Janus kinase inhibitors (JAKis) have revolutionized the treatment landscape for various inflammatory and autoimmune diseases since their introduction in 2012. The expanded indications of JAKis have raised concerns about the associated risk of thrombosis, venous thromboembolic events (VTEs), and arterial thrombosis. This literature review examines studies reporting the risk of VTEs associated with JAKis in patients with inflammatory diseases. Phase I to III trials showed no increased risk of VTEs. However, these studies were not designed to detect adverse events such as VTEs. The pharmacovigilance data indicated that the frequency of VTE reports was higher than that of other adverse events. An increased risk of VTEs was also observed in the ORAL Surveillance study, a randomized, noninferiority, postmarketing phase IV safety study comparing tofacitinib with anti-tumor necrosis factor in patients with rheumatoid arthritis. However, limitations have to be acknowledged: pharmacovigilance data are declarative and subject to bias, VTE was a secondary outcome in the ORAL study, with noncomparable VTE risk factors between groups and increased thrombosis risks only at high doses of tofacitinib. Nevertheless, these data have led regulatory organizations such as the Food and Drug Administration and the European Medicines Agency to issue precautionary measures regarding the use of JAKis in inflammatory diseases. Most well-conducted real-life studies are in rheumatoid arthritis and do not confirm an excess of VTE risk associated with JAKis. Considering those conflicting results and limitations, future research should focus on specific indications and patient profiles, taking into account the complex interaction between drug treatment and underlying disease activity, to be able to draw definite conclusion about the VTE risk associated with JAKis.

Le diagnostic de Sclérose latérale amyotrophique (SLA) repose sur l’association de signes de souffrance des neurones moteurs centraux et périphériques d’extension progressive au niveau des sphères bulbaire, cervicale, thoracique et lombaire, en l’absence de diagnostic différentiel permettant d’expliquer les symptômes. Le bilan organisé chez un patient présentant des signes évocateurs de la maladie doit donc être clinique, électrophysiologique, biologique et radiologique. L’objectif de ce bilan est d’étayer le diagnostic de SLA et d’écarter les pathologies – en particulier curables – pouvant mimer la maladie. Cette approche implique une bonne connaissance des différents phénotypes cliniques de la SLA et de ses principaux diagnostics différentiels.The diagnosis of amyotrophic lateral sclerosis (ALS) relies on signs of upper and lower motoneuron degeneration in bulbar, cervical, thoracic and lumbar regions, in the absence of differential diagnosis. The diagnostic strategy for suspected ALS is based on clinical, electrophysiological, biological, and radiological explorations, to confirm the diagnosis and exclude ALS mimics. This approach requires knowledge of the clinical phenotypes of ALS and its main differential diagnoses.

A 70-year-old man reported recent swelling and erythema of both ears, sparing the lobules and highly evocative of relapsing polychondritis (top left image). Moreover, a fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT) scan revealed ear and nose cartilage hypermetabolism (bottom left image), without evidence of tracheobronchial involvement. Unexpectedly, cervical, mediastinal, retroperitoneal and inguinal hypermetabolic lymph nodes were also detected. Serum protein electrophoresis and immunofixation disclosed an immunoglobulin M kappa (IgMκ) monoclonal gammopathy (5 g/l). Cervical lymph node and ear cartilage biopsy specimen analysis (centre) showed a kappa monotypic B-cell infiltrate (CD20+, CD5−, CD23−, CD10−, cyclin D1−, CD3−) with MYD88 gene somatic mutation. Waldenström macroglobulinaemia was diagnosed and monotherapy with oral ibrutinib was started. Complete clinical and PET-CT remission was obtained within a few months (right images). Diagnosis of relapsing polychondritis is mostly based on clinical features of cartilage inflammation.1 Histological proof is not usually required. Of note, relapsing polychondritis in elderly males has recently been connected to a new autoinflammatory syndrome related to a specific gene (UBA1) somatic mutation in myeloid cells.2 Although our 70-year-old patient presented with clinically defined relapsing polychondritis the suspicion of a lymphoproliferative disorder led to a biopsy of the external ear cartilage. This showed massive involvement by B-cell non-Hodgkin lymphoma, clinically mimicking polychondritis.

Impaired immune response with uncontrolled inflammation and various immunological disorders have been reported during SARS-CoV-2 infection. Here, we report a case of cold agglutinin disease occurring during a severe coronavirus disease 2019 (COVID-19) in a French intensive care unit. A patient was presented with acute respiratory distress syndrome, acute renal failure and haemolytic anaemia. Direct antiglobulin test was positive with a cold agglutinin titre of 1/512. No other cause than COVID-19 explained the occurrence of cold agglutinin disease; however, causality could not be formally established. Persistent anaemia despite transfusion therapy and the short-term life-threatening, prompted the infusion of a monoclonal anti-C5 antibody (eculizumab). Eculizumab therapy quasi-fully resolved haemolysis within a few days, but ultimately the patient died from his severe COVID-19 infection. Data regarding the specific treatment of cold agglutinin disease during COVID-19 are rare. Although additional studies are warranted, eculizumab may be considered in critical situations.

Over several decades, the economic situation and consideration of patient quality of life have been responsible for increased outpatient treatment. It is in this context that outpatient antimicrobial treatment (OPAT) has rapidly developed. The availability of elastomeric infusion pumps has permitted prolonged or continuous antibiotic administration by dint of a mechanical device necessitating neither gravity nor a source of electricity. In numerous situations, its utilization optimizes administration of time-dependent antibiotics while freeing the patient from the constraints associated with infusion by gravity, volumetric pump or electrical syringe pump and, more often than not, limiting the number of nurse interventions to one or two a day. That much said, the installation of these pumps, which is not systematically justified, entails markedly increased OPAT costs and is liable to expose the patient to a risk of therapeutic failure or adverse effects due to the instability of the molecules utilized in a non-controlled environment, instability that necessitates close monitoring of their use. More precisely, a prescriber must take into consideration the stability parameters of each molecule (infusion duration, concentration following dilution, nature of the diluent and pump temperature). The objective of this work is to evaluate the different means of utilization of elastomeric infusion pumps in intravenous antibiotic administration outside of hospital. Following a review of the literature, we will present a tool for optimized antibiotic prescription, in a town setting by means of an infusion device.