Sihem El Aidli

Fatal liver injury associated with clopidogrel

Clopidogrel, an adenosine diphosphate receptor blocker, is widely used as an adjunctive antiplatelet therapy in acute coronary syndrome and percutaneous coronary stenting. It appears to be a safe drug with few occurrences of liver side‐effects that usually resolved after drug withdrawal. We report a serious liver injury with fatal outcome in a 63‐year‐old man developed 19 days after starting clopidogrel for percutaneous coronary stenting.

Recurrent dysosmia induced by pyrazinamide.

Pyrazinamide can have adverse effects such as hepatic toxicity, hyperuricemia or digestive disorders. In rare cases, alterations in taste and smell function have been reported for pyrazinamide when combined with other drugs. We report a case of reversible olfactory disorder related to pyrazinamide in a woman, with a positive rechallenge. The patient presented every day a sensation of smelling something burning 15 min after drug intake. Dysosmia disappeared completely after pyrazinamide withdrawal and recurred after its rechallenge. The case was reported to the Tunisian Centre of Pharmacovigilance.

Facial Hyperpigmentation during Imatinib Therapy for Gastrointestinal Stromal Tumor

We report a rare case of facial hyperpigmentation during imatinib therapy for a gastrointestinal stromal tumor.

Cardiac arrhythmia induced by interferon beta-1a

Cardiac adverse effects have never been reported with interferon (INF) beta. We report a case of left bundle branch block in a 35‐year‐old woman treated with INF beta‐1a for multiple sclerosis. Five years after INF therapy, she presented loss of consciousness, retrosternal pains, short breath and lowered tolerance of effort. ECG and Holter 24‐h ECG monitoring revealed permanent complete left bundle branch block. Nine months after stopping INF, no abnormalities were found at ECG and echocardiogram examination.

DRESS syndrome à la ciprofloxacine

The Drug rash with hypereosinophilia and systemic symptoms (DRESS) syndrome, or hypersensitivity syndrome, is a severe drug-induced hypersensitivity syndrome. It has been exceptionally described with ciprofloxacin. We report a 47-year-old-woman who developed DRESS syndrome, 2 days after taking ciprofloxacin for a urinary infection. She had a generalized maculopapular rash, severe rhabdomyolysis, liver involvement, renal failure and hypereosinophilia. Clinical symptoms had completely resolved after ciprofloxacin withdrawal. Renal failure has decrease after short corticosteroid treatment.

Sulfasalazine-induced Aseptic Meningitis with Positive Rechallenge: a Case Report and Review of the Literature

Aseptic meningitis is characterized by serious inflammation of brain membranes (meninges). The main non infectious causes of meningitis include primary tumors of central nervous system, metastatic carcinomas, granulomatous angiitis, sarcoidosis, systemic lupus erythematosus, rheumatoid arthritis, Behçet’s syndrome or drugs.[1] Drug-induced aseptic meningitis (DIAM) is principally associated with non-steroid anti inflammatory drugs, antibiotics, intravenous immunoglobulins, monoclonal antibodies against CD3, intrathecal agents and vaccines. It was rarely reported with leflunomide, methotrexate, infliximab, or sulfasalazine.[2] We report a case of aseptic meningitis induced by sulfasalazine (Salazopirine®) with positive rechallenge in a slow acetylator phenotype patient suffering from ankilosing spondylarthritis. This case was notified to the National centre of pharmacovigilance of Tunis (Tunisia) on september 18th, 2011. 2. Case report

Anaphylactic shock induced by mephenesin.

La Presse Medicale - In Press.Proof corrected by the author Available online since mercredi 7 mai 2014

Peripheral neuropathy during Infliximab therapy for rheumatoid arthritis

La Presse Medicale - In Press.Proof corrected by the author Available online since mardi 15 avril 2014

Meprobamate-Induced Fixed Drug Eruption

Meprobamate is usually a safe drug prescribed for anxiety disorders. Fixed drug eruption (FDE) is an exceptional cutaneous adverse effect of this drug. We report a case of FDE induced by meprobamate with positive patch test. A 22-year-old woman was prescribed for depression meprobamate, aceprometazine, valpromide and lorazepam. On the second day of treatment, the patient presented red erythematous and pruriginous plaques in the limbs and the face. After stopping the previous treatment, the patients lesions resolved completely within 3 weeks with residual pigmentation. One month later, patch tests were performed and were positive to meprobamate. Exceptional cases of FDE were reported in literature with meprobamate. None has reported the use of patch test to confirm the diagnosis.

Precocious Puberty in an Epileptic Child Treated with Valproate

Valproate is effective for treatment of a variety of seizure types both in adults and children.[1] Its use in young women has been associated with an increased incidence of menstrual abnormalities, polycystic ovaries and hyperandrogenism.[2] Sexual precocity,which is defined as the appearance of secondary sex characteristics before the age of 8 in girls and 9 in boys,[3] has never been reported. We report a case of a precocious puberty developed in an epileptic child treated with valproate.