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Iron deficiency is the most frequent cause of hypochromic microcytic anemia in children, but other causes, some of them requiring specific management, may be involved. Checking the iron-status is absolutely mandatory. When iron-status parameters are low, inadequate intake, malabsorption, blood loss, and abnormal iron utilization must be tested. In absence of iron deficiency, α- and β-globin and heme biosynthetic gene status must be checked. Assessing the iron stock level is difficult, because there is an overlap between the values observed in iron-replete and iron-deprived patients, so that at least 2 iron-status parameters must be below normal for diagnosing iron deficiency. Furthermore, inflammation may also mimic some characteristics of iron deficiency. Diagnosing iron deficiency leads to prescribing iron supplementation with follow-up at the end and 3 months after cessation of treatment. When iron stores are not replete at the end of treatment, compliance and dosage must be reevaluated and occult bleeding sought. The latter is also required when the iron store decreases 3 months after cessation of iron replacement.

Objectif Nous rapportons l’experience pediatrique Francaise de sept cas d’inflammation digestive survenus sous traitement par etanercept. Methodes Etude multicentrique retrospective. Les patients inclus etaient traites par etanercept pour une arthrite juvenile idiopathique (AJI) et ont developpe une inflammation digestive histologiquement prouvee sous ce traitement. Une relecture centralisee de toutes les biopsies digestives a ete effectuee. Resultats Sept patients ont ete inclus. Il a ete retrouve une inflammation digestive aspecifique (3 cas), ou une maladie de Crohn (4 cas). Une pancolite severe a ete notee chez 4 patients. Les signes digestifs comportaient : douleurs abdominales (n = 7), diarrhee (n =5), anorexie (n = 5), abces anal (n = 2), ulceres buccaux (n = 1) et febricule (n = 1). Une remission clinique a ete constatee chez tous les patients a l’arret de l’etanercept et mise en place d’un traitement specifique de l’inflammation digestive. Discussion L’imputabilite de l’etanercept a ete retenue sur (i) la survenue des symptomes apres son introduction, (ii) l’absence d’antecedents digestifs (iii) l’amelioration clinique a l’arret du traitement. Conclusion Une inflammation digestive doit etre evoquee devant l’apparition de symptomes evocateurs survenant sous traitement par etanercept.