Revue De Medecine Interne最新文献

英文中文

Mycoplasma pneumoniae pneumonia associated with severe neutropenia 肺炎支原体肺炎伴严重中性粒细胞减少症。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2025-12-31 DOI: 10.1016/j.revmed.2025.12.004

Dounia Abbas , Amanda Blot-Cossard , Delphine Giusti , Amélie Servettaz , Firouze Bani-Sadr

Introduction

Cold agglutinin haemolytic anaemia, aplastic anaemia, immune thrombocytopaenia and hemophagocytosis are well-established complications of Mycoplasma pneumoniae infection. In contrast, severe neutropenia has rarely been described.

Case report

We report the case of a 71-year-old with systemic lupus erythematosus who presented with severe febrile neutropenia (0.2 G/L) and mild thrombocytopenia (75 G/L) revealing M. pneumoniae pneumonia. Erythema multiforme appeared secondary. Granulocyte autoantibodies were negative. Neutropenia and thrombocytopenia resolved within three days after azithromycin initiation.

Discussion

Four other cases of M. pneumoniae pneumonia presenting with severe febrile neutropenia have been reported in the literature. They were associated with thrombocytopenia and/or anemia in all cases. Granulocyte autoantibodies were positive in 2 cases. This rare case highlights the importance of considering M. pneumoniae infection in the differential diagnosis of febrile neutropenia and illustrates that rapid resolution of neutropenia can be observed under antibiotic therapy alone.

简介：冷凝血素溶血性贫血、再生障碍性贫血、免疫性血小板减少症和噬血细胞症是肺炎支原体感染的公认并发症。相比之下，严重的中性粒细胞减少症很少被描述。病例报告：我们报告一例71岁系统性红斑狼疮患者，表现为严重发热性中性粒细胞减少（0.2G/L）和轻度血小板减少（75 G/L），显示肺炎支原体肺炎。多形性红斑继发。粒细胞自身抗体阴性。中性粒细胞减少症和血小板减少症在阿奇霉素启动后三天内消失。讨论：另外四例肺炎支原体肺炎表现为严重发热性中性粒细胞减少症已在文献中报道。它们在所有病例中都与血小板减少症和/或贫血有关。2例粒细胞自身抗体阳性。这一罕见病例强调了在发热性中性粒细胞减少症的鉴别诊断中考虑肺炎支原体感染的重要性，并说明在单独抗生素治疗下可以观察到中性粒细胞减少症的快速解决。

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引用次数: 0

Renal abnormalities 肾功能异常。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2025-09-15 DOI: 10.1016/j.revmed.2025.08.014

Pierre-Antoine Castan , Bertrand Lioger , Maxime Gouguet , Abderrazak El Yamani , Olivia Dolleans

引用次数: 0

Women's knowledge concerning the impact of chronic systemic diseases and related treatments on pregnancy 妇女对慢性全身性疾病及相关治疗对妊娠影响的认识。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2025-09-09 DOI: 10.1016/j.revmed.2025.08.003

Marie Rolland , Odile Souchaud-Debouverie , Quentin Bodard , Aurélie Grados , Marie Pathé , Mathieu Puyade , Mickaël Martin

Introduction

Many women of childbearing age are being treated for chronic conditions that require long-term medication. We assessed the knowledge of women being treated in internal medicine and clinical immunology, regarding the impact of their disease and specific treatments on a potential pregnancy.

Methods

Between September 1st, 2019, and November 1st, 2020, in four hospitals in the Poitou-Charentes region, a questionnaire was given to every woman aged 18 to 44 who came in for an internal medicine and clinical immunology consultation for the follow-up of a chronic systemic disease. Women who were already pregnant or breastfeeding were excluded.

Results

One hundred and ten women were included. Lupus was the most common condition (29%). Knowledge of follow-up was adequate for 38%, 58%, and 86% of women with vasculitis, connective tissue disease or sickle cell disease, respectively. Regarding treatments, responses were correct for 71% of contraindicated treatments and 41% of authorized treatments. Knowledge was no better among women who wanted to become pregnant (correct answers for treatments: 34%) or among women who were not using contraception and did not want to become pregnant (correct answers for treatments: 50%). Only half of the women reported having received information on the subject from a healthcare professional.

Conclusion

Essential information on maternal and fetal safety is not properly understood by women of childbearing age, nor is it sufficiently communicated by healthcare professionals. It seems important to strengthen the questioning process and inform patients about the risks to mothers and fetuses.

导言：许多育龄妇女正在接受需要长期药物治疗的慢性病治疗。我们评估了正在接受内科和临床免疫学治疗的妇女的知识，关于她们的疾病和特定治疗对潜在怀孕的影响。方法：在2019年9月1日至2020年11月1日期间，在普瓦图-夏朗德地区的四家医院，对每位18至44岁的女性进行内科和临床免疫学咨询，以随访慢性全身性疾病。已经怀孕或哺乳的妇女被排除在外。结果：共纳入110名女性。狼疮是最常见的疾病（29%）。分别有38%、58%和86%的女性血管炎、结缔组织病和镰状细胞病患者了解随访情况。在治疗方面，71%的禁忌症治疗和41%的授权治疗的反应是正确的。想要怀孕的妇女（治疗方面的正确答案为34%）或没有使用避孕措施且不想怀孕的妇女（治疗方面的正确答案为50%）的知识水平也没有提高。只有一半的妇女报告说，她们从保健专业人员那里得到了这方面的信息。结论：育龄妇女对孕产妇和胎儿安全的基本信息了解不足，卫生保健专业人员也没有充分沟通。加强询问过程并告知患者对母亲和胎儿的风险似乎很重要。

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引用次数: 0

Issue Contents 问题内容

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2026-02-18 DOI: 10.1016/S0248-8663(26)00025-1

引用次数: 0

Transition écologique hospitalière : présentation du guide de déprescription des examens biologiques [可持续的医疗保健转型：描述不必要的生物测试的指南]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2026-02-11 DOI: 10.1016/j.revmed.2026.01.010

Nathalie Costedoat-Chalumeau , Véronique Bortolotti , Adrien Michon , Pierre Louis Cariou , Marion Casadevall , Caroline Charre , Agnès Ferroni , Camille Chenevier-Gobeaux , Claire Goulvestre , Hélène Lelong , Marianne Leruez-Ville , Alice-Andrée Mariaggi , Nicolas Pallet , Perrine Parize , Charlotte Laurent , Yann Nguyen , Benjamin de Sainte Marie , Christophe Richez , Pauline Richebe , Juliette Pavie

引用次数: 0

Immuno’logique (l’actualité scientifique que vous n’auriez pas osé lire ailleurs) : la face cachée du syndrome VEXAS 免疫学（你在其他任何地方都不敢读到的科学更新）：VEXAS综合征的隐藏面孔。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2025-09-12 DOI: 10.1016/j.revmed.2025.08.008

Valentin Lacombe

The VEXAS syndrome, whose phenotype has been extensively described in recent years, is now beginning to unveil the secrets of its pathophysiology. For those who tend to keep a respectful distance from basic science papers, Immuno’logical offers a guided dive into two recent fascinating publications, that challenge several long-held assumptions: no, VEXAS is not merely a myeloid disorder; no, UBA1-wild-type cells are not blameless in systemic inflammation; and no, UBA1-mutated progenitors do not owe their clonal dominance to uncontrolled proliferation. To understand it all, we will decode ubiquitination, single-cell RNA-sequencing, and clonal expansion – thoroughly but without unnecessary complexity – to uncover the hidden gems within these studies. In short, let's be serious without taking ourselves too seriously, and explore the hidden side of VEXAS syndrome.

近年来，人们对VEXAS综合征的表型进行了广泛的描述，现在开始揭示其病理生理学的秘密。对于那些倾向于与基础科学论文保持尊重距离的人来说，《免疫学》杂志提供了两篇最近发表的引人入胜的论文的指导，它们挑战了几个长期存在的假设：不，VEXAS不仅仅是一种髓系疾病；不，uba1野生型细胞在全身性炎症中并非无可指责；不，uba1突变的祖细胞的克隆优势并不归功于不受控制的增殖。为了理解这一切，我们将解码泛素化，单细胞rna测序和克隆扩增-彻底但没有不必要的复杂性-发现这些研究中隐藏的宝石。简而言之，让我们认真一点，不要太把自己当回事，探索一下VEXAS综合征隐藏的一面。

引用次数: 0

Évolution de la nomenclature des maladies hépatiques stéatosiques : vers un changement de paradigme [脂肪肝疾病命名法的演变：走向范式转变]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2025-12-19 DOI: 10.1016/j.revmed.2025.12.003

Philippe Halfon

Metabolic steatotic diseases affect 16.7% of the French population, i.e. approximately 8 million individuals. Approximately 60% of type 2 diabetes patients have hepatic steatosis, 30% of whom also have fibrosis. The progression of fibrosis, linked to systemic inflammation, is associated with a significant increase in cardiovascular and cancer mortality (particularly hepatocellular carcinoma and colorectal adenocarcinoma). In 2023, an international reform of the nomenclature led to the replacement of the old terminology “non-alcoholic fatty liver disease (NAFLD)” and “non-alcoholic steatohepatitis (NASH)” in order to better reflect the metabolic causes. The following terms were defined: “steatotic liver disease (SLD)”, which refers to all forms of steatosis, “metabolic dysfunction-associated steatotic liver disease (MASLD)”, which explicitly includes metabolic factors, and “metabolic dysfunction-associated steatohepatitis (MASH)”, which emphasizes histologically confirmed metabolic steatohepatitis. A new entity, “metabolic alcohol-related liver disease (MetALD),” refers to MASLD with moderate but regular alcohol consumption. The definition of “alcohol-related liver disease (ALD)” remains unchanged (alcohol consumption greater than 50–60 g/day). “Cryptogenic steatosis” includes cases with no known cause. This new classification allows for the continued use of previous data and aims to improve patient stratification for personalized treatments.

代谢性脂肪变性疾病影响16.7%的法国人口，即约800万人。大约60%的2型糖尿病患者有肝脂肪变性，其中30%有肝纤维化。与全身性炎症相关的纤维化进展与心血管和癌症死亡率（特别是肝细胞癌和结直肠腺癌）的显著增加有关。2023年，国际上对命名法进行了改革，取代了旧的术语“非酒精性脂肪性肝病（NAFLD）”和“非酒精性脂肪性肝炎（NASH）”，以便更好地反映代谢原因。定义了以下术语：“脂肪变性肝病（SLD）”，指所有形式的脂肪变性；“代谢功能障碍相关脂肪变性肝病（MASLD）”，明确包括代谢因素；“代谢功能障碍相关脂肪性肝炎（MASH）”，强调组织学证实的代谢性脂肪性肝炎。一个新的实体，“代谢性酒精相关肝病（MetALD）”，是指中度但有规律饮酒的MASLD。“酒精相关性肝病（ALD）”的定义保持不变（酒精摄入量大于50-60克/天）。“隐源性脂肪变性”包括病因不明的病例。这种新的分类允许继续使用以前的数据，旨在改善患者分层的个性化治疗。

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引用次数: 0

Poumon et sclérodermie systémique [肺和系统性硬化症]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2025-08-27 DOI: 10.1016/j.revmed.2025.08.006

Éric Hachulla

Interstitial lung disease (ILD) is a frequent and potentially life-threatening complication of systemic sclerosis, affecting 40 to 50% of patients. Systematic screening with high-resolution computed tomography and pulmonary function tests (PFTs), including DLCO, is recommended at diagnosis. ILD may be present even in patients with normal PFTs. Prognosis depends on the initial extent of ILD, assessed by imaging and forced vital capacity (FVC). Current guidelines (PNDS, ACR/CHEST, EULAR) recommend a personalized management approach based on progression risk. Mycophenolate mofetil (MMF) is considered the first-line treatment. Rituximab (RTX), evaluated in several trials, has shown a favorable effect on FVC stabilization or improvement. Tocilizumab has also demonstrated a slowing of FVC decline in ILD subgroups in two randomized trials, although the primary endpoint based on the modified Rodnan skin score was negative. Nintedanib demonstrated efficacy in the SENSCIS trial by significantly reducing the annual rate of FVC decline, including in patients receiving MMF. In cases of disease progression despite appropriate initial treatment, hematopoietic stem cell transplantation or a combination of MMF and RTX may be considered. Lung transplantation can be an option for refractory forms. A comprehensive approach including oxygen therapy, pulmonary rehabilitation, and infection prophylaxis is essential.

间质性肺病（ILD）是系统性硬化症的一种常见且可能危及生命的并发症，影响40%至50%的患者。诊断时建议采用高分辨率计算机断层扫描和肺功能检查（PFTs）进行系统筛查，包括DLCO。即使在pft正常的患者中，ILD也可能存在。预后取决于ILD的初始程度，通过影像学和用力肺活量（FVC）来评估。目前的指南（PNDS, ACR/CHEST， EULAR）推荐基于进展风险的个性化管理方法。霉酚酸酯（MMF）被认为是一线治疗。在几个试验中评估的利妥昔单抗（RTX）显示出对FVC稳定或改善的有利作用。在两项随机试验中，Tocilizumab也显示出ILD亚组FVC下降的减缓，尽管基于改良罗德曼皮肤评分的主要终点为阴性。尼达尼布在SENSCIS试验中通过显著降低FVC年下降率（包括接受MMF的患者）证明了其有效性。在疾病进展的情况下，尽管适当的初始治疗，造血干细胞移植或MMF和RTX的组合可以考虑。肺移植是治疗难治性疾病的一种选择。包括氧疗、肺部康复和感染预防在内的综合治疗方法是必不可少的。

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引用次数: 0

Une éruption papuleuse faussement inquiétante [令人担忧的假丘疹]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2025-10-21 DOI: 10.1016/j.revmed.2025.10.002

Quentin Gomes de Pinho , Audrey Benyamine , Coline Rabourdin , Samuel Martinez-Levy , Zian Bouchette , Françoise Dolbeault , Victoire Cosialls , Brigitte Granel

引用次数: 0

Encéphalopathie hépatique secondaire à une sténose post-radiothérapie de la veine fémorale commune [放疗后股总静脉狭窄相关的肝性脑病]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2025-12-17 DOI: 10.1016/j.revmed.2025.12.001

Florent Broca , Mylène Dufrenoy , Robin James , Lucie Cathelineau , Gwenaël Le Guyader , Estelle Antoine , Mickaël Martin

Introduction

Hepatic encephalopathy is a neuropsychologic disorder due to hyperammonaemia, related to liver failure and/or portosystemic shunts for instance. We herein describe the case of a 74-year-old woman who developed hepatic encephalopathy in the context of portal hypertension secondary to chronic stenosis of the left common femoral vein.

Case report

A 74-year-old woman presented with confusion and major hyperammonemia (> 100 μmol/L). She had a past medical history of angioma of the left leg treated with radiotherapy. Post radiotherapy stenosis of the left common femoral vein occurred, then bypass paths leading to large pelvic varicose veins draining into the inferior mesenteric vein. There was no evidence for liver failure and common causes of confusion were excluded. The liver biopsy was refused by the patient. In the absence of another etiology, the retained diagnosis was an hepatic encephalopathy secondary to portal hypertension, related to inferior mesenteric vein hyper flow draining into the splenic vein, then into the portal vein. Treatment by lactulose and rifaximine allowed clinical improvement and hyperammonemia reduction.

Conclusion

An hepatic encephalopathy may occur without any evidence of hepatopathy, in the context of venous malformations responsible for portal venous hyper flow, as illustrated by this unusual case report.

简介：肝性脑病是一种由高氨血症引起的神经心理障碍，与肝功能衰竭和/或门静脉分流等有关。我们在此描述的情况下，74岁的妇女谁发展肝性脑病在门静脉高压继发慢性狭窄的左总股静脉。病例报告：一名74岁女性，表现为精神错乱和重度高氨血症（bbb100 μmol/L）。既往有左腿血管瘤病史，曾接受放射治疗。放射治疗后发生左股总静脉狭窄，然后绕道导致盆腔大静脉曲张流入肠系膜下静脉。没有肝衰竭的证据，排除了常见的精神错乱原因。患者拒绝肝活检。在没有其他病因的情况下，保留的诊断是继发于门静脉高压症的肝性脑病，与肠系膜下静脉血流进入脾静脉，然后进入门静脉有关。乳果糖和利福昔明治疗使临床改善和高氨血症减少。结论：肝性脑病可能在没有任何肝病证据的情况下发生，在静脉畸形导致门静脉超流的情况下，正如这个不寻常的病例报告所示。

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