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.
Celiac disease is an autoimmune enteropathy, secondary to an allergy to gluten in genetically predisposed subjects, results in clinical polymorphism, with the presence of malabsorption syndrome, is a villous atrophy demonstrated using gastroscopy, which allows to biopsy the duodenal mucosa in order to demonstrate this atrophy at the histological level and also the demonstration of basal lymphocytosis, its associated clinical, endoscopic and histological abnormalities are positive for anti-ACs. IgA-type transglutaminase, the latter may be deficient, the chosen which is frequent in celiac patients compared to the general population, making sometimes the diagnosis is a challenge for the clinician. We report the case of an association between an IgA deficiency and celiac disease in a 20-year-old patient with no personal or family pathological history, revealed by diarrhea with signs of deficiency in connection with malabsorption and the presence of the sign suggestive at endoscopy. digestive system, with an analysis of the relationship between seronegative celiac disease (SNCD) and immunoglobulin A deficiency through a review of the literature on the main medical databases
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.
The association of celiac disease and idiopathic portal hypertension is a rare entity whose etiopathogenic mechanism has not yet been elucidated. We report two cases of celiac disease associated with idiopathic portal hypertension. In both cases celiac disease diagnosis was made based on the positivity of anti-tissue transglutaminase IgA and villous atrophy on the pathological study of duodenal biopsies. Idiopathic portal hypertension was retained after complete biological, radiological and endoscopic assessment excluding all possible causes that can manifest as portal hypertension. Both patients improved after gluten-free diet.
The AIH-PBC overlap syndrome is the most common form of OS. The aim: to study the clinical and paraclinical characteristics of the overlap syndrome and to specify the therapeutic and evolutionary characteristics. Methods: The medical data of 42 PBC patients were evaluated for associated autoimmune hepatitis. Results: Among the 42 cases of PBC, we retained 16 cases of OS (37%). All female the association of diagnostic criteria for PBC and HAI was simultaneous in 80%. Treatment with AUDC, corticosteroid and Azathioprine was started in the majority of our patients. The course was marked by a complete (10 cases) or incomplete (n = 6) response. Conclusion: OS should be considered in the presence of any mixed cytolytic and cholestatic liver disease. Its recognition is essential in order to adapt treatment and prevent progression to cirrhosis and its complications.
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