RESUMO
The relapse rate in antiphospholipid syndrome (APS) remains high, i.e. around 20%-21% at 5â¯years in thrombotic APS and 20-28% in obstetrical APS [2, 3]. Hydroxychloroquine (HCQ) appears as an additional therapy, as it possesses immunomodulatory and anti-thrombotic various effects [4-16]. Our group recently obtained the orphan designation of HCQ in antiphospholipid syndrome by the European Medicine Agency. Furthermore, the leaders of the project made the proposal of an international project, HIBISCUS, about the use of Hydroxychloroquine in secondary prevention of obstetrical and thrombotic events in primary APS. This study has been launched in several countries and at now, 53 centers from 16 countries participate to this international trial. This trial consists in two parts: a retrospective and a prospective study. The French part of the trial in thrombosis has been granted by the French Minister of Health in December 2015 (the academic trial independent of the pharmaceutical industry PHRC N PAPIRUS) and is coordinated by one of the members of the leading consortium of HIBISCUS.
Assuntos
Síndrome Antifosfolipídica/complicações , Parto Obstétrico , Hidroxicloroquina/uso terapêutico , Trombose/prevenção & controle , Feminino , Humanos , Gravidez , Resultado da Gravidez , Prevenção Secundária , Trombose/etiologiaRESUMO
A 38-year-old man presented at the first-aid department complaining of fever, general malaise and a painful left groin. The complaints had started shortly after an active holiday in Finland. Physical examination showed enlarged left sided inguinal lymph nodes and a marked eschar on the left lower leg. In terms of differential diagnosis a Rickettsia or a tularemia infection were considered. The pathogen for tularemia, Francisella tularensis subspecies holarctica, was isolated in wound discharge from the patient. Serology also indicated infection with F. tularensis. The patient was treated at home with oral doxycycline and recovered fully in a few days. In patients presenting with an eschar, rickettsiosis is often the first and only disease that is considered. This case report clearly emphasizes that a differential diagnosis of an eschar can be made and that this includes tularemia.