Background and objective. The Bacillus Calmette-Guérin (BCG) vaccine may cause severe complications in children with inborn errors of immunity (IEI), particularly in those with severe combined immunodeficiency (SCID), Mendelian susceptibility to mycobacterial disease (MSMD), and chronic granulomatous disease (CGD). This study aimed to describe the clinical spectrum, immunological characteristics, and outcomes of BCG-related complications in pediatric patients with IEI. Methods. We conducted a retrospective, single-center descriptive study including children with confirmed IEI who developed BCG-related complications and were followed at the Ibn Rochd Children’s Hospital, Casablanca, between 2004 and 2023. HIV-infected patients were excluded. Clinical presentation, immunological findings, genetic analyses, and outcomes were reviewed. Results. Forty-eight children were included, with a mean age of 10.8 months and a male predominance (58.3%). The cohort comprised three main groups according to the underlying immunodeficiency: severe combined immunodeficiency (SCID, n = 20), Mendelian susceptibility to mycobacterial disease (MSMD, n = 14), and chronic granulomatous disease (CGD, n = 9). Five additional patients with atypical lymphocytic phenotypes were analyzed separately. Consanguinity was reported in 45% of cases. BCG-related complications were classified as localized in 25% of patients, locoregional in 44%, and disseminated in 31%. Clinical manifestations included lymphadenitis, bone and skin involvement, and systemic symptoms. Genetic confirmation was available for all patients with MSMD and for a subset of patients with SCID and CGD. Disseminated forms were more frequent among children with SCID. Conclusion. BCG-related complications may represent an important early manifestation of underlying IEI in infancy, particularly in severe forms such as SCID. These findings highlight the need for increased clinical awareness of IEI in infants presenting with post-BCG complications.
Background: Drug-induced acute pancreatitis is a rare but clinically significant complication. Benzodiazepines (BZD) carry a low evidentiary tier in established drug causality classifications, yet pharmacovigilance data suggest a measurable association with acute pancreatitis risk, particularly in the overdose setting. We report a case of alprazolam-induced acute pancreatitis diagnosed incidentally in a comatose patient, discuss the pathophysiological mechanisms, apply a structured causality assessment, and review the relevant literature. Case Presentation: A 40-year-old woman with no prior medical history was admitted six hours after the intentional ingestion of 20 tablets of alprazolam 0.5 mg (total dose: 10 mg) in a suicide attempt. She presented with altered consciousness (GCS 11/15), bilateral miosis, hypoxemia (SpO2 85% on room air), and tachycardia (HR 100 beats/min). Arterial blood gas analysis revealed severe respiratory acidosis (pH 7.11, PaCO2 94 mmHg). Laboratory workup demonstrated a markedly elevated serum lipase level of 311 IU/L (reference range: 7–60 IU/L for our institution), with no biliary, alcoholic, metabolic, or other drug-related etiology identified. Abdominal CT confirmed acute pancreatitis classified as mCTSI 2 (Balthazar grade C). Causality assessment using the Naranjo Adverse Drug Reaction Probability Scale yielded a score of 5 (probable). The clinical course was complicated by moderate ARDS, aspiration pneumonia, and transient hepatic cytolysis. The patient was transferred to the ICU and successfully extubated on day 25. Conclusion: This case highlights acute pancreatitis as a rare but genuine complication of BZD overdose, detectable only through systematic lipase screening in patients with impaired consciousness. Two mechanisms are proposed: direct TSPO-mediated acinar cell toxicity and hypoxia-mediated microvascular injury, likely acting synergistically in the massive overdose context. Systematic serum lipase measurements should be considered in the workup of severe drug intoxications.
Introduction La sclérose en plaques (SEP) est une maladie auto-immune démyélinisante du système nerveux central. Certains patients développent des formes agressives, résistantes aux traitements de première ligne. Objectifs Cette étude vise à évaluer l’efficacité et la tolérance du cyclophosphamide comme traitement de fond de la SEP agressive, en comparaison avec d’autres traitements de haute efficacité. Méthodes Étude rétrospective incluant 172 patients suivis au service de neurologie du CHU IBN ROCHD de Casablanca pour SEP agressive entre 2016 et 2023. Les patients ont été traités soit par cyclophosphamide (75,5 %), soit par d’autres traitements de haute efficacité (24,5 % : natalizumab ou anti-CD20). L’efficacité a été évaluée par le taux annualisé de poussées et la progression du score EDSS. La tolérance au cyclophosphamide a été évaluée par le recueil systématique des effets indésirables. Résultats Le cyclophosphamide a montré une amélioration moyenne du score EDSS de 1,3 points, avec 80,8 % des patients stables radiologiquement et 82,5 % libres de poussées cliniques (taux annualisé : 0,0615). Pour les autres traitements, l’amélioration moyenne était de 1,7 points, avec 90 % de stabilité radiologique et 85 % sans poussées (taux annualisé : 0,0952). Aucune différence significative n’a été observée concernant l’activité radiologique (p=0,5724) et les poussées (p=0,6729). Cependant, 19,2 % des patients sous cyclophosphamide ont signalé des effets secondaires (nausées, vomissements, lymphopénie). Discussion L’étude suggère une efficacité comparable entre le cyclophosphamide et les autres traitements de haute efficacité dans les formes agressives de SEP. Le choix du cyclophosphamide était principalement lié à des facteurs socio-économiques. Conclusion Malgré ses limites (nature rétrospective, taille d’échantillon), cette étude souligne l’importance d’avoir des options thérapeutiques efficaces et abordables dans les contextes de ressources limitées.
Smoking is a major lifestyle factor associated with impaired male reproductive health, affecting both active smokers and individuals exposed to secondhand smoke. It also represents a significant source of cadmium (Cd) exposure, a toxic metal associated with altered sperm quality. This study aimed to evaluate the association between active and passive smoking and semen parameters, sperm DNA fragmentation, and chromatin decondensation, as well as cadmium (Cd) and zinc (Zn) levels in seminal plasma. A total of 280 men from infertile couples were included and categorized into three groups: 104 non-smokers (control), 90 active smokers, and 86 passive smokers. Semen samples were analyzed according to the WHO 2021 guidelines. Cadmium and zinc concentrations in seminal plasma were determined using inductively coupled plasma atomic emission spectroscopy (ICP-AES), and sperm DNA fragmentation and chromatin decondensation were evaluated. The findings indicated that both active and passive smoking were associated with impaired semen parameters, increased sperm DNA fragmentation and chromatin decondensation, decreased zinc levels, and elevated cadmium concentrations in seminal plasma.
This case report is significant due to its illustration of how infectious endocarditis on a prosthetic mitral valve revealed an underlying metastatic colorectal cancer. Although uncommon, associations between cardiac infection and advanced malignancy, particularly with malignancy serving as the source of infection, have been documented in the literature, making this case clinically significant and complex. A 54-year-old postmenopausal woman with insulin-dependent diabetes and poorly managed hypertension, who had previously undergone mitral valve replacement with a mechanical prosthesis and tricuspid valve repair for rheumatic mitral stenosis, was admitted for atrial fibrillation with rapid ventricular response. On admission, she presented with normochromic normocytic anaemia (7.7 g/dL), elevated inflammatory markers (CRP 250 mg/L), and leukocytosis (14,000/µL, neutrophils 10,000/µL). Transthoracic and transesophageal echocardiography identified vegetation on the mitral prosthesis with elevated gradients. Blood cultures were positive for Escherichia coli. A thoraco-abdominopelvic CT scan revealed a rectal tumor, confirmed by FDG-PET, with features consistent with metastatic colorectal cancer, considered the entry point for the infectious endocarditis. Tumor markers including ACE, CA 19 − 9, and CA 72 − 4 were elevated. The patient was treated with dual antibiotic therapy and showed initial clinical improvement but later died due to ventricular tachycardia. This case highlights the importance of considering atypical sources, such as metastatic cancer, in unresolved cases of endocarditis. It underscores the need for comprehensive diagnostic assessment, including oncologic evaluation, in patients with prosthetic valve endocarditis caused by atypical pathogens like E. coli. It also stresses the importance of multidisciplinary collaboration between cardiology and oncology teams. This case report is significant due to its illustration of how infectious endocarditis on a prosthetic mitral valve revealed an underlying metastatic colorectal cancer (CRC).
