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Résumé Introduction Le rituximab est un anticorps monoclonal anti-CD20 souvent bien toléré. Pourtant, un syndrome immuno-allergique sévère mais rare associant fièvre, frissons et thrombopénie peut apparaître peu après la perfusion de rituximab. Observation Nous rapportons le cas d’une thrombopénie aiguë sévère induite au rituximab d’évolution favorable chez un patient ayant une leucémie lymphoïde chronique et discutons les mécanismes sous-jacents possibles. Conclusion Malgré la potentielle sévérité initiale de la thrombopénie induite au rituximab dans la leucémie lymphoïde chronique, la chimiothérapie ne devrait pas être interrompue, la tolérance peut s’améliorer avec le contrôle de la maladie hématologique. Introduction Rituximab is a chimeric anti-CD20 monoclonal antibody generally well tolerated. However, a severe but rare rituximab-related immune-toxic syndrome, associating fever, chills and thrombocytopenia can occur shortly after the infusion. Case report We report a case of severe acute rituximab-induced thrombocytopenia with favorable outcome in a patient with chronic lymphocytic leukemia and discuss the possible underlying mechanisms. Conclusion Despite the potential initial severity of rituximab-induced thrombocytopenia in CLL, chemotherapy should not be discontinued; tolerance might increase as the hematologic disorder is controlled. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Tramadol is a weak opioid analgesic used as a step two analgesic, approved in France for the treatment of moderate to severe pain in adult patients. The most common side effects are gastrointestinal and neurologic. Hypoglycaemia is an almost unknown side effect. Case reports: We report two patients who presented with severe hypoglycaemia related to oral administration of tramadol in non diabetic patients. The underlying mechanisms of hypoglycaemia induced by tramadol are unclear. The only weak opioid analgesic drug reported to cause hypoglycaemia is propoxyphene, which has been widely used in France. The recent withdrawal of dextropropoxyphene in France might increase the prescriptions of tramadol and healthcare professionals should be aware of the risk of hypoglycaemia. Conclusion: The risk of hypoglycaemia should be added to the summary of product characteristics of tramadol. [Copyright &y& Elsevier]

Du fait de leur faible incidence et des difficultés diagnostiques, les cytopénies auto-immunes (CAI) induites par les inhibiteurs de points de contrôle immunitaire (IPCI) restent peu décrites. Les plus large séries publiées de cytopénies associées aux ICPI ne détaillent pas les critères diagnostiques des cytopénies et/ou leur prise en charge, limitant l'interprétation de ces données [1–3]. L'objectif de cette étude était de mieux décrire les CAI induites par les ICPI, à partir des données issues de la base nationale de pharmacovigilance. Tous les notification d'effets indésirables hématologiques de grade ≥ 2 impliquant au moins 1 ICPI, codé comme médicament suspect ou interaction jusqu'au 31 mars 2022 ont été extraites de la base nationale de pharmacovigilance. Les patients étaient inclus s'ils avaient présenté une cytopénie auto-immune de grade ≥ 2 après l'initiation d'un traitement par ICPI. Les cytopénies pour lesquelles une autre cause était possible (cytotoxiques, lupus érythémateux systémique, leucémie lymphoïde chronique ou encore infections) ont été exclues. Les cas douteux étaient revus par un groupe d'experts en médecine interne, hématologie et pharmacovigilance. Soixante-huit patients ont été inclus, pour un total de 75 CAI induites par les ICPI. Les hommes représentaient 63 % des cas et l'âge médian était de 63,0 ans. Les cancers les plus fréquemment rapportés étaient le cancer du poumon (47,1 %) et le mélanome (32,4 %). La majorité des patients (80,9 %) avaient reçu un anti- programmed cell death 1 (PD-1). Sept patients (10,3 %) avaient un antécédent de maladie auto-immune. Le purpura thrombopénique immunologique (PTI) et l'anémie hémolytique auto-immune (AHAI) étaient les CAI plus fréquemment notifiés (avec 50,7 % et 25,3 % des cas respectivement). La CAI survenait dans un délai médian 2 mois après l'instauration d'un ICPI. Plus de la moitié des CAI étaient de grade ≥ 4 et 3 patients (4,4 %) sont décédés des complications des CAI (hémorragie sur PTI réfractaire [ n = 2] et thrombose en contexte d'AHAI active sévère [ n = 1]). Sur les 61 réponses au traitement évaluables, une rémission complète ou partielle après traitement conventionnel était observée dans 72,1 % des CAI. Parmi les 10 patients ayant eu une réintroduction de l'ICPI après une CAI de grade ≥ 2, 3 ont présenté une récidive de CAI. Cette étude de grand effectif, incluant des patients traités par ICPI en vie réelle et pour un large panel de cancers, montre que les CAI induites par les ICPI sont rares mais potentiellement graves. Du fait des biais inhérents aux bases de données de pharmacovigilance des études prospectives complémentaires sont nécessaires afin d'identifier les facteurs de risque de CAI chez les patients traités par ICPI. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les neuroleptiques sont les principaux médicaments antipsychotiques utilisés dans les services de psychiatrie ou de médecine. La survenue d’une hyperthermie, notamment dans le cadre du syndrome malin des neuroleptiques, est un effet indésirable classique de ces traitements. L’hypothermie est en revanche une complication beaucoup moins connue. Observation Nous rapportons une nouvelle observation d’hypothermie aux neuroleptiques, survenant chez une femme de 72 ans, sans autres antécédents médicaux. L’hypothermie persistante accompagnée de troubles de la vigilance et d’une bradycardie a occasionné chez cette patiente un bilan étiologique exhaustif pour identifier sa cause ainsi qu’une hospitalisation prolongée. Les résultats d’une revue de la base nationale de pharmacovigilance française mettent en évidence que près d’un quart (153/614) des hypothermies médicamenteuses sont attribuées aux psychotropes, et principalement aux neuroleptiques (99/153). Conclusion Une meilleure connaissance de l’hypothermie aux neuroleptiques devrait permettre de faciliter le diagnostic précoce et la déclaration de cet effet indésirable encore méconnu de la plupart des cliniciens. Introduction Neuroleptics are the main antipsychotic agents used in psychiatric or medicine departments. The occurrence of hyperthermia, particularly in the context of the neuroleptic malignant syndrome, is a well-known side effect of these treatments. Conversely, the occurrence of hypothermia is less known from clinicians. Case report We reported a 72-year-old woman, who presented with hypothermia associated with treatment with neuroleptics. This patient had no other medical comorbidities. Because of persistent hypothermia, altered consciousness and bradycardia, exhaustive diagnostic work-up as well as a prolonged hospitalization were necessary. The results of a review of the national French pharmacovigilance database showed that nearly a quarter (153/614) of drug-related hypothermia are attributed to psychotropic drug, mainly neuroleptics (99/153). Conclusion A better awareness of hypothermia associated to neuroleptics should facilitate early diagnosis and reporting this side effect of neuroleptics. [ABSTRACT FROM AUTHOR]

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., (Copyright © 2022 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

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., (Copyright © 2019 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Rituximab is a chimeric anti-CD20 monoclonal antibody generally well tolerated. However, a severe but rare rituximab-related immune-toxic syndrome, associating fever, chills and thrombocytopenia can occur shortly after the infusion., Case Report: We report a case of severe acute rituximab-induced thrombocytopenia with favorable outcome in a patient with chronic lymphocytic leukemia and discuss the possible underlying mechanisms., Conclusion: Despite the potential initial severity of rituximab-induced thrombocytopenia in CLL, chemotherapy should not be discontinued; tolerance might increase as the hematologic disorder is controlled., (Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Introduction: Neuroleptics are the main antipsychotic agents used in psychiatric or medicine departments. The occurrence of hyperthermia, particularly in the context of the neuroleptic malignant syndrome, is a well-known side effect of these treatments. Conversely, the occurrence of hypothermia is less known from clinicians., Case Report: We reported a 72-year-old woman, who presented with hypothermia associated with treatment with neuroleptics. This patient had no other medical comorbidities. Because of persistent hypothermia, altered consciousness and bradycardia, exhaustive diagnostic work-up as well as a prolonged hospitalization were necessary. The results of a review of the national French pharmacovigilance database showed that nearly a quarter (153/614) of drug-related hypothermia are attributed to psychotropic drug, mainly neuroleptics (99/153)., Conclusion: A better awareness of hypothermia associated to neuroleptics should facilitate early diagnosis and reporting this side effect of neuroleptics., (Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Background: More than 100 drugs have been registered as inducing subacute cutaneous lupus erythematosus (SCLE). Recently, some types of chemotherapy have also been incriminated. If SCLE develops in a setting of neoplasia, two possibilities should be considered: it is either a paraneoplastic syndrome or it is caused by the chemotherapy, thus calling for important decisions on the benefit/risk of stopping potentially effective medication. We report a case of SCLE induced by Xeloda (capecitabine)., Patients and Methods: A 50-year-old female patient consulted with an annular erythematosquamous and pruriginous eruption, predominantly on areas of the body exposed to sunlight, occurring 4 months after the initiation of capecitabine for advanced colon cancer. She had presented systemic lupus erythematosus (SLE) for many years, which was not treated, was not progressive and had no cutaneous manifestations. The appearance of the cutaneous lesions, positivity for anti-SSA antibodies and the histological aspect led to diagnosis of SCLE. The lesions were resistant to treatment with hydroxychloroquine and systemic corticosteroids, but disappeared after discontinuation of capecitabine, suggesting chemotherapy-induced SCLE., Discussion: Some types of chemotherapy such as capecitabine may reveal or induce SCLE lesions, whether or not there is a previous history of SLE. Cases of chemotherapy-induced cutaneous lupus reported to the French pharmacovigilance agency are rare, but this side effect must be recognised due to the constantly rising use of this type of anticancer agent., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: Tramadol is a weak opioid analgesic used as a step two analgesic, approved in France for the treatment of moderate to severe pain in adult patients. The most common side effects are gastrointestinal and neurologic. Hypoglycaemia is an almost unknown side effect., Case Reports: We report two patients who presented with severe hypoglycaemia related to oral administration of tramadol in non diabetic patients. The underlying mechanisms of hypoglycaemia induced by tramadol are unclear. The only weak opioid analgesic drug reported to cause hypoglycaemia is propoxyphene, which has been widely used in France. The recent withdrawal of dextropropoxyphene in France might increase the prescriptions of tramadol and healthcare professionals should be aware of the risk of hypoglycaemia., Conclusion: The risk of hypoglycaemia should be added to the summary of product characteristics of tramadol., (Copyright © 2011 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Drugs affecting the central nervous system form a unique group of products for surveillance because they could be misused, abused or diverted. Considering the characteristics of this behaviour that is often concealed, specific post-marketing surveillance systems have been developed to monitor abuse of prescription drugs in some countries. The purpose of this review is to list and to describe post-marketing surveillance systems, according their methodology, in France and in foreign countries. These programs are based on adverse effect notifications, medical or legal consequences of abuse, general or specific population-based survey, professional networks or medication databases. Some programs use simultaneously several information sources. In conclusion, the multifaceted nature, the diversity and the inventiveness of post-marketing surveillance systems reflects the complexity of the abuse issue., (© 2011 Société Française de Pharmacologie et de Thérapeutique.)

Introduction: The data on consumption of psychoactive substances among new prisoners are documented but not detailed with precision. Nevertheless, analyzing the consumption's characteristics of psychoactive products would led to a better caring of subjects at the entry in the prison. The consumption of psychoactive drugs the week before the imprisonments of subjects seen in prison were studied from the Observation of Illegal Drugs and Misuse of Psychotropic Medications (OPPIDUM) program's between 2003 and 2006. These were compared to those of others subjects with an history of abuse/dependence or under an opiate maintenance therapy presented in other structures of care., Methods: OPPIDUM is an annual cross-sectional national study, repeated each year in October since several years. It is based on the Network of the Centres for Evaluation and Information on Pharmacodependence (CEIP) which recruits, via the medical system (drug users outpatient care centers, psychiatric units, drug-addict units...), subjects presenting a drug dependency or benefiting of an opiate maintenance treatment., Results: During the four years between (2003 to 2006), 13,008 subjects were included. Seven percent (n=893) of them were in prison. They are younger and present worse social-economical indicators compared to the others subjects seen in other structures of care. In comparison to other subjects, the prisoners consume more products, more illicit ones and more benzodiazepines like flunitrazepam and clonazepam before their imprisonment. The medicines are consumed with higher doses and are more often obtained illegally (35% vs 14%). These subjects are less often under an opiate maintenance therapy (51% vs 74%). Between 2003 and 2006 the consumption of cocaine, increased from 18% to 28% for the patients before their confinement and from 11% to 21% for the heroine. Nevertheless, the consumption of benzodiazepines have decreased passing from 41% to 25%; and the consumption and of opiate maintenance treatment taken out of a protocol have decreased from 11% to 4%., Discussion: This study underlines the specificity of the characteristics of consumption of psychotropic drugs before the imprisonment of the subjects with history of abuse/dependence or under an opiate maintenance therapy by report to consumers presented in other structures of care. It outlines the need to optimize the care by a better knowledge of the consumption of psychoactive products., (2009 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)