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.

[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.