S. Mattioni

Isoniazid-Induced Recurrent Pancreatitis

CONTEXT Drug induced pancreatitis are rare but potentially serious. Thus, drug withdrawal is warranted. CASE REPORT A 79-year-old woman who was treated with antituberculosis therapy for 5 weeks was admitted to our unit for pancreatitis. Usual etiologies of pancreatitis were eliminated. Because of vomiting, antituberculosis therapy was withdrawn and symptoms disappeared. Eight days later, the same treatment was reintroduced and the patient presented recurrent pancreatitis; thus, treatment was withheld again followed by disappearance of clinical and biological abnormalities. Two days later, a treatment without isoniazid was reintroduced and no recurrence of symptoms was observed. CONCLUSIONS We have experienced a case of isoniazid induced pancreatitis. This is a rare cause of pancreatitis but potentially fatal thus recognition of drug induced pancreatitis and definitive withdrawal of the drug is required.

Cardiac manifestations in sickle cell disease varies with patient genotype

Cardiac involvement is well characterized in sickle cell anaemia (SCA) but cardiac features associated with Haemoglobin SC (HbSC) disease are mostly unknown. We compared 60 patients with HbSC disease (median age 31 years, 25 men) to 60 SCA patients and 60 controls matched for age and gender. Left ventricular ejection fraction (LVEF), left ventricle (LV) mass index (LVMi), cardiac index and peak tricuspid regurgitation velocity (TRV) were measured using echocardiography. LV filling pressures were assessed using the ratio of early diastolic transmitral velocity to tissue velocity (E/e’ ratio). The LVMi was higher in both genotypes compared to controls. However, whereas LV hypertrophy was observed only in 3(5%) HbSC patients, this condition was diagnosed in 27(45%) SCA patients (P < 0·0001). While cardiac index and TRV were similar in HbSC compared to controls, SCA patients exhibited elevated cardiac output and TRV. LVEF was similar in the 3 groups. However, both genotypes had a higher E/e’ ratio compared to controls. Cardiac involvement in SCA was related to anaemia and haemolysis, while LV diastolic dysfunction and TRV in HbSC disease patients were related to arterial hypertension and overweight comorbidities. In summary, cardiac involvement and its determinants are different in HbSC disease and SCA. Patients genotype should be considered with regard to the echocardiographic indications and findings.

La drépanocytose en France

Resume La drepanocytose est une maladie monogenique de transmission autosomique recessive. Elle resulte d’une mutation ponctuelle du sixieme codon du gene de la bglobine qui entraine une polymerisation de l’hemoglobine mutee (H βS) en situation desoxygenee. L’HbS est a l’origine de l’hemolyse et des phenomenes vaso-occlusifs. C’est la premiere maladie genetique en France et dans le monde. Du fait des progres des traitements et de l’allongement de l’esperance de vie des malades la prevalence de cette maladie est en constante augmentation et elle a ete reconnue comme priorite de sante publique par les autorites de sante nationales et internationales. Au cours de cette maladie chronique emaillee de complications aigues, le biologiste intervient a differentes etapes de la prise en charge du malade (etablissement du diagnostic, suivi du traitement, depistage de certaines complications et diagnostic prenatal).