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Loïc Guillevin

Publications and source records attributed to Loïc Guillevin.

At least 73 records · Page 4Linked to original sources
PubMed2003

New insights into the pathogenesis of systemic sclerosis.

Systemic sclerosis (SSc) is a connective tissue disorder characterized by vascular abnormalities and excessive collagen synthesis. Extracellular matrix overproduction by fibroblasts results from abnormal interactions among endothelial cells, mononuclear cells (lymphocytes and monocytes) and fibroblasts, in a setting of vascular hyperreactivity and tissue hypoxia. Many autoantibodies have been identified in the sera of SSc patients; some of them are specific to the disease, such as anti-centromere antibodies in limited SSc, anti-topoisomerase 1 and anti-RNA polymerase I/III antibodies in diffuse SSc. Their pathogenetic role(s) remains uncertain. However, genetic, environmental and possibly alloreactive factors might also contribute to disease susceptibility.

Autoantibodies↗
PubMed2003

Lymphoma complicating common variable immunodeficiency with granulomatous disease: report of two cases.

Common variable immunodeficiency (CVID) is a primary defect that is characterized by impaired antibody production. CVID patients may develop recurrent infections, autoimmune disorders and/or systemic granulomatosis. It is well documented that CVID patients are at risk to develop malignant lymphomas. However, to the best of our knowledge, lymphoma complicating the course of CVID associated with systemic granulomatosis has never been reported. We describe two CVID patients with systemic granulomatosis who developed B-cell lymphomas, one related to Epstein Barr virus infection, 5 and 12 yr after CVID had been diagnosed.

B-Lymphocytes↗
PubMed2003

Indications of plasma exchanges for systemic vasculitides.

Indications of plasma exchanges for systemic vasculitides are well delineated according to the results of therapeutic trials undergone during the past decades. In combination with antiviral agents and/or immunosuppressants plasma exchanges appear to be essential in the treatment of HBV-related polyarteritis nodosa: pauci-immune glomerulonephritis, kidney-limited or as a feature of Wegener's granulomatosis or microscopic polyangiitis; Goodpasture's syndrome, and for some complications of cryoglobulinemia. In patients with HIV and HBV-associated vasculitides, for which immunosuppressants are deleterious, plasma exchanges are also helpful and have been shown to be effective, combined with an antiretroviral regimen. In polyarteritis nodosa without HBV infection, Wegener's granulomatosis, Churg-Strauss syndrome and in other systemic diseases vasculitides, plasma exchanges can help to control or attenuate the disease. We review herein these indications of plasma exchanges in the light of the results of major trials.

Humans↗
PubMed2003

When should immunosuppressants be prescribed to treat systemic vasculitides?

Steroids and immunosuppressants are indicated to treat systemic vasculitides. However, the therapeutic strategy is different from one disease to the other. Treatment choice should be adapted to the predictable outcome, severity, pathogenic mechanisms and patient's general condition. In polyarteritis nodosa, Churg Strauss syndrome, and microscopic polyangiitis we have demonstrated that immunosuppressants should not be systematically prescribed. Immunosuppressants should be only prescribed in the most severe patients, when factors of poor prognosis are present. In Wegener's granulomatosis, immunosuppressants should be systematically prescribed together with steroids. The optimal treatment duration is of 12 months for polyarteritis nodosa and Churg-Strauss syndrome. A more prolonged treatment is mandatory in Wegener's granulomatosis, at least 18 months. The new therapeutic strategies comprise also new immunosuppressants and new immunomodulating agents which could replace or be associated to the "older drugs".

Churg-Strauss Syndrome↗
PubMed2003

[Insulin autoimmune syndrome revealing systemic lupus erythematosus].

A 22-year-old woman was admitted in August 2001 for loss of consciousness due to hypoglycemia. Her serum insulin level during the hypoglycemic episode was high at 121 mU/l (normal range: 5-25 mU/l). She had never received an insulin injection. Insulin antibodies by radioimmunoassay were positive. During hospitalisation, the patient presented clinical and biological features of systemic lupus erythematosus (SLE). Treatment with high-dose corticosteroids and cyclophosphamide resulted in restoration of euglycemia associated with resolution of circulating anti-insulin antibodies and parallel improvement in clinical and laboratory features of SLE.

Adrenal Cortex Hormones↗
PubMed2003

Polyarteritis nodosa presenting as acute leg ischemia.

We describe a 33-year-old hypertensive woman with otherwise apparently good health, in whom acute leg ischemia by acute occlusion of the 3 infrapopliteal arteries led to the diagnosis of polyarteritis nodosa (PAN). Angiography and ultrasound imaging showed multiple microaneurysmal and thrombotic lesions, notably in the kidneys and the 4 extremities. Cutaneous biopsy showed necrotizing angiitis. She was treated with corticosteroids. Ischemia improved progressively, with normal walking after several months. Three points were remarkable in this case of PAN: (1) its unusual presentation; (2) the absence of constitutional symptoms despite the diffuse distribution of vascular lesions; (3) the good visualization of peripheral microaneurysms by ultrasonography (US), suggesting a potential diagnostic interest for US examination of the limbs in PAN.

Acute Disease↗
PubMed2003

[Epidemiology of HIV-associated malignancies].

Human immunodeficiency virus (HIV)-associated malignancies include acquired immunodeficiency virus: Aids-defining malignancies, Kaposi's sarcoma, (KS), non-Hodgkin's lymphoma (NHL), and, since 1993, invasive cervical cancer (1CC), and non-Aids defining malignancies. Most cancers that are associated with HIV infection are driven by oncogenic viruses such as Epstein-Barr virus, human herpes virus 8 and human papillomavirus. Highly active antiretroviral therapy (HAART) is affecting the incidence of several Aids defining malignancies. The incidence of KS and primary central nervous system lymphoma (PCNSL) has dropped since the introduction of HAART in 1996. Systemic NHL appears to be declining in incidence as well, but to a lesser degree than KS and PCNLS. In contrast, the incidence of invasive cervical carcinoma has not changed in the HAART era. The impact of HAART on the epidemiology of other HIV-associated malignancies, including Hodgkin's disease and anal carcinoma, remains unclear.

Antiretroviral Therapy, Highly Active↗
PubMed2003

[Simultaneous hepatitis B virus infection and polyarteritis nodosa. Three cases].

In polyarteritis nodosa (PAN) due to hepatitis B virus (HBV) infection, the insidious nature of the infection makes very difficult to establish the chronology which often remains unknown. PN occurs in the majority of patients during the year following infection. Simultaneous occurrence or occurrence immediately after infection with the HBV is exceptional. We report here three cases of this form of simultaneous HBV infection and PN and describe the particular clinical, virological and evolutive features of the disease.

Adult↗
PubMed2003

[Abdominal and digestive manifestations in systemic vasculitides].

Digestive involvement is frequent during the course of systemic small and medium-sized vessel vasculitides. Clinical manifestations range from rapidly regressive abdominal pain to surgical manifestations associated with poor prognosis. These are usually associated with extra-abdominal signs, reflecting vasculitis activity. Isolated gastrointestinal involvement is observed in only 16% of these patients. The main clinical manifestations are common to all vasculitides (ischemia, bowel infarction and perforations, gastrointestinal hemorrhage due to mucosal ulcerations or aneurysmal ruptures), but some are more specific to one type (granulomatous ileo-colitis during Wegener's granulomatosis, eosinophilic colitis during Churg-Strauss syndrome). Gastrointestinal arteriography can be helpful for diagnosis, but has no prognostic value, likewise for the presence of ANCA. As there are no identified factors predictive of a surgical abdomen, therapy must be adapted individually, using steroids and immunosuppressive agents, generally cyclophosphamide. Prompt surgical and medical care of these seriously ill patients has lowered mortality from nearly 100% twenty years ago to approximately 23 to 56% currently.

Gastrointestinal Diseases↗
PubMed2002

Comparison between adult endocarditis due to beta-hemolytic streptococci (serogroups A, B, C, and G) and Streptococcus milleri: a multicenter study in France.

BACKGROUND: Limited data exist on infective endocarditis (IE) due to Streptococcus milleri (Sm) or beta-hemolytic streptococci (BHS). Because BHS and Sm share some physiologic and pathogenic properties, we wondered whether IE caused by these streptococci might present similarities. METHODS: Through a nationwide retrospective study in France, the medical and microbiologic charts of adults with definite Sm or BHS IE observed between January 1, 1991, and December 31, 1996, in university and general hospitals were reviewed. RESULTS: Fifty-six patients had BHS IE (33 men and 23 women; median age, 59 years; range, 18-91 years) and 29 had Sm IE (18 men and 11 women; median age, 66 years; range, 37-97 years). The BHS group tended to have more underlying medical conditions (46%) and fewer previous cardiopathies (48%) than the Sm group (28% and 71%, respectively). Multivariate analysis showed that a longer median time of IE evolution before diagnosis and identification of the presumed portal of entry were independently associated with Sm IE (P<.01). Extracardiac complications were more frequent in the BHS group (55%) than in the Sm group (39%). Comparison of echocardiographic findings between the 2 groups did not establish any statistically significant difference. Thirty-six patients (64%) in the BHS group and 18 (62%) in the Sm group underwent valve replacement. Overall, mortality was 27% for the BHS group and 14% for the Sm group. For all patients, multivariate analysis retained older age as the only significant risk factor for death (P =.01). CONCLUSION: Compared with Sm IE, BHS IE occurs in younger patients with more underlying diseases and fewer underlying cardiopathies and has a more aggressive presentation and evolution.

Adult↗
PubMed2002

Management of virus-induced systemic vasculitides.

The best therapeutic strategy in virus-induced vasculitides should take into account the etiology of the disease and be adapted to the pathogenesis. The combination of antiviral treatments and plasma exchanges has been proven effective in polyarteritis nodosa. In HIV-related vasculitis, this strategy is effective and does not jeopardize the outcome of AIDS, as do cytotoxic agents. In vasculitis related to hepatitis C virus-associated cryoglobulinemia, plasma exchanges improve the outcome, but the poor effectiveness of antiviral drugs usually does not favor a definite recovery of the patients. Relapses are frequent.

Antineoplastic Agents↗
PubMed2002

Surgical resection of lung cancer in patients with underlying interstitial lung disease.

BACKGROUND: The association between interstitial lung disease (ILD) and an increased risk of developing lung cancer has been reported. The goal of this retrospective study was to determine the outcome of lung cancer resection among patients with ILD. METHODS: Between January 1979 and March 1999, 27 patients with both lung cancer and ILD were identified. Seven patients with poor pulmonary function tests or distant metastases underwent medical treatment and were excluded from this study. Twenty patients treated by surgical resection were analyzed. RESULTS: Various types of ILD such as sarcoidosis (n = 7), idiopathic interstitial pneumonia (n = 4), histiocytosis X (n = 4), pneumoconiosis (n = 4), and amiodarone-induced ILD (n = 1) were observed. Tumors were located in the peripheral part of the lung in 16 cases. The most frequent tumor cell types were squamous and adenocarcinoma. The resections consisted of lobectomy (n = 16), bilobectomy (n = 1), and pneumonectomy (n = 3). Most cancers were stage I (n = 10) or II (n = 6). There was no postoperative death. The postoperative course was uneventful in 16 cases. The majority of patients (70%) did not experience respiratory insufficiency during the follow-up period. The actuarial 2-year and 5-year survival rates were, respectively, 83.5% and 66.4%. CONCLUSIONS: In this series, the long-term survival of patients who had lung cancer resection appeared to be not affected by the association with ILD. This could be explained by an adequate preoperative selection based on pulmonary function tests and a preferential choice for lobectomies. Thus, surgical resection should be offered to properly selected patients with lung cancer and underlying ILD.

Adult↗
PubMed2002

Treatment of adult systemic mastocytosis with interferon-alpha: results of a multicentre phase II trial on 20 patients.

Systemic mastocytosis (SM) is characterized by proliferation of mast cells in various organs, which may release a wide variety of mediators, thereby explaining the broad clinical spectrum of disease manifestations. The potentially life-threatening systemic symptoms and tumoral proliferation are poorly controlled despite the use of several cytotoxic chemotherapies and/or symptomatic treatments. Twenty consecutive adult SM patients with histologically confirmed bone marrow (BM) involvement received interferon-alpha subcutaneously (1-5 million units/m2/d, with progressive dose intensification over the first month of treatment) and were evaluated after 6 months of therapy. Seven of them had previously received symptomatic treatments, including steroids, which were ineffective. Among the 13 patients treated for at least 6 months, seven partial and six minor responses, mainly concerning vascular congestion and skin lesions, were obtained, while BM infiltration remained unchanged in 12 patients. The significant reduction of mast-cell mediator levels after 6 months of treatment was not predictive of clinical remission. The rate of depression was unexpectedly high (seven patients; 35%). Two patients died soon after starting therapy (one myocardial infarction, one septic shock). Six months of interferon-alpha may relieve vascular congestion in adults with SM, probably by inhibiting mast-cell degranulation.

Adult↗
PubMed2002

Delayed relapse of Churg-Strauss syndrome manifesting as colon ulcers with mucosal granulomas: 3 cases.

Churg-Strauss syndrome (CSS) is characterized by small vessel vasculitis and extravascular granulomas. The American College of Rheumatology classification criteria for CSS include asthma, eosinophili, and clinical manifestation of vasculitis. Gastrointestinal (GI) manifestations occur in 30% of patients, but are inaugural in only 16%. They denote vasculitis of the stomach and small bowel wall, and consist in protean, nonspecific pain. GI involvement is of adverse prognostic significance in CSS. Ulcer formation in the GI tract mucosa is a rarer manifestation, usually discovered upon laparotomy or autopsy. We describe 3 new cases of colonic ulcers in CSS. Unusual features were diagnosis of the ulcers during a delayed relapse and presence of eosinophilic granulomas within the mucosa.

Churg-Strauss Syndrome↗
PubMed2002

[Neuromeningeal tuberculosis in northeastern suburbs of Paris. Nineteen cases].

SUBJECT: Analyze characteristics of neuromeningeal tuberculosis in the northeastern suburbs of Paris. MATERIAL AND METHOD: Retrospective study of 19 observations between 1988 and 1999. RESULTS: Thirteen cases of meningitis, 3 cases of meningitis associated with a tuberculoma and 3 cases with isolated tuberculoma were described. Young subjects (average age 46.4), foreign born (73.7%) were preferentially affected. Three patients were infected by the human immunodeficiency virus. Weight-loss and weakness (84%), fever (79%), headache (63%) dominate the clinical manifestations. The diagnosis delay was 56.6 days, and the therapeutic time, 8.6 days. The search for acid fast bacilli was positive only in one case on direct examination of the cerebrospinal fluid, whereas the culture was positive in 68.7% of the cases. Cerebral imagery was abnormal in13 patients. Average duration of antituberculous treatment was 13,4 months (range: 9-24). Corticosteroids were associated in 12 patients. Thirteen patients were cured, 3 died and 3 were lost to follow up. CONCLUSION: The characteristics of neuromeningeal tuberculosis are not modified, but the diagnosis delay of the neuromeningeal tuberculosis, which conditions the prognosis, remains significant. The optimal duration of the antituberculous treatment and the conditions of the steroid therapy have to be specified.

Adult↗
PubMed2002

[Psychiatric manifestations of systemic sclerosis].

Systemic sclerosis (SSc) is a rare conjuctive tissue disorder that is characterized by fibrosis of the skin and internal organs as well as vascular obliteration phenomenons. SSc is responsible for increased morbidity and mortality, and skin fibrosis may be responsible for major body changes. These phenomenons may contribute to the occurrence of psychological disturbances such as anxiety and depression, whereas the incidence of psychotic symptoms is very low in SSc patients. However, the prevalence of psychiatric symptoms during the course of SSc has not been evaluated yet with standardized evaluation scales, and an important breakthrough can be made in understanding the underlying mechanisms of psychiatric manifestations, in order to improve therapeutic management and quality of life.

Adaptation, Psychological↗
PubMed2002

[Long-term treatments for systemic sclerosis: what are the perspectives?].

Systemic sclerosis (SSc) is responsible for fibrosis of the dermis and other organs as well as vascular abnormalities. While the pathogenesis of SSc is continually being better understood, there is still no single therapeutic agent that has been shown to increase survival in a prospective randomized trial. Traditional medications such as colchicine and D-penicillamine are disappointing in clinical practice, and the latter one failed to clearly show benefit when tested in a prospective placebo controlled trial comparing conventional high dose versus low dose. Conversely, new disease modifying agents are emerging such as cyclophosphamide (CYC) in interstitial pulmonary disease and stem cell autograft after high dose CYC therapy in patients who develop visceral involvement in the three first years of evolution of the disease. Organ specific therapy may show dramatic benefit, such as angiotensin converting enzyme inhibitors in renal crisis and epoprostenol in primary pulmonary hypertension. We will try to review disease modifying agents available in SSc and emphasize new therapeutic agents that are currently being evaluated, including vasodilators, anti-inflammatory, anti-fibrosing agents and immunosuppressive molecules.

Angiotensin-Converting Enzyme Inhibitors↗