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With the worldwide vaccination campaign against the COVID-19 pandemic, a constant increase of cutaneous and extracutaneous adverse effects have been reported. Various immune-mediated diseases (IMD) flares or new disease onset after SARS-CoV2-vaccination has been described. 1 A few cases of Dermatomyositis (DM)/polymyositis (PM) after immunization with different vaccines have been reported in patients with possible genetic predisposition.

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Kaposiform hemangioendothelioma is a rare, borderline tumor that typically occurs during early childhood. Kasabach–Merritt phenomenon is a complication characterized by a consumptive coagulopathy resulting from the localized intravascular coagulation. Hypercalcemia generation is a rare association that was related in our case to parathyroid hormone‐related protein produced by this angioma.

Introduction Excessive and inappropriate use of antibiotics is highly associated with the emergence of antibiotic resistance. Antibiotic resistance reduces the effectiveness and number of options for antibiotic treatment, leading to increased morbidity, mortality, and health care expenditures. This study aimed to characterize antimicrobial prescriptions and to determine multidrug resistance (MDR prevalence in tertiary-level university hospitals (TLUH). Methods It was a point-prevalence survey of antimicrobial use in the two TLUH of Southern Tunisia, in 2019. For inpatients receiving antimicrobials, detailed information was collected. Results Totally, 1047 inpatients were included in our study. The sex ratio (male/female) was 1.1. The mean age was 50 ± 12 years. Overall, 410 cases (39.2%) were on antimicrobials. A significant association was noted between receiving antimicrobial drugs and admission in intensive care units (ICU) (65.% vs 30.2%; p < 0.001), having a surgical history, notably minimal invasive (81.9% vs 30.7%; p < 0.001)and indwelling invasive medical devices such as urinary (17.6% vs 3.9%; p < 0.001). and central vascular catheters (8.6% vs 2.2%; p < 0.001). Main antimicrobials were penicillin (26.7%), fluoroquinolones (20%) and third-generation cephalosporins (16.5%). Prophylactic indication constituted 24.9% (102 cases) of prescriptions, among which 81.3% were judged inappropriate for dose or timing while health-care associated infections accounted for 46.4% of all prescriptions. Parenteral route was prescribed in 302 cases (73%). Antibiotic indications were documented 221 cases (53.9%). Of 78 isolates, 50% were multidrug resistant strains, among which the commonest pathogen was extending-spectrum-beta lactamase producing Escherichia Coli (10 cases,25.6%). Conclusions This study demonstrated a high prevalence of antimicrobial use and MDR which needs addressing especially for surgical prophylaxis and empirical broad-spectrum antimicrobial prescriptions. Key messages High prevalence of multidrug resistance. The needs to addressing especially for surgical prophylaxis and empirical broad-spectrum antimicrobial prescriptions.