La maladie de Still de l’adulte (MSA) et les lymphomes sont des pathologies dont la présentation clinique et même histopathologique est très proche. L′association des deux pathologies est rarement rapportée dans la littérature. Nous rapportons une observation de maladie de Still de l′adulte diagnostiquée chez une patiente de 26 ans antérieurement traitée pour lymphome malin non hodgkinien (LMNH) à grandes cellules B par chimiothérapie et auto-greffe de cellules souches hématopoïétiques avec rémission complète. Les cas de MSA associés aux lymphomes sont rares et dans tous les cas le diagnostic de MSA avait précédé celui de lymphome. Notre observation est particulière par la succession LMNH puis MSA et soulève plusieurs hypothèses sur les liens entre ces deux pathologies. Les liens entre maladies dysimmunitaires et hémopathies lymphoïdes ont largement été prouvés, qu′il s′agisse de l′évolution de maladies auto-immunes vers un lymphome ou de manifestations dysimmunitaires survenant au cours de ce dernier. Notre cas illustre la difficulté de distinction entre ces entités.
Aim of the study:The aim was to determine the blood concentrations of hydroxychloroquine in Moroccan systemic lupus erythematosus patients and identify the factors associated with interindividual variation. Methods: A cross-sectional study enrolled patients with lupus erythematosus. We recorded demographic features of patients and main clinical and biological characteristics of the disease. We determined the blood concentrations of hydroxychloroquine for the entire patient enrolled in this study by liquid chromatographymass spectrometry. Patients were divided according to their blood hydroxychloroquine level into three groups: low blood concentration (<500 ng/mL), therapeutic range (500-2000 ng/mL) and high blood HCQ concentration (>2000). Results: Eighty subjects were included; 77 were female and the mean age was 36.9±12, 2 years. The median concentration of hydroxychloroquine was 830 ng/mL (range: 35-3,200 ng/mL); 13 patients (16%) had low blood levels, 59 (74%) were in therapeutic range while 8 (10%) had high blood concentrations. Low body mass index and the use of corticosteroids were associated with high hydroxychloroquine concentrations (p=0.03 and p=0.02 respectively). Conclusion: We report for the first time the blood concentration of hydroxychloroquine in Moroccan lupus patients and we found significant variability between patients for the same dose. Various factors affected this concentration and further studies are needed to expand the sample.
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