[Necrotic leg ulcer revealing vasculitis induced by vitamin K antagonists]. / Ulcère de jambe nécrotique révélant une vasculite induite par les antivitamines K.

UNLABELLED: Vitamin K antagonists are widely used in thromboembolic diseases. Hemorrhagic complications related to drug overdose represent their main side effect. We report a rare side effect, a severe and unexpected type of skin vasculitis - necrotic leg ulcer - induced by vitamin K antagonist. CASE REPORT: A 63-year-old female with a history of diabetes developed hyperalgesic necrotic ulcerations on the lower limbs one month after starting an acenocoumarol-based treatment for ischemic heart disease. Histological examination revealed lymphocytic vasculitis with fibrinoid necrosis. Etiological explorations searching for vasculitis were negative. In the absence of a precise etiology, drug-induced ulcer was suspected. Low molecular weight heparin was prescribed to replace acenocoumarol. The lesions slowly resolved with topical treatment. DISCUSSION: The chronological criteria and the negativity of etiological explorations allowed the diagnosis of vitamin K antagonist-induced necrotic skin ulcer. Clinicians should be aware of this rare complication induced by oral anticoagulants because of its practical therapeutic implications. This is the first case of necrotic leg ulcer induced by acenocoumarol corresponding histologically to necrotising lymphocytic vasculitis.

[Epidemiological profile of snake bites in a pediatric intensive care unit at the Children's Hospital of Marrakech, Morocco]. / Épidémiologie des envenimations vipérines en réanimation pédiatrique à l'hôpital d'enfants de Marrakech (Maroc).

Snake bites are a serious medical emergency. They are most commonly associated with substantial morbidity and mortality in many parts of the world. This study aimed to determine the epidemiological profile of snake bites, as well as their severity and treatment in children in the Marrakech pediatric intensive care unit. The clinicobiological picture, physiopathology, the toxicokinetics of the venom, and the risk factors are discussed. Treatment of confirmed envenomation is based on antivenom administration via the venous route as soon as possible after the bite. Its efficacy and tolerance have been established by several studies. In our context, no specific immunotherapy is available, and the management of snake bites is based on symptomatic measures. Hence, the local health institutions must ensure the availability of antivenom specific to the Moroccan snake species, the only proven specific therapy against snake bite envenomation. The administration of highly purified immunoglobulin appears to improve the prognosis of envenomation, reduce morbidity and mortality, and reduce the length of the hospital stay.