Angioedème bradykinique d'évolution fatale suite à une prise d'énalapril. A propos d'un cas

L'angiœdème bradykinique est une maladie rare et grave qui constitue une complication exceptionnelle du traitement aux Inhibiteurs de l'Enzyme de Conversion (IEC). Elle engage le pronostic vital des patients dans 75% des cas et représente une urgence médicale majeure. L'évolution de cette affection est totalement imprévisible avec un risque de décès par asphyxie. Les auteurs rapportent l'observation d'une patiente de 70 ans hypertendue qui a présenté un angiœdème bradykinique d'évolution fatale deux jours après l'initiation de son traitement antihypertenseur par les IEC. Au travers cette observation, les auteurs voudraient mettre en lumière cette affection mortelle, de diagnostic difficile souvent méconnue

[Fatal Toxic Epidermal Necrolysis Induced by Diclofenac Re-Administration in the Teaching Hospital of Bouaké (Côte d'Ivoire)]. / Syndrome de Lyell d'évolution fatale suite à la réadministration de diclofénac, au CHU de Bouaké (Côte d'Ivoire).

Lyell's syndrome or toxic epidermal necrolysis is an acute and severe cutaneous adverse drug reaction with a significant morbidity and mortality. It is a very rare condition but a vital emergency with a poor prognosis. The diagnosis is clinical and confirmed by a cutaneous biopsy showing a necrosis of the epidermis. It can be due to many drugs including non-steroidal anti-inflammatory drugs. We report a case of fatal Lyell's syndrome after oral re-administration of diclofenac in a patient with a previous history of diclofenac-related Stevens-Johnson syndrome, four years back.

Nous rapportons un cas de syndrome de Lyell mortel après réadministration orale de diclofénac chez un patient ayant des antécédents de syndrome de Stevens-Johnson lié au diclofénac quatre ans auparavant.

[Fixed drug eruption after taking ethambutol]. / Érythème pigmenté fixe secondaire à la prise d'éthambutol.

INTRODUCTION: Fixed drug eruption (FDE) is a specific skin reaction and the only exclusively medicinal dermatosis. Among the drugs usually responsible are the antituberculous antibiotics including rifampicin and, less often, isoniazid and pyrazinamide. FDE after taking ethambutol is rarely described. CASE REPORT: A 32-year old HIV negative patient presented a FDE localized to the internal surface of the lips and the interdigital folds during the 4th month of antituberculous treatment comprising rifampicin, isoniazid and ethambutol. The diagnosis was supported by the characteristic appearances of the lesions of FDE and their early reappearance in the same areas after accidental reintroduction of antituberculous triple therapy including ethambutol. Double-agent therapy with rifamicin and isoniazid was tolerated well. CONCLUSION: Discovery of FDE requires a rigorous search for the responsible medicine. During antituberculous treatment, the practitioner has to bear in mind the potential role of ethambutol, which is possibly potentiated by rifampicin.

[Post-vaccinal adverse effects monitoring during national campaign of vaccination against measles in Côte d'Ivoire]. / Incidence des manifestations post-immunisations lors de la campagne nationale de vaccination contre la rougeole en Côte d'Ivoire.

In spite of the effectiveness of anti-measles vaccine, its administration is not deprived of serious risks. Adverse Event Following Immunisation (AEFI) can harm successes of the vaccination. The objective was to determine the incidence of the AEFI in this vaccinated population. A prospective study of passive AEFI monitoring was initiated during the national campaign of vaccination against the measles from August 18th to 27th, 2005. It concerned children between 9 months to 15 years old. Were included all events occurred between August 18th and September 18th, 2005, on vaccinated children. These events were analyzed according to WHO criteria's. 75 cases of AEFI were notified. The incidence of AEFI was estimated at 1.91 cases per 10(5) vaccinated children. Children from 5 to 59 months represented 57.33% with a sex ratio of 1.33. 20% of AEFI were serious. The AEFI had occurred in the first three days after vaccination (69.33%). The cutaneomucous allergies were represented more than half of AEFI (53.33%), followed by feverish syndromes (24%). The causes were the vaccine reactions (67%), coincidences (29%) and errors of program (4%). The outcome was favourable in 97.33% of cases with 2 cases of death. Our study reveals good safety of vaccine against measles. The issues caused by serious AEFI could be regulated by an operational system of vaccinovigilance in order to improve the vaccination cover because it is a public health priority.

[Blackwater fever during antimalarial treatment in Abidjan (West Africa): report of 41 cases]. / Fievre bilieuse hémoglobinurique au cours du traitement antipaludique à abidjan : à propos de 41 cas.

Intravascular haemolysis, particularly blackwater fever is a rare but severe clinical syndrome, occurring after ingestion of antimalarials. A resurgence of this affection which occurred frequently during the colonization has lately been noticed. We have conducted a prospective study in order to identify the main antimalarials which are responsible for this syndrome. We reported 41 cases from 1996 to 2000, among which 80% of blackwater fever cases were associated with quinine ingestion or similar structural molecules. Their causal role is well established. For the other molecules it is difficult to underscore their role. The mortality rate is around 18%. The morbidity is high because 90% of patients have suffered from renal failure. Among them, 47% required dialysis. We are facing a public health issue thus a rational use of antimalarials is necessary.