Drug rash with eosinophilia and systemic symptoms to antituberculosis treatment

Drug Rash with Eosinophilia and Systemic Symptoms [DRESS] syndrome reflects a serious hypersensitivity reaction to drugs. This syndrome is an uncommon adverse reaction due to antituberculosis drugs and is sometimes difficult to identify the culprit agent. We report a case of a 45-year-old woman who received combined antituberculosis drugs [RHZE] for lymph node tuberculosis. Clinical manifestations included fever, dyspnea, rash, hypereosinophilia and visceral involvement [liver involvment]. After symptom resolution and biology normalization, anti-tuberculosis drugs were reintroduced successively one after another. Systemic symptoms reappeared with the four anti-tuberculosis drugs. The clinical outcome was favorable with second line antituberculosis treatment

[Diagnosis approach of pulmonary embolism]

Pulmonary embolism [PE] is a fairly common condition that can be fatal. The variability of presentation sets clinician up for potentially missing the diagnosis. Routine laboratory findings are nonspecific and are not useful in diagnosis of PE. Diagnosis is based on clinical prediction rule in combination with laboratory tests such as the D-dimers test leading to the realization of a confirming examination. To precise the confirming examinations of PE and propose an algorithm based on clinical prediction rules in combination with D dimmers. A Pub Med search was conducted using the following key words: pulmonary embolism computed tomography pulmonary angiography, scintigraphy and D Dimer. The study was based on a review of 18 studies including meta analysis, reviews and original articles referring recent strategy diagnosis of pulmonary embolism. Ventilation/ perfusion scan is a type of examination that is used less often because it is not a widespread technology. However, it may be useful in patients who have an allergy to iodinated contrast. Ultrasonography of the legs, also known as leg doppler, in search of deep venous thrombosis [DVT] may help the diagnosis approach particularly when other exams are not available or contraindicated. This may be a valid approach in pregnancy. The gold standard for diagnosing PE is pulmonary angiography. It is used less often due to wider acceptance of multi detector CT scans, which are non-invasive. A normal ventilation/perfusion scan rules out the diagnosis of PE with negative predictive value of 97%. There is no consensus in pregnancy. Finally, the MRI has a low and insufficient sensibility to diagnose PE. D Dimers, multidetector CT, ventilation/ perfusion scintigraphy and ultrasonography of the legs are the most useful examinations to diagnose PE. Many algorithms were established depends on medical experience and examination availability

Sugar tumor

Clear cell tumor of the lung is a rare and very unusual benign pulmonary tumor. This tumor is called sugar tumor because of the abundance of glycogen on its cells. To report a case of sugar tumor and discuss clinical, evolutive features and diagnosis difficulties of this tumor. A case of 75 years old woman presenting as a round pulmonary opacity. Computed tomography [CT] scans showed in the left lower lobe a solitary pulmonary solid tumor with central calcifications. The patient underwent tumor resection. Pathologic examination, including immunohistochemical studies, revealed a benign clear cell tumor, so-called [sugar tumor]. It's the second case reported in Tunisia. This very rare tumor of the lung is characterized by some immunohistological features. Its evolution is favourable after surgery

[Sarcoidosis in Tunisia: epidemiologic and clinical study]

The epidemiologic study of sarcoidosis is problematic and differing incidences across the world are reported. In Tunisia, the incidence of this affection is yet unknown. This is at least attributable to the lack of large series and the overshadowing presence of tuberculosis. To determine presenting signs, symptoms and investigations particularities. We report a retrospective series patients with sarcoidosis followed up in the Rabta university hospital between 1991 and 2005 and try to determine presenting signs, symptoms and investigations particularities. 131 patients [79 women and 52 men] with a median age of 47 +/- 14 years were reviewed. They were symptomatic in 95% of cases. Cutaneous symptoms were present at onset in 56.8%, respiratory symptoms in 48.6% and general symptoms in 41.6%. Thoracic presentation was observed in 81.3%. Chest X-ray changes and tomodensitometry showed that type II and III were predominant. Lung function was disturbed in 58.5% of the cases. Extrathoracic involvement, observed in 89.3% of the cases, was largely dominated by cutaneous lesions. Histopathological lesions provided diagnosis in 66.6%. The relative high frequency of dermatological lesions suggests genetic or even environmental predisposition to develop sarcoidosis such as sunlight exposition

Transitory, spotaneously recovering, peripheral facial nerve palsy after vionorelbine administration

Vinorclbine is a semi-synthetic vinca alkaloid that has demonstrated a broad spectrum of activity. It is widely used in non small cell lung cancer. We report the case of a 50 year old man, having stage IV lung carcinoma with a unique cerebral metastasis in the right hemisphere. Focal cerebral radiotherapy was first administrated followed by intravenous chemotherapy associating vinorelbine to cisplatin. He has developed multiple subsequent and transitory episodes of monolateral peripheral facial nerve palsy in the left side during vinorelbine administration. The palsy has completely and spontaneously resolved at a short interval, around twenty minutes, after the end of the drug infusion. Obvious cerebral tumor progression was excluded by means of CT scan; the drug was thereby administrated as scheduled until the end of the treatment. We describe an unusual side effect, until now reported in only two cases, having brain-stem gliomas, among English and French literature, dealing with vinorelbine as adjuvant treatment. We discuss possible neurological and oncnlogical implications

[Exercise induced anaphylaxis]

Exercise-induced anaphylaxis [EIA] is a rare physical allergy, sometimes severe, triggered by exertion following specific food intake. Although described several years ago, this condition is not well known; the diagnosis is frequently made several years after follow up. The aim is to describe the physiopathologic mechanism, etiologic factors, clinical manifestations and diagnostic means. Review of the literature. It is likely that exercise induce the release of a sufficient amount of mediators from mast IgE dependant cells exceeding a certain threshold. A number of food trigger have been suggested in EIA, the most commonly reported agent is wheat which has to be systematically looked for. A range of physical activities have been associated with EIA. Intensive physical activities are more likely to provoke an attack than less strenuous ones. The recognition of specific food causative role do not indicate the avoidance of food intake but exercise is forbidden within the four hours following specific aliment ingestion. Further studies seem to be necessary to clarify the mechanism of food dependent exercise-induced anaphylaxis

[Pulmonary tuberculosis in child]

Pulmonary tuberculosis is a major public health problem in the world and particularly in Tunisia. Child is not saved by this illness. The pulmonary tuberculosis present epidemiological and diagnosis specificity in child, especially characterized by difficulty diagnosis at this age. It is also characterized by therapeutic difficulties

[Isoniazid phenotype in a group of Tunisian patients. About 620 patients]

Isoniazid is a first line antituberculosis drug metabolized mainly in the liver by the Nacetyltransferase2. There are differences between individuals in acetylation metabolism. Subjects are thereby characterized as being rapid or slow acetylation. The purpose is to study the distribution pattern of acetylation in patients with tuberculosis followed up the teaching Hospital of La Rabta. The determination of acetylator phenotype was carried out on 620 tuberculosis patients during a period of 12 years. There were 483 men and 137 women with a median age of 40.3 years. The test was investigated before drug regimen administration at the dose of 5 mg/kg. A blood sample was taken three hours after the first administration. The determination of acetylation profile was worked out by Vivien hypothesis. In our population 391 were low and 229 were fast acetylators. The median dose recommended within the test was 3.04 mg/kg/day. 56% of our patients were initially receiving high dose of isoniazid. An increase in serum transaminase was initially observed in 60 patients among whom 47 slow acetylators. After dose adaptation, 53 patients had improved their biological abnormalities. The majority of Tunisian population seem to belong to slow acetylators modal. The frequency of hepatotoxicity suggests reducing the recommended dose of isoniazid from 5 to 3 mg/kg/day