[Sirolimus-associated interstitial pneumonitis in a renal transplant patient]. / Pneumopathie organisée au sirolimus: un diagnostic à évoquer chez le patient transplanté d'organe.

INTRODUCTION: Sirolimus is a new immunosuppressive drug used in organ transplantation, particularly in renal transplantation. In the future, it could replace calcineurin inhibitors such as cyclosporine. It is currently associated with side effects, such as thrombocytopenia and hyperlipidemia. Several interstitial pneumonitis associated with sirolimus has been previously described in renal transplant recipients associated with marked general symptoms. EXEGESIS: We report on a 65-year-old renal recipient presenting with a non typical case of sirolimus interstitial pneumonitis. He presented with fever and marked general symptoms for several months. CT scan showed a unilateral interstitial pneumonitis. After infectious, inflammatory and tumoral diseases were ruled out, sirolimus associated interstitial pneumonitis was evoked. The patient improved quickly after discontinuation of sirolimus. CONCLUSION: It is important to evoke, after eliminating other aetiologies, sirolimus induced pneumonitis in face of an organ transplant recipient presenting with marked general symptoms even if the pulmonary symptoms are not predominant.

T-Cell suicide gene therapy for organ transplantation: induction of long-lasting tolerance to allogeneic heart without generalized immunosuppression.

Standard immunosuppressive drugs used for allogeneic organ transplantation do not specifically target alloreactive T cells and must be given for the lifetime of the patient, resulting in significant morbidity and mortality. We aimed to induce experimental immune tolerance to vascularized heart allograft using a suicide gene allowing selective elimination of dividing T cells expressing Herpes simplex virus type 1 thymidine kinase upon ganciclovir administration. We show that without ganciclovir, transgenic mice selectively expressing thymidine kinase in T cells rejected a vascularized cardiac allograft in 7 days. In contrast, allograft was definitively accepted after a 7-day course of ganciclovir initiated at the time of allotransplantation. Interestingly, T cells from both rejecting and tolerant mice proliferated in response to donor or third-party allogeneic stimulation. This state of tolerance was challenged through a second vascularized cardiac allotransplantation. Third-party allografts were rejected while those syngeneic to the first allograft were accepted without any additional treatment. These results show that short-term pharmacogenetic immunosuppression can induce long-lasting, robust, and specific tolerance to solid vascularized allograft without generalized continuous immunosuppression.

[Behcet's disease and iatrogenic arterial complications: importance of pre-operative noninvasive explorations]. / Maladie de Behçet et complications artérielles iatrogènes: intérêt des explorations pré-opératoires non invasives.

We report a case of Behçet's disease complicated with a popliteal aneurysm, which appeared 8 years after first etiologic diagnosis. The points of interest of this observation are the pre-operative explorations and particularly the Magnetic Resonance Angiography (RMA). This last seems to be particularly safe for aortic and lower limbs aneurysms explorations, and can be performed without arterial functions. In fact the risk of arteriogram is effective in Behçet's disease with secondary false aneurysms. RMA and US-Doppler scan must be first proposed in Behçet's disease in case of aortic and peripheral aneurysms.

[New acute poisoning syndromes of drug origin]. / Nouveaux syndromes toxiques aigus d'origine médicamenteuse.

The slow but constant modifications of the pharmacopeia and prescribing habits are at the origin of changes in the causes of intoxications by medications, which are reflected in the syndromes observed in daily practice. New syndromes have appeared: serotoninergic syndrome, adrenergic syndromes, toxic malignant hyperthermia, opioid toxic syndrome, intoxication by drugs with membrane-stabilizing effect. Recognizing these syndromes is not only useful to determine the possible causes of on intoxication, but also to direct appropriate, specific therapeutic interventions.