</p><p><strong>Conclusion: </strong>Analysis of data on conventional inpatient care in internal medicine at Lyon University Hospital shows a major qualitative change, with older patients with more comorbidities and higher severity stay profiles, leading to an increase in the number of inpatient deaths, and greater use of rehabilitation units.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":"443-448"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063746","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}

{"title":"[Azygos continuation of the inferior vena cava associated with \"H syndrome\"].","authors":"Khaoula Boumeriem, Imrani Kaoutar, Ait Belhaj El Mahdi, Moatassim Billah Nabil, Nassar Itimad","doi":"10.1016/j.revmed.2025.05.013","DOIUrl":"10.1016/j.revmed.2025.05.013","url":null,"abstract":"<p><strong>Introduction: </strong>The syndrome H is a rare autosomal recessive genetic disorder first described in 2008, caused by SLC29A3 gene mutations. It presents with variable cutaneous, joint, auditory, vascular, and hematologic features.</p><p><strong>Observation: </strong>A 24-year-old man with recently diagnosed syndrome H presented with hyperpigmented patches on the lower abdomen and legs, sparing the joints, and splayed toe deformities. CT imaging revealed agenesis of the hepatic segment of the inferior vena cava (IVC) with a left-sided aberrant IVC draining via the azygos system into the superior vena cava. Inguinal lymphadenopathy and mild hepatomegaly were also noted. Lab results were normal. Skin biopsy confirmed dermal fibrosis with perivascular infiltrate.</p><p><strong>Conclusion: </strong>This case illustrates the clinical variability of the syndrome H and the value of imaging in detecting rare vascular malformations such as IVC interruption, reported in only two other cases. Management is symptomatic, with a multidisciplinary approach and genetic counseling.</p>","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":"486-489"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228008","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}

{"title":"What do patients with familial Mediterranean fever and the doctors who prescribe it know about colchicine? Results of a national survey of 255 patients and 203 doctors in France.","authors":"P Mertz, L Savey, M Delplanque, P Belamich, C Bayado, V Hentgen, S Georgin-Lavialle","doi":"10.1016/j.revmed.2025.05.009","DOIUrl":"10.1016/j.revmed.2025.05.009","url":null,"abstract":"","PeriodicalId":94122,"journal":{"name":"La Revue de medecine interne","volume":" ","pages":"501-502"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176253","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}