Antibiotics are drugs widely used all around the world. Central nervous system adverse drug reactions (CNS ADRs) are mostly under-suspected with antibiotics. Nevertheless, these ADRs could lead to severe complications such as encephalopathy. To illustrate the clinical patterns of these off-target ADRs, we here present data from pharmacovigilance system, through different populations and points of view (worldwide, French population, vulnerable population and individual). These data could help clinicians to better know about CNS ADRs with antibiotics, to better identify risk factors and vulnerable patients and to highlight the importance to set up the right diagnostic explorations in the best timing to avoid complications. Clinicians should request a pharmacological opinion from pharmacologist (biologists and pharmacovigilance clinicians) in front of vulnerable population before or during antibiotics. Pharmacovigilance advice could help clinicians in the diagnosis and the management of an ADR. Therapeutic drug monitoring is particularly contributive to adjust doses of antibiotics administered in vulnerable patients. Pharmacovigilance advice and TDM are essential to perform personalized medicine, and contribute to the proper use of drugs.

We report the case of a 6-year-old girl, admitted at the 32th days of chemotherapy induction of a B acute lymphoblastic leukemia for pseudohyponatremia (121 mmol/L), which revealed a major hypertriglyceridemia (125 g/L). The milky aspect of blood samples was remarquable. We suspected a hypertriglyceridemia induced by L-asparaginase. We introduced a treatment by hyperhydratation, insulinotherapy, free fat diet and one plasmapheresis. Decrease of hypertriglyceridemia was quickly observed. However on the tenth day she presented a pancreatitis. Fenofibrate, ursodeoxycholic acid and heparin were added. Clinical improvement allowed discharge from hospitalization at day 16.

Therapies - In Press.Proof corrected by the author Available online since jeudi 20 octobre 2016

Allopurinol, widely used in the treatment of hyperuricemia and gout, has been shown to cause severe cutaneous reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, as well as systemic reactions such as DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms). The HLA-B*5801 allele is known to be a risk factor for severe cutaneous manifestations of hypersensitivity to allopurinol, mostly in Asian populations.We report the observation of a 47-year-old Chinese patient, with no previous medical history, carrying the HLA-B*5801 allele, who developed an isolated allopurinol hypersensitivity necrotizing renal vasculitis without cutaneous manifestations.. The identification of this allele should be proposed before prescribing allopurinol in patients originating from certain regions of Asia, and the imputability of allopurinol should be evoked in case of necrotizing renal vasculitis, even without associated cutaneous involvement.

Introduction. - Allopurinol, widely used in the treatment of hyperuricemia and gout, has been shown to cause severe cutaneous reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, as well as systemic reactions such as DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms). The HLA-B*5801 allele is known to be a risk factor for severe cutaneous manifestations of hypersensitivity to allopurinol, mostly in Asian populations. Observation. - We report the observation of a 47-year-old Chinese patient, with no previous medical history, carrying the HLA-B*5801 allele, who developed an isolated allopurinol hypersensitivity necrotizing renal vasculitis without cutaneous manifestations. Discussion. - . The identification of this allele should be proposed before prescribing allopurinol in patients originating from certain regions of Asia, and the imputability of allopurinol should be evoked in case of necrotizing renal vasculitis, even without associated cutaneous involvement. (c) 2022 Societe Nationale Franc, aise de Medecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

Medical use of cannabis has been receiving growing attention over the last few decades in modern medicine. As we know that the endocannabinoid system is largely involved in neurological disorders, we focused on the scientific rationale of medical cannabis in three neurological disorders: amyotrophic lateral sclerosis, Parkinson's disease, and Alzheimer's disease through pharmacological plausibility, clinical studies, and patients' view. Clinical studies (randomized controlled trials, open-label studies, cohorts, and case reports) exploring medical cannabis in these disorders show different results depending on the methods and outcomes. Some show benefits on motor symptoms and others on non-motor symptoms and quality of life. Concerning patients' view, several web surveys were collected, highlighting the real use of cannabis to relieve symptoms of neurological disorders, mostly outside a medical pathway. This anarchic use keeps questioning particularly in terms of risks: consumption of street cannabis, drug-drug interactions with usual medical treatment, consideration of medical history, and adverse reactions (psychiatric, respiratory, cardiovascular disorders, etc.), underlining the importance of a medical supervision. To date, most scientific data support the therapeutic potential of cannabis in neurological disorders. As far as patients and patients' associations are calling for it, there is an urgent need to manage clinical studies to provide stronger evidence and secure medical cannabis use.

Les inhibiteurs de checkpoint immunitaire (ICI), tels que les anticorps anti-PD-1, PD-L1 et anti-CTLA-4, sont efficaces dans de nombreux cancers. Cependant, entre 70 et 90 % des patients présentent des effets indésirables (EI). Le lupus érythémateux immuno-induit (LEII) est un EI rare. L’objectif de notre étude était d’éstimer la prévalence des LEII dans une population traitée en oncodermatologie pour un mélanome métastatique et décrire les caractéristiques cliniques et biologiques des patients présentant un LEII. Nous avons interrogé rétrospectivement la base de données Melbase afin d’estimer la prévalence de LEII dans la population de mélanome traitée par ICI dans notre centre et la base nationale de pharmacovigilance (BNPV). Sur 330 patients traités par ICI pour un mélanome dans notre centre depuis 2013, 2 patients présentaient un LEII (0,6 %). Dans la BNPV, 11 LEII étaient enregistrés, dont 6 femmes. L’âge médian était de 65 ans [42-82], les cancers primitifs étaient des adénocarcinomes pulmonaires (5), des mélanomes (4), un cancer du sein et un cancer ovarien. Les traitements reçus étaient : nivolumab en monothérapie (4) ou associé à ipilimumab (1), pembrolizumab (3), atezolizumab (2) durvalumab (1). Le délai médian entre l’introduction des ICI et les premiers symptômes était de 3 mois [0,5-6]. Huit patients sur 11 présentaient un lupus cutané isolé confirmé histologiquement, 6 étaient des femmes, 1 avait des lésions muqueuses, 5 avaient des anticorps anti-SSA. Les traitements utilisés étaient des dermocorticoïdes (8/8), du plaquenil (3/8), des corticoïdes oraux (2/8) permettant une évolution favorable. L’ICI était poursuivi ou repris chez 3 patients sans récidive. Trois patients sur 11 présentaient un lupus érythémateux systémique (LES) répondant aux critères EULAR/ACR 2019, 2 patients présentaient une atteinte articulaire avec des anticorps anti-ADN natifs, d’évolution favorable sous corticoïdes et plaquenil, un présentait des sérites et un syndrome d’Evans traité par corticoïdes et immunoglobulines intraveineuses. Chez ces 3 patients, l’immunothérapie a été interrompue sans reprise. Les lupus induits sont des EI rares dont les inducteurs les plus incriminés sont l’hydralazine et la procaïnamide. Les LEII sont peu rapportés et de diagnostic difficile de par l’absence de critères diagnostiques établis et la présentation clinique et biologique variée. Son incidence est estimée à 0,48 % dans l’étude de Michot et al. [1], proche de celle de notre expérience (0,6 %). L’atteinte cutanée isolée semble plus fréquente que la présentation systémique avec une prédominance de forme subaiguë et d’anti SSA. Les traitements classiques du lupus sont à proposer et l’arrêt de l’immunothérapie est à discuter selon la présentation clinique. Le LEII est un EI rare mais parfois sévère. Le diagnostic peut être difficile devant des signes cliniques et biologiques variés.

Introduction. - The diagnosis of bilateral papilledema implies emergency medical care to look for intracranial hypertension and arteritic ischemic neuropathy. However, other causes must also be mentioned, including drugs. Too often underrated because of their usual benignity, drug side ophthalmological effects can be severe and are typically bilateral. Case report. - An 80-year-old woman was hospitalized for bilateral papilledema, predominantly in the left eye, with lowered visual acuity. After ruling out intracranial hypertension, arteritic ischemic optic neuropathy, non-arteritic, and inflammatory bilateral papilledema, the diagnosis was toxic optic neuropathy. Conclusion. - Bilateral edematous optic neuropathy is a known side effect of amiodarone, uncommon but to be known because of the large number of patients benefiting from this treatment. (C) 2019 Societe Nationale Francaise de Medecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

Proton pump inhibitor (PPI) drugs are approved for the management of gastric acid–related diseases, mainly treatment of gastroesophageal reflux disease, treatment of nonsteroidal anti-inflammatory drugs (NSAID)–related gastrointestinal complications and prevention in at-risk patients, Helicobacter pylori eradication, and treatment of ulcers. PPIs are one of the most commonly prescribed drug class worldwide, and off-label use is widespread. The aim of this study was to describe outpatient PPI use of the whole adult population in France, based on the French National Health Data System (SNDS).