{"id":2305,"date":"2019-12-31T19:32:10","date_gmt":"2019-12-31T18:32:10","guid":{"rendered":"https:\/\/angh.net\/abstracts\/cytolyse-au-cours-dune-maladie-de-crohn\/"},"modified":"2019-12-31T19:32:10","modified_gmt":"2019-12-31T18:32:10","slug":"cytolyse-au-cours-dune-maladie-de-crohn","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/cytolyse-au-cours-dune-maladie-de-crohn\/","title":{"rendered":"Cytolyse au cours d&rsquo;une maladie de Crohn"},"content":{"rendered":"<p><strong>2019<\/strong><\/p>\n<p><em>Elvire Desjonqui\u00e8res, Anne-Laure Desgabriel, Julie Assaraf, Lisa Lelouch, Shuaib Alqallaf, Mathias Vidon, Laurent Costes, Herv\u00e9 Hag\u00e8ge, Isabelle Rosa<\/em><\/p>\n<p><strong>Gastroent\u00e9rologie <\/strong>&#8211; \u00a02019-05-14 &#8211;\u00a0CC &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Mme C, ag\u00e9e de 26 ans est hospitalis\u00e9e pour une pouss\u00e9e de  maladie de crohn il\u00e9o-colique. Elle \u00e9tait suivie pour une maladie de Crohn  il\u00e9ocolique et p\u00e9rin\u00e9ale, diagnostiqu\u00e9e en f\u00e9vrier 2015et trait\u00e9e par PENTASA jusqu\u2019en septembre 2016.Devant l\u2019atteinte caecale, on d\u00e9cide d\u2019introduire un traitement par PENTASA et MIKICORT. A J15 du traitement, apparition d\u2019une cytolyse h\u00e9patique isol\u00e9e (ASAT 297 UI\/L, ALAT \u00e0 809 UI\/L)conduisant \u00e0 la suspension du pentasa et Mikicort, et am\u00e9lioration en quelques jours du bilan h\u00e9patique (ASAT \u00e0 222 UI\/L, ALAT \u00e0 565 UI\/L).Une d\u00e9gradation de l\u2019\u00e9tat digestif conduisait 7 jours apr\u00e8s \u00e0 l\u2019introduction de cortancyl per os, suivie d\u2019une r\u00e9ascension des transaminases (ASAT 514 UI\/L, ALAT 1099 UI\/L). La suspension de la corticoth\u00e9rapie permettait une diminution des transaminases. Malheureusement la patiente pr\u00e9sentait de nouveau une pouss\u00e9e s\u00e9v\u00e8re 6 jours apr\u00e8s l\u2019interruption des cortico\u00efdes pour laquelle il est d\u00e9but\u00e9 une corticoth\u00e9rapie intraveineuse (40 mg\/j), relay\u00e9e per os \u00e0 72h. Une d\u00e9gradation rapide du bilan h\u00e9patique avec ASAT 978 UI\/L, ALAT 2095 UI\/L survenait d\u00e8s J2 et cette fois persistait malgr\u00e9 le nouvel arr\u00eat des corticoides. Apr\u00e8s introduction d&rsquo;Aciclovir IV dans l&rsquo;hypoth\u00e8se d&rsquo;une cause virale non document\u00e9e d\u00e9masqu\u00e9e par la corticoth\u00e9rapie, on constatait une diminution drastique des transaminases et la normalisation du bilan h\u00e9patique.  Un bilan de cytolyse exhaustif comprenant une PBH ne montrait aucun argument \u00e9tiologique. Une recherche de m\u00e9tag\u00e9nomique sur sang et biopsie h\u00e9patique n\u2019a pas permis de mettre en \u00e9vidence de g\u00e9nome fongique, bact\u00e9rien et viral d\u00e9tect\u00e9s.Il est finalement introduit un traitement immunosuppresseur de fond par Humira sans nouvel \u00e9pisode de cytolyse au d\u00e9cours et la patiente est asymptomatique sur le plan digestif.<br \/>\nQuelles sont vos hypoth\u00e8ses ?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2019 Elvire Desjonqui\u00e8res, Anne-Laure Desgabriel, Julie Assaraf, Lisa Lelouch, Shuaib Alqallaf, Mathias Vidon, Laurent Costes, Herv\u00e9 Hag\u00e8ge, Isabelle Rosa Gastroent\u00e9rologie &#8211; \u00a02019-05-14 &#8211;\u00a0CC &#8211; ________________________________ Mme C, ag\u00e9e de 26 ans est hospitalis\u00e9e pour une pouss\u00e9e de maladie de crohn il\u00e9o-colique. Elle \u00e9tait suivie pour une maladie de Crohn il\u00e9ocolique et p\u00e9rin\u00e9ale, diagnostiqu\u00e9e en f\u00e9vrier [&hellip;]<\/p>\n","protected":false},"author":1,"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":[4],"tags":[30],"class_list":["post-2305","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-30"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Cytolyse au cours d&#039;une maladie de Crohn - Abstracts des congr\u00e8s de l&#039;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\/cytolyse-au-cours-dune-maladie-de-crohn\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cytolyse au cours d&#039;une maladie de Crohn - 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