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Biomedical subjects

B Milpied

Publications and source records attributed to B Milpied.

At least 19 recordsLinked to original sources
PubMed2005

[Thalidomide in the treatment of chronic discoid lupus erythematosus].

INTRODUCTION: Thalidomide is the second line treatment of chronic lupus erythematosus. The efficacy of this treatment, the minimal effective doses and tolerance are poorly documented in the literature. PATIENTS AND METHODS: We present the data of a single-center retrospective studied among 18 patients with chronic lupus erythematosus, treated with thalidomide from 1998 to 2003. Inclusion criteria were: the presence of clinical lesions evoking the disease, confirmed by histological examination and direct immunofluorescence and treatment with thalidomide for more than 2 months. RESULTS: Mean age on diagnosis was of 35.8 years. Thalidomide had been initiated a mean of 10.6 years after diagnosis of chronic lupus erythematosus. In 13 out of 18 patients, thalidomide had been prescribed because of failure with prior treatments. Fifteen patients were improved by thalidomide (83.3 p. 100), with 11 (61 p. 100) complete and 4 (22 p. 100) partial remissions. Two (11 p. 100) patients were stabilized and treatment failed in one. The mean initial dose was of 100 mg/d (50-150), and maintenance dose was of around 50 mg/d (56 mg/d). The mean follow-up with thalidomide was of 19.4 months. Only one withdrawal due to side effects was reported. The most frequent side effects were: asthenia (33 p. 100), paresthesia (22 p. 100) and weight gain (16.6 p. 100). No side effects were reported in 10 out of 18 patients. DISCUSSION: This study confirms the efficacy of low dose thalidomide in the treatment of chronic lupus erythematosus. In our experience, tolerance to this treatment is good, the most frequent side effect was asthenia, but usually mild. No significant peripheral neuropathy was noted. The fear of side effects, notably neurological, should not delay initiation of thalidomide in the case of failure with current treatments.

Adolescent↗
PubMed2003

[Severe cutaneous drug reactions to celecoxib (Celebrex)].

INTRODUCTION: Celecoxib (Celebrex) is a Cox 2 selective non steroidal anti-inflammatory agent. Adverse reactions reported are usually benign, such as maculopapular exanthema. However, recently severe toxiderma have started to appear. We report two patients who developed a sever celecoxib drug skin reaction. OBSERVATIONS: Case no 1. In a 73 year-old woman, treated with celecoxib for cervical arthralgia, a maculopapular exanthema five days after treatment was started. The exanthema, initially edematous and purpural became bullous with multi-visceral failure (disseminated intravascular coagulation, renal failure, hepatitis and pancreatic). The disease slowly regressed. Case no 2. A 72 year-old man, treated for cervicalgia with celecoxib, presented a pustular exanthema of the face and the trunk, ten days after introduction of the treatment, associated with an inflammatory syndrome and hepatic cytolysis. Within 8 days the disease had regressed. In both these patients, the celecoxib patch tests were positive. DISCUSSION: Until now, the side effects reported with celecoxib have been generally benign exanthemas. We report two cases of severe celecoxib-induced toxiderma: a hypersensitivity syndrome with multi-organ failure and an acute generalized atypical exanthematous pustulosis. These severe toxidermas have rarely been reported in the literature, but we now need to reassess the risks with these new molecules.

Aged↗
PubMed2001

[Primary cutaneous cryptococcosis in HIV-seronegative subjects].

BACKGROUND: Primary cutaneous cryptococcosis is an uncommon clinical entity characterized by direct skin inoculation without systemic involvement. We report four cases of this affection in HIV-negative patients seen between 1990 and 1999 in Nantes Dermatological Clinic. CASE REPORTS: Patients mean age was seventy. Three patients had recent exposure to soil or birds, and two remembered a trauma before the lesion appeared. In three cases the lesion was on the hand. In two cases the lesion was an ulcerated nodule, in another an abscess and in the last a cellulitis. Two subjects were treated by fludarabin and systemic corticosteroids for respectively chronic lymphocytic leukemia and Waldenstrom's macroglobulinemia. The third had a CD4 lymphopenia. Cultural examination confirmed the diagnosis. Treatment, with fluconazole in 3 cases and ketoconazole and itraconazole in 1 case, resulted in healing of the skin lesion in a few months. DISCUSSION: Recognition of primary cutaneous cryptococcosis as a clinical entity has long been debated. An altered immunological status is an important factor for developing this disease. There is often a clear history of trauma or exposure to soil or birds preceding the development of the lesion. Clinically it often looks like a papule or an ulcerated nodule. The lesion is confined to the skin without systemic involvement. The prognosis is excellent thanks to the use of oral antifungal imidazoles.

Aged↗
PubMed1999

[Varicella zoster virus infection area in 39 HIV-infected patients. Therapeutic management].

OBJECTIVES: The main goal of this study was to assess therapeutic strategies in HIV-infected patients with varicella-zoster virus infection. PATIENTS AND METHODS: This retrospective study conducted between 1989 and 1996 concerned 39 HIV-infected patients who had reached the AIDS stage and had at least one episode of varcella-zoster infection. Epidemiological, clinical and therapeutic data were recorded. Chi-squared test was used for comparisons. RESULTS: A total of 78 episodes of varicella-zoster infection occurred including 39 primary episodes and 39 recurrences. Aciclovir (ACV) 200 mg per os was given in 27 cases as first intention therapy (mean dose 4000 mg/day for a mean 10 days), ACV 800 mg per os in 10 cases (mean dose 4000 mg per day for a mean 10 days), and intravenous ACV in 23 cases (mean dose 30 mg/kg/day for a mean 7 days). Foscarnet was used 5 times, 90-100 mg per day for 8 to 21 days. We did not observe any difference in efficacy between the three ACV formulations, probably because of the small number of patients in the series and the retrospective nature of the study. All of the failures of the oral treatments occurred in patients with CD4 counts below 100/mm3. CONCLUSION: Aciclovir (800 mg) can be given in HIV-infected patients who develop non-complicated varicella-zoster virus infection. Intravenous aciclovir should be reserved for severe disseminated and/or neurological forms and for highly immunodepressed patients (for example those with a CD4 count below 200/mm3). These findings should be confirmed by prospective studies.

AIDS-Related Opportunistic Infections↗
PubMed1998

Randomised comparison of thalidomide versus placebo in toxic epidermal necrolysis.

BACKGROUND: Toxic epidermal necrolysis (TEN) is associated with a 30% death rate. Tumour necrosis factor alpha (TNF-alpha) has been implicated in the pathogenesis of TEN. Thalidomide is a potent inhibitor of TNF-alpha action. We did a double-blind, randomised, placebo-controlled study of thalidomide in TEN. METHODS: The patients received a 5-day course of thalidomide 400 mg daily or placebo. The main endpoint was the progression of skin detachment after day 7. Secondary endpoints were the severity of the disease, evaluated with the simplified acute physiology score (SAPS), and the mortality. TNF-alpha and interleukin 6 were measured. FINDINGS: The study was stopped because there was excess mortality in the thalidomide group--ten of 12 patients died compared with three of ten in the placebo group (Fisher's exact test with Katz's approximation, relative risk=2.78, p=0.03). After adjustment for SAPS, mortality remained significantly higher in the thalidomide group than in the placebo group (exact logistic regression mid-p=0.007; 95% CI for odds ratio 2.7 to infinity). Plasma TNF-alpha concentration was higher in the thalidomide group than the placebo group on day 2, though the difference was not significant (Wilcoxon rank-sum test p=0.07). INTERPRETATION: Even though few patients were included, our data suggest that thalidomide is detrimental in TEN, possibly because of a paradoxical enhancement of TNF-alpha production.

Adult↗
PubMed1996

[Thrombotic microangiopathies in HIV infection: 4 cases].

Thrombotic microangiopathy (TMA) has been rarely described in HIV-infected patients. We report four cases of TMA during HIV infection and we analyse clinical, biological, etiologic, therapeutic and evolutive aspects of these four cases. Initial symptomatology is non specific and diagnosis is often delayed. Peripheric thrombopenia with haemolytic anemia and renal failure must be suggestive of the diagnosis. TMA can be present at any stage of HIV infection. Physiopathological mechanism of TMA during HIV infection remains unclear. These cases lead to suspect the role of opportunistic infections, neoplasia or HIV directly by endothelial injury or indirectly by cytokines secretion. Therapy of TMA is not different from non-HIV patients. Improvement with treatment must be obtained but long-term prognosis remains poor in account of HIV infection.

Adult↗
PubMed1996

[Lyell syndrome after amoxicillin administration in a 2 year old child].

The authors report a toxic epidermal necrolysis (TEN) due to ampicillin (Agram) in a 2-year-old child. During the acute phase a septic syndrome occurred. The severity of the clinical and biological symptoms led to the administration of antibiotics, their systematic use remaining controversial. Recovery was favourable in a paediatric burn centre. Sequelae were minor. TEN, the physiopathological mechanism of which remaining still unknown, may carry a vital risk.

Amoxicillin↗
PubMed1994

[Lichenoid eruption induced by gold salts. An autonomous eruption].

INTRODUCTION: We report a severe lichenoid drug eruption due to gold salts which relapsed 8 months after the cessation of chrysotherapy. CASE REPORT: A 56 year old man, 3 months after the beginning of a gold sodium propanol sulfonate therapy, developed a polymorphous eruption with violin papules on the trunk, eczematous lesions on the limbs and erosive stomatitis. Gold salts were definitively withdrawn. We saw the patient four months after gold therapy cessation: the eruption remained and diagnosis of severe drug cutaneo-mucous lichenoid eruption was done. We saw thereafter the patient again, 8 months after gold therapy cessation: the eruption had relapsed, more intense. DISCUSSION: We suggest that lichenoid eruption, first caused by gold salts, has become autonomous.

Antirheumatic Agents↗
PubMed1990

Epidermal interleukin 1 in normal skin of patients with HIV infection.

Interleukin 1 (IL-1) in the epidermis plays an important role together with Langerhans cells in the activation of the T cells. To determine whether IL-1 could be located in the normal epidermis of 54 patients with HIV infection and related to the stage of the disease, an indirect immunofluorescence technique was used. Intense epidermal fluorescence to IL-1 was noted in the asymptomatic stage II of the disease, whereas there was minimal reactivity in the other stages.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Prognostic value of Langerhans cells in the epidermis of HIV patients.

We measured the number of Langerhans cells in clinically normal epidermis and the number of T4 lymphocytes in the plasma in 24 patients infected with HIV, and related these to the stage of the disease. A correlation is demonstrated between the numbers of Langerhans cells and T4 lymphocytes. Numbers of Langerhans cells were lower in patients with disease stages III and IV than in those with disease stage II. Thus Langerhans cell numbers could be of prognostic value in this disease.

Acquired Immunodeficiency Syndrome↗