IBD is a common, serious and disabling chronic digestive disease, Their different manifestations, whether digestive and extra-digestive, require a multi-professional care adapted to each specific patient. Anti-TNFs are now an essential therapeutic weapon in the management of inflammatory bowel disease (IBD). Their effectiveness in both the short and long term has been demonstrated in various studies. However short and long term anti-tnf results vary from patient to patient which can be explained in many cases by the significant number of discontinued treatment in patients that experience side effects. The purpose of our work is to study the different side effects occurring in patients under biotherapy, the management of these side effects and their prevention. We prospectively analyzed since four years the medical records of 54 IBD patients who received anti-TNF treatment. An exhaustive pre-therapeutic assessment was performed systematically in all patients. A clinical and biological control was carried out systematically before each therapeutic administration to search for undesirable reactions. Side effects were classified into several categories including immediate hypersensitivity reactions, dermatological complications, infectious, neurological, haematological, neoplasic and cardiac complications. During this period, 54 patients were treated with biotherapies, representing 24.2% of all IBD patients. We observed 29 side effects, an incidence of 46% including two severe effects 3.5%, occurring on average after one month of treatment. The hematological undesirable effects were the most frequent appeared in 14 patients (26%), severe infection specifically tuberculosis appeared in 2 patients (3.6%), allergic effects were severe in only one case (anaphylactic shock), finally the secondary cutaneous lesions of Anti-TNF were observed in a single patient (extensive psoriasis). Severe adverse reactions led to permanent discontinuation of Anti-TNF in 24.1% of cases. The use of anti-TNF treatment is likely to generate numerous undesirable effects, hence the advantage of respecting the recommendations relating to the assessment before any treatment with biotherapy and of making regular clinical follow-up during treatment with a meticulous clinical examination as well as biological monitoring in order to prevent the occurrence of these complications, and to manage them correctly once they appear.

Hodgkin's disease is reported especially in young age, suspected in the presence of suspicious lymphadenopathy. Its revelation by acute hepatitis remains very exceptional. We report the case of a 25-year-old admitted in the emergency department for a febrile cholestatic jaundice, an erythroderma, an epistaxis with gingivorragias and edema of the lower limbs. Clinical examination revealed bilateral retroauricular and inguinal lymphadenopathy. The diagnosis of acute CMV hepatitis was based on the positivity of serology and Polymerase chain reaction "PCR". Anatomopathological and immunohistochemical examination of lymphadenopathy confirmed the diagnosis of Hodgkin's disease. CMV hepatitis is not exceptional in an immunocompromised patient, what is exceptional in our observation is the fact that it has ushered an Hodgkin's disease.