Plasma Exchange for Lyme Neuroborreliosis delayed diagnosis: A case report.

Lyme neuroborreliosis (LNB) is a rare infectious disease, caused by Borrelia burgdorferi spirochetes and responsible for a variety of neurological manifestations. The most common manifestations of LNB in children are cranial nerve involvement, especially facial nerve palsy often accompanied by lymphocytic meningitis. In this article, we present a case of a 4-year-old boy presented to our emergency department with abdominal pain evolving for a week and symmetrical ascending progression of weakness responsible for severe respiratory failure. Diagnosis of Guillain-Barré syndrome (GBS) was initially suspected. Although our patient had received 2 courses (each of 5 days) of Intravenous immunoglobulin (IVG) treatment, no clinical improvement was observed. The diagnosis of LNB was confirmed by detection of both IgG and IgM specific antibodies in serum. The patient's muscle weakness got better after a 2- week course of Ceftriaxone but respiratory muscle failure didn't improve with two extubation failures. Consequently, we decided to conduct plasmapheresis procedures. We managed to extubate the child and discharge him after a good recovery of his symptoms. Pediatricians must consider LNB disease in the differential diagnosis of GBS, especially when the patient didn't recover after IVG treatment. This case shows that plasmapheresis could be effective for pediatric neuroborreliosis cases with severe neurological disorders.

[Study of cross reactivity between proton pump inhibitors]. / Étude de l'allergie croisée entre les différents inhibiteurs de la pompe à protons.

Although rare, anaphylactic reactions induced by PPIs have been reported. The presence of cross-reactivity between different members of the group is not clear. We analyzed all cases of allergic skin reactions to PPIs notified in regional pharmacovigilance center of Sfax during a 12 years period and assessed the possibility of cross-reactions between different molecules of this class. An enquiry of pharmacovigilance was conducted for each case according to the French imputation method. We called then, all patients who developed an allergic reaction to a PPI with a plausible or credible imputation. A patch test to all the molecules was carried out to study the possibility of cross-reactivity between PPIs. Thirty-seven patients have developed skin disease, with a total of 1 172 cutaneous adverse effects (3%) notified in our regional pharmacovigilance center. The skin disease most frequently observed was maculopapular rash (19 cases or 51%), followed by urticaria in 9 cases (24%). The omeprazole was the most implicated in the genesis of these adverse events (in 31 cases: 83.78%). Lansoprazole was administered to 5 patients having allergy to omeprazole with good tolerance. Patch tests were realized for6 patients having allergy to omeprazole. They were positive with omeprazole at 72 h in all cases and negative with lansoprazole in 5 cases. In one third of cases, lansoprazole was a good alternative at patients developing allergy to omeprazole, esomeprazole or pantoprazole. In one case we have contraindicated all PPIs. In the other cases we have preconized surveillance for the use of lansoprazole.