A fatal presentation of DRESS syndrome with multiple visceral failure mimicking septic shock.

Introduction: The DRESS syndrome is a life-threatening multi-organ system reaction induced by drugs Characterized by a long latency between drug exposure and disease onset, allopurinol is the most incriminated drug. Case presentation: We report a case of 56-year-old patient with history of gout under allopurinol admitted in emergency for shock state associated erythematosquamous lesions reaching 65% of the body surface, a septic was suspected but the bacteriological investigations were negative and the patient had an isolated hyper eosinophilia so diagnosis of dress syndrome induced by allopurinol was retained The patient presented an acute renal failure that was treated successfully by renal replacement therapy, and corticosteroids. Discussion: DRESS syndrome has a mortality of 10-20%. Its clinical presentation is predominantly cutaneous, with or without visceral involvement. The cornerstone of the management of DRESS syndrome is the identification and discontinuation of the causative drug. Early diagnosis and screening for visceral involvement can reduce mortality. Conclusion: The DRESS syndrome is a severe adverse drug reaction and has high mortality rates Furthermore, judicious use of allopurinol may decrease its incidence.

High-flow nasal oxygen therapy decrease the risk of mortality and the use of invasive mechanical ventilation in patients with severe SARS-CoV-2 pneumonia? A retrospective and comparative study of 265 cases.

INTRODUCTION: Corona virus disease (Covid-19) affects the airways and induces pulmonary lesions, patients with this disease require oxygen therapy as the disease progresses. Several oxygenation options have been used, l'HFNO had showed beneficial effects. THE OBJECTIVE OF THIS STUDY: To evaluate the efficacy of high-flow nasal oxygen HFNO versus non-invasive ventilation in COVID-19. METHODS: This is a retrospective and comparative study conducted over a period of 10 months from March 2020 to December 2020 and involving 600 patients hospitalized in the intensive care unit of the CHU Mohammed VI of Oujda for the management of acute respiratory failure caused by COVID-19. RESULTS: Out of 600 patients with acute respiratory failure, 265 patients were included in the analyses. 162 (61.10%) patients were treated with HFNO, the intubation rate was 49.7% (80 patients out of 162) of which 63 died intubated (78.8%). Concerning the 82 non-intubated patients, only 16 died (19.8%).The total number of patients who received NIV was 71 (26.8%), 33 (46.5%) required mechanical ventilation. In-hospital mortality in patients treated with NIV was 100%.The difference in mortality outcome between the two groups was significantly (P < 0.0001) reduced in HFNO. CONCLUSIONS: Treatment with high-flow oxygen improved survival in patients with acute hypoxemic respiratory failure compared with noninvasive ventilation, although no difference was observed in intubation rate.

Hypertriglyceridemia revealing acute pancreatitis: A case report.

INTRODUCTION: Acute pancreatitis (AP) is considered one of the potentially rare complications of severe hypertriglyceridemia (HTG). Multiple treatment modalities have been suggested for patients with HTG-AP, such as permanent removal of TG by plasmapheresis, the use of insulin and heparin to enhance lipoprotein lipase activity and fibrate therapy, but the data remains limited. CASE MANAGEMENT: we reported a case of 33-year-old women admitted for HTG-induced PA (HTG-AP). The patient had hypertriglyceridemia for 7 years under fibrate therapy as a medical history. On admission to our intensive care unit, his triglyceride level was 1060 mg/dl and the lipase level was 298 IU/L. An abdominal CT scan revealed stage E AP. The patient was treated with a low dose insulin infusion (0.05 unit/kg/h) with heparin and 5-day course of plasmapheresis, Fibrate therapy was maintained. His triglycerides went down to 130.9 mg/dl and she was discharged. CONCLUSION: Early recognition of severe HTG can prevent progression to multiples diseases such as acute pancreatitis, can facilitate appropriate or even aggressive treatment to minimize complications of this.

Ischemic stroke revealing COVID-19 infection: Case report.

INTRODUCTION: SARS-COV-2 viral infection primarily targets the respiratory system with a clinical picture that varies from simple symptoms to respiratory distress syndrome requiring hospitalization in the intensive care unit; SARS-CoV-2 also has neuro-invasive capabilities and could spread from the respiratory system to the central nervous system. Recently, some patients with COVID-19 have been shown to have neurological symptoms such as headache, anosmia, dysgeusia, dizziness, impaired consciousness, and ischemic stroke. CASE PRESENTATION: we describe a case of ischemic stroke as the main presentation of COVID-19 in a 68 years old man with no previous history, without any associated respiratory signs; clinical examination revealed left hemiparesis with dysarthria and left facial paralysis, NIHSS score was at 11, the brain CT scan performed 1h30min later, completed by a brain MRI that came back in favor of right frontal, temporal and parietal ischemic stroke. The decision of thrombolysis was indicated in urgency, and the patient benefited from thrombolysis, which proceeded without incidents; the outcome was favorable with regression of symptoms.Ischemic stroke has been widely described among the thromboembolic complications of COVID-19, but only a few papers have reported it as a primary manifestation of COVID-19. CONCLUSION: SARS-COV 2 infection can spread from the respiratory system to the central nervous system, resulting in an inflammatory response and excessive secretion of inflammatory markers, leading to ischemic stroke.

Lymphopenia in Covid-19: A single center retrospective study of 589 cases.

BACKGROUND: Lymphopenia is one of features that helps identify patients with severe Covid-19. This retrospectively study analyzed the association of lymphopenia with the severity of COVID-19 infection, determinate the predictive factors of lymphopenia and the significance of mortality in patient with lymphopenia. METHODS: This retrospective study included patients diagnosed with Covid-19 and admitted to intensive care unit of our university hospital center From Mars 1st 2020, to December 31st, 2020. RESULTS: In this study, 589 patients were included, a group had lymphopenia with 357 cases (60.06%) and the non-lymphopenia group with 232 cases (39.4%). The median age of our patients having lymphopenia was 65 years (56-76). Hypertension and diabetes were noted in the majority of patients with lymphopenia than in the non-lymphopenia group. Lymphopenia was strongly correlated to the inflammatory biomarkers of COVID-19 and were significant. A significant correlation was found between lymphopenia group and CT scan. Lymphopenia was observed as an indicator of prolonged duration of hospitalization but was not significant. CONCLUSION: Analytical data from this retrospective study shows the importance in the association between lymphopenia and the severity of COVID-19 infection, hence the need for dynamic monitoring of the number of lymphocytes on admission and during hospitalization of these patients.

Predictive factors of mortality related to COVID-19: A retrospective cohort study of 600 cases in the intensive care unit of the university hospital of Oujda.

INTRODUCTION: Although the corona virus is responsible in the majority of cases for mild symptoms, there are sometimes severe and even lethal forms of this disease. Our study aimed to identify clinical and para-clinical predictors of mortality related to COVID-19. MATERIALS AND METHODS: This is a single-center retrospective cohort study conducted from March 2020 to December 2020 at intensive care unit department of Mohamed VI University Hospital Oujda, Morocco including 600 patients with COVID-19. RESULTS: We included 600 patients, the mortality rate was 32.50%, the predictors of mortality identified in our study were: associated heart disease (RR: 1.826; CI: [1.081-3.084]; p:0.024), high D-dimer level at admission (RR:1.027; CI: [1.011-1.047]; p:0.001), need for mechanical ventilation (RR: 4.158; CI: [2.648-6.530]; p: <0.0001). CONCLUSION: Based on these results, we were able to identify 3 predictors of COVID 19 mortality (associated heart failure, high D-dimer level on admission, and need for mechanical ventilation). These predictors could help clinicians to identify early patients with high risk of lethality in order to reduce mortality related to corona virus.

Early initiation of awake venovenous extracorporeal membrane oxygenation (ECMO) in critical COVID-19 pneumonia: A case reports.

INTRODUCTION: Overall, patients with Sars-cov-2 disease treated with mechanical ventilation, which is not the case in our study. This report presents our first successful experience of awake ECMO application in a critical patient with hypoxemic Respiratory Failure related to COVID-19 infection in Morocco. CASE MANAGEMENT: We have reported a 52-year-old female patient who was diagnosed with COVID-19 infection and progressed to critical cases. She was a candidate for applying awake extracorporeal membrane oxygenation (ECMO) in the absence of invasive mechanical ventilation, under local anesthesia alone with good progress and ventilatory weaning. CONCLUSION: This therapeutic attitude can be beneficial for certain critical and severe cases due to COVID-19 infection. Each ECMO program should develop goals, methods, protocols, and best practices while adapting appropriately to the personnel and equipment available.

Fatal poisoning of pregnant women by peganum harmala L.: A case reports.

INTRODUCTION: Peganum harmala L. is a cosmopolitan plant within the Mediterranean region. It's normally employed in ancient drugs in Morocco as sedative and abortifacient however exposes users to the danger of dose and poisoning. The medical specialty active compounds of this plant embody variety of carboline and quinazoline alkaloids accountable of its pharmacological and medical effects. CASE REPORT: We tend to report the case of a 20-year-old woman, intoxicated with the Peganum harmala L. On admission, she was shocked with agitation vomittiong and disturbances of consciousness. Laboratory tests showed anemia, thrombocytopenia, acute kidney disease, increase in transaminases and a positive plasma bHCG. Cerebral CT disclosed multiple areas of cerebral ischemia with subarachnoid hemorrhage, thoraco-abdominal-pelvic CT scan showed an enlarged uterus, the location of an interior hemorrhage while not physiological condition sac and inhalation pneumonia. Early treatment was given, she was intubated, ventilated artificially and sedated, symptomatic treatment was received. Hemodialysis was needed for her renal failure and anuria. She was extubated after six days and discharged from the hospital after one month and a half. CONCLUSION: Doctors operating in areas where P. harmala is prescribed or used as an ancient medicine should recognize the signs and symptoms of its toxicity in order to treat and initiate prompt and adequate management. The prognosis is generally favorable, excessive use of high doses of P. Harmala L. can lead to fatal evolution.

Acute respiratory distress syndrome caused by varicella pneumonia in immunocompetent adult: Clinical case.

INTRODUCTION: Varicella zona infection is a rare condition in immunocompetent adults. It can lead to severe and lethal complications including Varicella pneumonia that can rapidly progress to acute respiratory distress syndrome a rare and life-threatening situation. CLINICAL CASE: A 63 years old man was admitted to the intensive care unit for pneumonia with generalized papulovesicular lesions. After investigations, the diagnosis of Varicella pneumonia complicated with acute respiratory distress syndrome was maintained and the patient was put on mechanical ventilation, and despite proper management (antiviral treatment; protective ventilation and prone position) the patient died 48 hours after his admission. CONCLUSION: Despite its rarity, Varicella pneumonia can be a life-threatening situation in immunocompetent adults. The diagnosis must be evoked when the patient presented with respiratory manifestations with dermatologic lesions.