La Revue de medecine interne最新文献

Diffuse interstitial lung diseases (ILDs) represent a complex and heterogeneous group of pulmonary disorders, requiring a structured, rigorous, and integrated radiologic approach for accurate diagnosis. High-resolution computed tomography (CT) remains the cornerstone examination, enabling precise identification of elementary lesions and their organization into diagnostic imaging patterns that are critical for etiologic classification. This analysis, guided by the most recent international guidelines, relies on strict technical protocols (thin slices, expiratory and prone acquisitions), longitudinal comparative reading, and systematic multidisciplinary discussion. The recognition of progressive pulmonary fibrosis as a distinct clinical entity with significant prognostic and therapeutic implications underscores the need for consistent and reproducible imaging assessment. Emerging tools such as artificial intelligence and photon-counting CT are enhancing early lesion detection, quantitative analysis, and prognostic stratification, allowing for dynamic evaluation of ILD progression and facilitating more personalized therapeutic strategies. This article aims to provide a structured radiologic interpretation framework based on elementary lesions, their distribution, and their organization into imaging patterns, while addressing common diagnostic pitfalls and incorporating the latest international recommendations.

Introduction: Giant cell arteritis (GCA) is the most common vasculitis after the age of 50. Large vessel vasculitis (LVV) is frequently observed in 40 to 70% of cases, primarily affecting the aorta. Extracranial LVV is scarcely described.

Observation: We present four cases of LVV-GCA without aortitis. LVV was found in 3 cases on PET-CT showing limb involvement, for the last case, CT scan revealed involvement of mesenteric artery. The diagnosis of GCA was confirmed in three of the four cases by temporal artery biopsy. In the last case, the diagnosis was made after PET-CT analysis and ophthalmological examination with a pathognomonic angiography. Three patients developed corticosteroid dependence and the last one was lost to follow-up.

Conclusion: LVV without aortitis evolution is rarely described. We report here 4 cases, 3 of whom became corticosteroid dependent. Larger cohort studies are needed to assess the prognosis and therapeutic impact of this particular phenotype of GCA.

Finding increased red cell indices - elevated RBC count, hemoglobin, or hematocrit (erythrocytosis) - is common in medicine. The key question is whether this reflects a myeloproliferative neoplasm (polycythemia vera, primary myelofibrosis, or essential thrombocythemia) driven by mutations such as JAK2, because it can cause thrombotic or hemorrhagic complications or progress to myeloid leukemia. We propose a diagnostic pathway for erythrocytosis that outlines the principal causes to exclude by targeted history and physical examination and incorporates the TRAKJAK score to predict JAK2 mutation positivity. By reducing unnecessary downstream testing, the score can lower costs and the environmental footprint of care.

Aspiration pneumonia is a specific respiratory infection. It is frequent and severe, and represents a pressing issue given the growing ageing population. For the first time, French guidelines clarify how to manage this infection. We therefore wanted to present a revised review on this topic. The main aim is to highlight strategic elements based on pathophysiology. Diagnosis is based on clinical and radiological criteria; however, the aspiration event remains difficult to define. Biological tests are still important for follow-up and evaluating the impact of the disease on different organ systems. Microbiological examinations should not be performed systematically, but only under specific conditions. Antibiotherapy is based on simple principles: amoxicillin-clavulanic acid is the first-line treatment, administered orally wherever possible, and metronidazole should not be used. A careful analysis of the context and risk factors is essential for effective prevention. This is a multimodal and multidisciplinary approach involving rehabilitation, nutritional care and oral hygiene.

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 (0.2G/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.

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 50-60g/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.

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 (>100μmol/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.

Subcutaneous (SC) infusion, or hypodermoclysis, is a route of administration involving the injection of fluids or medications into the hypodermis. Historically used and subsequently abandoned due to complications arising from poor technique, it has regained interest since the 1990s, particularly in geriatrics and palliative care. Compared with the intravenous (IV) route, it is less invasive, better tolerated, easier to implement in outpatient settings, and carries a lower risk of serious complications. The pharmacokinetics of the SC route show slightly slower absorption than IV administration, with bioavailability often exceeding 80% for hydrosoluble compounds. Main indications include the preventive or therapeutic management of moderate dehydration, palliative care (analgesics, anxiolytics, antipyretics, antisecretory agents), and some antibiotics (such as ceftriaxone, as well as ertapenem and teicoplanin, with a good level of supporting evidence). In internal medicine departments, the SC route can also be used for furosemide, levetiracetam, and vitamin B12 when no alternative is available. Some vaccines may be administered subcutaneously in patients with contraindications to the intramuscular route. Local adverse events may occur but are generally mild (pain, edema), transient, and infections are rare. Although often used off-label, hypodermoclysis is a safe and practical alternative, particularly suited to elderly or frail patients, and meets current healthcare challenges related to outpatient medicine and hospital overcrowding. Its wider adoption relies on healthcare professional training, standardized protocols, and robust comparative data.