[Acute generalized exanthematous pustulosis. study of 22 cases]

Acute generalized exanthematous pustulosis [AGEP] is an uncommon but severe dermatosis, characterized by acute occurrence of fever, and erythemato-oedematous rash, covered by sterile nonfollicular pustules. Most cases of AGEP have been described in association with the intake of drugs. To determine clinical and prognostic features of AGEP in our patients. All cases of AGEP diagnosed between 1992 and 2007 according to EuroSCAR criteria have been collected. Twenty two patients [16 female, 6 male] with a mean age of 40.9 years [19-81] were included in the study. Clinical features showed in all cases an acute eruption with oedematous erythema, rapidly covered by nonfollicular pustules. The rash was mainly localized on big folds, trunk and/or limbs in 14 cases and generalized in 8 cases. A biological cytolysis was noted in 5 cases and a functional acute renal failure was objected in 2 cases. Etiological work up has found an association with the intake of drugs in 14 cases, a toxic cause [mercury] in 1 case and a B19 parvovirus infection in one case. The mean delay between drug intake and beginning of the eruption was 5 days [24 hours- 15 days]. Pharmacovigilance enquiry has concluded to a probable or plausible causality in all our cases. Clinical features improved with drug or toxic withdrawal with a mean delay of 7 days [4 -12 days]. A relapse of AGEP was observed in 2 cases after accidental introduction of the drug. AGEP is a cutaneous side effect not to ignore, because of its severe prognosis in case of systemic involvement and the possibility of relapses in case of retake of the causal drug

[Photosensitivity induced bt metformin: a report of 3 cases]

Metformin is an oral antihypoglycemic drug. Its cutaneous side effects are rare and photosensitivity had not been reported. We report 3 cases [a man and two women] of photosensitivity induced by metformin, notified to the Tunisian National Centre of Pharmacovigilance. Onset of the reaction was respectively 22 days, 4 months and 4 years. Daily dose of metformin varied from 1 to 2 tablets. Cutaneous lesions were located in sum exposed sites in all cases with extension to the back in one case. Lesions were eczematous in two cases and erythematous in one case. Lesions healed after stopping metformin in all cases with positive rechallenge in the 1st case. In patient treated by metformin, occurrence of photosensitivity can be related to this drug

[Risk Factors of side effects of antituberculosis drugs]

The aim of this study was to determine the side effects of standard antituberculosis therapy with isoniazid, rifampicin. pyrazinamide and streptomycine in patients treated for tuber-culosis. One hundred eighty nine patients with proven tuber-culosis, who initially received standard antituberculosis the-rapy, were retrospectively studied. Begaud and coil's method of side effects drugs imputability elaborated in 1999 was used in our study.Side effects related to therapy were present in 31.7% of the studied population.Gastrointestinal side effect was the most common [13.2%], isoniazid, rifampicin and pyrazinamide were often incriminated. The significant risk factors of hepatotoxicity were female gender [OR: 10.59] and concomitant hepatotoxic drugs [OR: 6]. Chocleovestibular toxicity was associated significantly with female gender [OR: 8.03] and diabetes mellitus [OR: 6.13]. Patients aged above 50, proved to be at risk for pyrazinomide intolerance and females for streptomycine. The study did not reveal any susceptibility to isoniazid and rifadine intolerance

[Drug tendon disorders]

Tendinitis is a rare adverse reaction described after drugs use. It's described with drug belonging to the same class. Physiopathology is still unknown. Fluoroquinolones especially pefloxacine, were the most incriminated. This drug induced tendinitis in older people aged more than 60 years. Approximatively one case out of five leads to tendon breaking off. The others lead to a favourable outcome after drug withdrawal. In three cases, tendinitis was described with statines, and concerned 2 men and I woman, aged more than 50 years. Simvastatine was suspected in two cases and the outcome was favourable in all cases after drug withdrawal. Other drugs, like corticosteroids, can exceptionally induce this side effect that can be serious. Consequences of drug tendinitis can then be dangerous and prescription of this class, and especially fluoroquinolones, must be cautious

[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