Metronidazole-Induced Encephalopathy With Probable Crohn Encephalitis: A Case Report.

OBJECTIVES: Metronidazole central nervous system toxicity is a rare finding in patients receiving the medication. We report a peculiar case of metronidazole central nervous system toxicity in which both the underlying condition (Crohn disease) and the drugs used to treat it are potential causes of encephalopathy. METHODS: A 26-year-old female with 6-year history of Crohn's disease for 6 years presented acute-onset encephalopathy. We provide bibliographic evidence to support metronidazole toxicity and potential Crohn disease-associated neurologic involvement. RESULTS: The patient presented dystonia, cerebellar ataxia, and altered mental status. Magnetic resonance imaging of the brain revealed typical findings of metronidazole toxicity and white matter involvement of the centrum semiovale. Immunoelectrophoresis and immunofixation of serum and cerebrospinal fluid proteins were consistent with a systemic inflammatory process. We concluded on an association between drug toxicity and probable Crohn-associated neurologic involvement. Metronidazole was stopped and the patient was placed on vitamin therapy and diazepam to control dystonia. She deteriorated and was transferred to the intensive care unit where she expired. CONCLUSIONS: Acute behavioral changes in a young patient constitute an emergency and differential diagnoses should include infective, inflammatory, metabolic, and toxic causes. Metronidazole is a potential toxic etiology.

Epidemiological, Diagnostic and Therapeutic Aspects of Hepatocellular Carcinoma in Morocco: A Case Series and Review of Literature.

INTRODUCTION: Hepatocellular carcinoma (HCC) is the most common primary liver tumor. It is considered a global public health problem given its incidence and high mortality rate. Epidemiological studies on hepatocellular carcinoma in our Moroccan and North African contexts are rare. Hence, our study aims to determine the epidemiological, clinical, paraclinical, etiological and therapeutic aspects of this pathology in our context. MATERIALS AND METHODS: We conducted a descriptive retrospective study on patients with HCC treated by the Hepato-gastroenterology department of the university hospital of Mohammed VI in Marrakech over a period of 7 years spread between 01/01/2015 and 31/12/2021. The epidemiological characteristics, diagnostic methods and therapeutic management of HCC in these patients have been described and analyzed. RESULTS: 100 patients with HCC were identified and included in our study. The average age was 63.3 ± 12.63 years with a male predominance. The predominant etiology was cirrhosis (87% of cases) then viral hepatitis C (35%) and B (27%) and of unknown origin in 29% of cases. HCC revealed cirrhosis in 41% and was diagnosed during cirrhosis surveillance in 36% of cases. The functional signs were dominated by abdominal pain (68%), deterioration of general condition (58%) and abdominal distension (43%). Alfa-fetoprotein was elevated in 73% of cases and was above 400ng/ml in 41% of cases. The diagnosis was mainly radiological in 92% and histological in 8% of cases. The radiological aspects of HCC were dominated by mononodular form (58%), a right lobar location (80%), a diameter greater than 5 cm (58%), a typical vascular aspect (86%) with portal thrombosis in 24% and metastases in 36% of cases, especially in lymph nodes. The majority of cirrhosis in our series was classified as Child-Pugh stage B (46%) at the time of diagnosis and most patients had an advanced stage of HCC with 31% at BCLC C and 28% at BCLC D. 72% of patients received palliative treatment, and only 6% received curative treatment. At the end of the study, 48% of patients had died with an overall survival of 6.5 months. CONCLUSION: Our study achieved its main objective by providing a snapshot of HCC in our context and confirmed that HCC remains with poor prognosis since its diagnosis is often late, limiting the therapeutic choices with a very short median survival. It also noted that the viral etiology remains the main cause of HCC in our population. Therefore, prevention remains the best therapeutic approach against HCC and the need for a national or at least a regional HCC registry in our country is essential in order to develop targeted preventive measures adapted to our context and to improve the diagnostic and therapeutic approaches for our patients.

ANCA and ASCA Profiles in a Moroccan Population With Inflammatory Bowel Diseases.

Introduction: Diagnosing inflammatory bowel disease (IBD) is hindered by the invasive procedures required for accurate classification as Crohn's disease (CD) or ulcerative colitis (UC). As alternatives, non-invasive tests using anti-Saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) have gained significance. This study evaluated ANCA and ASCA antibody frequencies in IBD and their role in disease characterization in a Moroccan population. Methods: Conducted at Marrakech's Mohammed VI University Hospital from 2014 to 2018, this cross-sectional study included patients with suggestive symptoms or confirmed IBD diagnosis based on clinical, endoscopic, and histological criteria. Immunological investigations detected p-ANCA, c-ANCA, and ASCA using immunofluorescence and immunodot assays. Results: Among 60 participants (mean age: 33.1 ± 11.75 years), the 20-30-year age group was most affected (31.67%). CD, UC, and indeterminate colitis (IC) were diagnosed in 46.67%, 45%, and 8.33% patients, respectively. Gastrointestinal symptoms were prevalent (98.3%), with ANCA+/ASCA-profile in 41% of UC patients versus 11% in CD, and ANCA-/ASCA + profile exclusive to CD (50%). ANCA positivity was significantly associated with UC, rectal syndrome, and inflammatory syndrome, whereas ASCA positivity was significantly associated with CD and König's syndrome (p < 0.05). Conclusion: This study highlighted demographic and phenotypic particularities of IBD in a Moroccan population. Non-invasive tests using ASCA and ANCA antibodies offer valuable alternatives to invasive procedures, facilitating personalized management strategies. Variations in ANCA and ASCA profiles provide insights into disease characterization and inform tailored treatment approaches.

Quality of life of Moroccan patients with celiac disease: Arabic translation, cross-cultural adaptation, and validation of the celiac disease questionnaire.

BACKGROUND AND STUDY AIMS: Celiac disease (CD) management is based on a lifelong gluten-free diet (GFD) that affects the quality of life (QoL) of patients with CD. Specific instruments have been used to evaluate this QoL, such as the CD-Questionnaire (CD-Q). This study aimed to translate, validate, and cross-culturally adapt the CD-Q in an Arabic version and then apply it to evaluate the QoL of Moroccan adult patients with CD. PATIENTS AND METHODS: The Moroccan version of the CD-Q (M-CD-Q) was administered to 150 patients with CD, and 112 of them completed it. The reproducibility and reliability of the M-CD-Q were studied by the intraclass coefficient (ICC) and Cronbach's α, respectively. Parametric and nonparametric tests, confirmatory factor analysis, and Spearman correlation were used for the statistical analysis performed by SPSS, and the goodness-of-fit test was determined using SPSS AMOS. RESULTS: No difficulties were found during the translation and cultural adaptation of the CD-Q. Cronbach's α showed good internal consistency. The retest showed excellent reproducibility (ICC > 0.4). The study of the psychometric properties of the M-CD-Q showed good acceptance, zero ceiling effect, and floor effect. The model fit was good [(root mean square error of approximation = 0.075 (<0.08) and χ2 = 509.04, p < 0.001]. The total scores showed a neutral QoL. This QoL was worse in the worries subscale, which is related to gluten-free products. The GFD did not improve the QoL of the examined samples. CONCLUSION: The M-CD-Q is the first reliable and adapted instrument in an Arab country for the evaluation of QoL in patients with CD. CD negatively influences this QoL, especially items related to gluten-free products.

Small bowel metastases from a testicular choriocarcinoma revealed by gastrointestinal bleeding: a case report.

Testicular germ cell tumors are the most common cancers in young men. In most cases, patients may present a painless testicular swelling. However, in 10% the presentation is variable and related to site of metastasis and complications. Clinically apparent gastrointestinal involvement was seen in 5% of cases and dominates by gastrointestinal bleeding. We report a case of testicular choriocarcinoma involving the small intestine revealed by melena and complicated by acute intussusception.

[Primary liver melanoma: about a case]. / Mélanome hépatique primitif: à propos d'un cas.

Malignant melanoma is a disease with high metastatic potential which starts in melanocytes. The liver is the organ most often targeted for metastatic spread. Nonetheless, primary liver melanoma is very rare. Few cases have been described. We here report the case of a female patient with primary liver melanoma diagnosed based on liver biopsy results and confirmed by histological and immunohistochemical analyses as well as by providing a comprehensive assessment excluding other localizations.

[Multinodular splenomegaly revealing multifocal, splenic and spinal tuberculosis: a case report]. / Splénomégalie multi-nodulaire révélatrice d'une tuberculose multifocale à localisation splénique et vertébrale: à propos d'un cas.

Splenic tuberculosis and Pott´s disease are two rare entities, in particular in immunocompetent people. We here report the case of a 57-year-old immunocompetent woman presenting with atypical pain in the left hypochondriac region evolving over the last 3 months, associated with lower limb paraparesis with progressive onset. Laboratory data did not provide any specific information regarding diagnosis, except for positive response to the QuantiFERON Test. Abdominal and pelvic computed tomography (CT) scan showed splenomegaly with multiple nodular, hypodense lesions in the spleen. Spinal cord magnetic resonance imaging (MRI) showed spondyldiscitis at the D10/D11 level with epidural and paravertebral collections responsible for medullary compression. GeneXpert assay on bone biopsy was positive and histological examination objectified granuloma characterized by the presence of central caseous necrosis. The diagnosis of multifocal tuberculosis was retained.

Differential diagnosis of COVID-19 in symptomatic patients at the University Hospital Center Mohammed VI, Marrakesh.

INTRODUCTION: coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 was first reported in Wuhan, China. Clinical spectrum of this disease has nonspecific symptoms shared by many other frequent infectious diseases of the respiratory tract and other respiratory tract diseases. This study explains the importance of differential diagnosis between COVID-19 and other lung diseases. METHODS: we analyzed in this study, the demographic features, clinical presentations, laboratory data and radiologic findings of the COVID-19 patients in comparison to those with other respiratory infections or diseases. RESULTS: the mean age of all patients was 38.04 years; 35 patients were later confirmed to be positive for SARS-CoV-2 infection. The most common symptoms reported by both groups included nonproductive cough and myalgia. Two of the non-COVID-19 patients were having below 92% oxygen saturation and low systolic blood pressure. The patients shared relatively similar laboratory findings except 3% of the non-COVID-19 patients who had lympho-neutropenia and 22.6% had high levels of C-reactive protein. Pulmonary tuberculosis and autoimmune disease respiratory disorder were suspected in 2 of the non-COVID-19 patients respectively. CONCLUSION: we emphasize the importance of good screening protocols, rapid detection of SARS-CoV-2 and other most common respiratory pathogens, which may help for a better control of COVID-19 spread and avoid delayed care of other lung diseases.

[Relationship between coeliac disease and multifocal tuberculosis: about a case and literature review]. / Association maladie cœliaque et tuberculose multifocale: à propos d'un cas avec revue de la littérature.

Coeliac disease is an autoimmune enteropathy related to gluten intolerance which occurs in subjects genetically disposed. The diagnosis is based on the combination of clinical biological and histological arguments. It is associated with many complications, including lymphoma. The risk of tuberculosis in patients with coeliac disease is increased. Several hypotheses explaining this association have been discussed. We report a case of coeliac disease associated with multifocal tuberculosis in a 17-year old patient.

Primary anal mucinous adenocarcinoma: a case series.

Primary mucinous adenocarcinoma is a rare malignancy of the anus (3% of anal cancers), the pathogenesis of which is better understood by immunohistochemistry. We reviewed cases of primary mucinous adenocarcinoma of the anus from 2000 to 2009 in the Hepatogastroenterology Department of the University Hospital Centre of Marrakech. Three cases were identified who were males with the mean age of 68years, and presented with a chronic anal fistula. Two cases had anal pain. Clinical examination revealed multiple fistulae in two cases with a secretion simulating 'cooked grains of tapioca'. Diagnosis was confirmed by histopathology and immunohistochemical profile (CK7 positive/CK20 negative). Imaging revealed a retro-rectal collection with thickening of the anal wall without metastasis (two cases). One patient underwent abdominoperinal resection without recurrence.