{"id":1929,"date":"2011-10-01T01:00:00","date_gmt":"2011-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/chute-isolee-du-facteur-v-sous-imurel\/"},"modified":"2018-10-20T18:40:01","modified_gmt":"2018-10-20T16:40:01","slug":"chute-isolee-du-facteur-v-sous-imurel","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/chute-isolee-du-facteur-v-sous-imurel\/","title":{"rendered":"Chute isol\u00e9e du facteur V sous IMUREL"},"content":{"rendered":"

2011<\/strong><\/p>\n

S\u00e9verine Hommel (1), Magali Picon (1), Serge Erlinger (1), Fran\u00e7ois Cessot (1), Didier Mathieu (1)
\n(1) Centre hospitalier du Pays d’Aix, Service de Gastroent\u00e9rologie et H\u00e9patologie du Dr PICON, Avenue des Tamaris, 13090 Aix en Provence<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02011-05-13 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Nous rapportons le cas d’un patient \u00e2g\u00e9 de 53 ans, suivi pour une rectocolite h\u00e9morragique (RCH) s’\u00e9tendant jusqu’\u00e0 l’angle colique droit, diagnostiqu\u00e9e en 1990 avec une pouss\u00e9e corticod\u00e9pendante en 12\/2009 ayant justifi\u00e9 l’introduction d’IMUREL \u00e0 la dose de 2.5 mg\/kg (175 mg).
\nCe patient a comme principaux ant\u00e9c\u00e9dents: une thalass\u00e9mie mineure, un tabagisme sevr\u00e9 \u00e0 20 PA (EFR normales), un \u00e9thylisme sevr\u00e9, une chol\u00e9cystectomie, un ant\u00e9c\u00e9dent de cancer gastrique chez son p\u00e8re (FOGD normale, HP-) et de cancer colorectal chez sa m\u00e8re (coloscopies\/2 ans normales).
\nSous IMUREL, un sevrage en corticoides est obtenu ainsi qu’une r\u00e9mission clinique et une cicatrisation endoscopique (aspect macroscopique + biopsies). Un suivi r\u00e9gulier biologique sous IMUREL est instaur\u00e9 de mani\u00e8re mensuelle puis trimestrielle avec des controles sans particularit\u00e9.
\nFin janvier 2011, est introduit un traitement par PENTASA 2g en pr\u00e9vention du cancer colorectal (compte tenu du terrain et de ses ant\u00e9c\u00e9dents familiaux). Quinze jours apr\u00e8s cette introduction, un bilan biologique est effectu\u00e9, retrouvant une chute du TP \u00e0 37% associ\u00e9e \u00e0 une an\u00e9mie \u00e0 9.6g\/dl (HB \u00e0 11g habituellement) et \u00e0 une lymphop\u00e9nie \u00e0 851\/mm3. Le reste de l’h\u00e9mogramme et le bilan h\u00e9patique sont normaux. Le bilan est compl\u00e9t\u00e9 en urgence par le dosage des facteurs de la coagulation (FII, V, VII, IX et X) revenant normaux sauf le facteur V (FV) abaiss\u00e9 \u00e0 34%. Sur le plan clinique, aucun flapping n’est constat\u00e9. Les s\u00e9rologies virales sont n\u00e9gatives (VHA, VHE, VHB et VHC), les s\u00e9rologies EBV, CMV et herp\u00e8s sont en faveur d’une immunisation ancienne.
\nLe dosage de la M\u00e9thyl 6 Mercaptopurine et des 6TGN revient tr\u00e8s \u00e9lev\u00e9. L’\u00e9chographie abdominale est normale.
\nTous les traitements sont arr\u00eat\u00e9s. A J3, on constate une remont\u00e9e du FV \u00e0 50% puis \u00e0 78% \u00e0 J15 avec parall\u00e8lement un retour \u00e0 un taux d’h\u00e9moglobine habituel et une correction de la lymphop\u00e9nie. Un dosage d’anticorps anti nucl\u00e9aire, anti facteur V et d’ACC, anti cardiolipine et phospholipides ainsi que de B2GP1 \u00e0 la recherche d’un syndrome des antiphospholipides (SAPL) est r\u00e9alis\u00e9, revenant n\u00e9gatif. L’activit\u00e9 de la TPMT est normale. Un traitement par PENTASA 2g par jour en entretien est r\u00e9introduit avec surveillance clinique et biologique rapproch\u00e9e.
\nLe diagnostic retenu est celui de chute isol\u00e9e du facteur V li\u00e9e \u00e0 la toxicit\u00e9 de l’IMUREL, probablement du fait de l’int\u00e9raction avec le PENTASA.
\nUne telle chute du FV sous IMUREL a \u00e9t\u00e9 rapport\u00e9e dans la litt\u00e9rature, 5 cas dans les MICI (Poupeney S et al, Inflamm Bowel Dis 2008 Jul; 14(7): 1024-5) mais \u00e9galement dans les maladies autoimmunes, le SAPL, sous traitemet (CIFLOX), dont le m\u00e9canisme exact reste inconnu. Des cas de r\u00e9introduction de l’IMUREL ont \u00e9t\u00e9 publi\u00e9s (dans une LLC) se soldant par de nouvelles chutes du FV. Au regard de cette exp\u00e9rience clinique, une surveillance du TP sous IMUREL semble pertinente.<\/p>\n","protected":false},"excerpt":{"rendered":"

2011 S\u00e9verine Hommel (1), Magali Picon (1), Serge Erlinger (1), Fran\u00e7ois Cessot (1), Didier Mathieu (1) (1) Centre hospitalier du Pays d’Aix, Service de Gastroent\u00e9rologie et H\u00e9patologie du Dr PICON, Avenue des Tamaris, 13090 Aix en Provence H\u00e9patologie – \u00a02011-05-13 –\u00a0CO – ________________________________ Nous rapportons le cas d’un patient \u00e2g\u00e9 de 53 ans, suivi pour […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[22],"class_list":["post-1929","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-22"],"yoast_head":"\nChute isol\u00e9e du facteur V sous IMUREL - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/chute-isolee-du-facteur-v-sous-imurel\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Chute isol\u00e9e du facteur V sous IMUREL - 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