Colonic lymphomatous polyposis mantle cell lymphoma: a case report and review of literature.

INTRODUCTION: Mantle cell lymphoma is a rare lymphoma of the gastrointestinal tract that may present as multiple lymphomatous polyposis. We report a case of lymphomatous polyposis with a review of the literature. CASE REPORT: A 56-year-old man of Black ethnicity and Ivorian nationality with no relevant past medical history, consulted for a sudden onset symptoms of gastrointestinal obstruction, which evolved over 2 days. Macroscopic examination revealed the presence of multiple polyploid formations of the colonic mucosa. Histology showed diffuse lymphomatous proliferation of submucosa consisting off small lymphoid cells with a hyperchromatic crenelated nucleus, suggesting lymphomatous polyposis. Immunohistochemical examination showed expression by the tumor cells of antibodies to CD20, CD5, Bcl2, and cyclin D1. They did not express antibodies to CD10 and CD23. The Ki67 proliferation index was 25%. We have thus retained the diagnosis of mantle cell lymphomatous polyposis. CONCLUSION: Multiple lymphomatous polyposis is a rare entity characterized by the presence of numerous gastrointestinal polyploid lesions sometimes involving several segments of the gastrointestinal tract. Typical lymphoma presenting as lymphomatous polyposis is mantle cell lymphoma; although, other tumors may have this aspect.

Ibuprofen Lyell's Syndrome In An Eight-Year-Old Child.

Lyell's syndrome or toxic epidermal necrolysis (TEN) is a rare but serious drug-like toxiderma. Treated as a recent extensive burn in intensive care, its management must be urgent, and adapted in order to improve the vital prognosis of patients and reduce their mortality. We report a severe case of Lyell's syndrome occurring 24 hours after oral administration of an anti-inflammatory drug (ibuprofen) as a self-medication in an eight-year-old child.

Le syndrome de Lyell (nécrolyse épidermique toxique - NET) est une toxidermie médicamenteuse rare mais grave. Son prise en charge, urgente, doit être réalisée en CTB car elle s'approche de celle d'un brûlé. Nous rapportons le cas d'une NET survenue 24h après la prise orale, en automédication, d'ibuprophène.

[Epidemiology and mortality factors of acute intoxication in intensive care in Bouaké (Ivory Coast) from 2015 to 2018]. / Epidemiologie et facteurs de mortalite des intoxications aiguës en reanimation a Bouake (Cote d'Ivoire) de 2015 a 2018.

INTRODUCTION: Acute poisoning is a common reason for admission to intensive care. OBJECTIVE: To describe the epidemiological profile, to analyze the mortality factors of patients admitted to intensive care for acute intoxication. PATIENTS AND METHODS: A retrospective, descriptive and analytical study covering four years (from January 1, 2015 to December 31, 2018) .Includes patients admitted to intensive care in Bouaké for acute intoxication. The variables studied were: socio-demographic characteristics, intoxication characteristics, clinical, therapeutic, evolutionary and prognostic characteristics. RESULTS: Of a total of 1476 admissions during the study period, 131 patients were admitted for acute intoxication, with a hospital prevalence of 8.8%. The average age was 19 (range: 1 month to 70 years). The sex ratio was 0.84. The majority of poisonings occurred at home (94%). Psychiatric history was present in 11% of patients. The poisoning occurred in urban areas in 72% of cases. The place of intoxication was the family home in 94% of cases. The nature of the intoxication and the type of poison toxin depended on the age of the intoxicated patients. The average admission time was 7.38 hours ± 12 hours (range: 30 minutes to 72 hours). The poisoning was symptomatic in 93% of the patients. The clinical symptoms observed were: gastrointestinal (70%), respiratory (62%) and neurological (43%). Vomiting attempts associated with self-medication were performed in 69% of patients. The substances used for self-medication were: palm oil (80%) and milk (20%). The treatment in intensive care was initially symptomatic then secondarily adapted to the nature of the incriminated or suspected toxin. The use of tracheal intubation and mechanical ventilation was necessary for 10% of the patients. The average stay in hospital was 1.64 ± 1.5 days (range: 1 to 10 days). The lethality was 8%. The factors of poor prognosis were the existence of a cardiovascular collapse (p <0.001), the presence of a deep coma (p <0.001) and the use of mechanical ventilation (p <0. 001). CONCLUSION: Acute intoxication is a public health problem in Bouaké and requires preventive action.

INTRODUCTION: Les intoxications aiguës constituent un motif fréquent d'admission en réanimation. OBJECTIF: Décrire le profil épidémiologique, analyser les facteurs de mortalité des patients admis en réanimation pour intoxications aiguës. PATIENTS ET MÉTHODES: Etude rétrospective, descriptive et analytique, portant sur quatre ans (du 1er janvier 2015 au 31 décembre 2018).Etaient inclus les patients admis en réanimation à Bouaké pour une intoxication aiguë. Les variables étudiées étaient: les caractéristiques sociodémographiques, les caractéristiques de l'intoxication, les caractéristiques cliniques, thérapeutiques, évolutives et le pronostic. RÉSULTATS: Sur un total de 1476 admissions durant la période d'étude, 131 patients ont été admis pour une intoxication aiguë, soit une prévalence hospitalière de 8,8 %. L'âge moyen était de 19 ans (extrême : 1 mois et 70 ans). Le sex-ratio était de 0,84. La majorité des intoxications avaient eu lieu au domicile (94 %). Les antécédents psychiatriques étaient présents chez 11% des patients. Les intoxications avaient lieu en milieu urbain dans 72% des cas. Le lieu de l'intoxication était le domicile familial dans 94% des cas. La nature de l'intoxication et le type de toxique incriminé était fonction de l'âge des patients intoxiqués. Le délai moyen d'admission était de 7,38 heures ± 12heures (extrêmes: 30 mn et 72 heures). Les intoxications étaient symptomatiques chez 93% des patients. Les symptômes cliniques observés étaient : gastro-intestinaux (70%), respiratoires (62 %) et neurologique (43%). Des tentatives de vomissements associées à une automédication ont été réalisées chez 69% des patients. Les substances utilisées pour l'automédication étaient : l'huile de palme (80 %) et de lait (20%). Le traitement en réanimation était initialement symptomatique puis secondairement adapté à la nature du toxique incriminé ou suspecté. Le recours à l'intubation trachéale et à la ventilation mécanique a été nécessaire chez 10% des intoxiqués. Le séjour moyen en hospitalisation a été de 1,64±1,5 jours (extrêmes : 1 et 10 jours). La létalité était de 8 %. Les facteurs de mauvais pronostic étaient : l'existence d'un collapsus cardiovasculaire (p <0,001), la présence d'un coma profond (p <0,001) et la réalisation d'une ventilation mécanique (p <0,001). CONCLUSION: Les intoxications aiguës constituent un problème de santé publique à Bouaké et nécessite des actions de prévention.

Angioedème bradykinique d'évolution fatale suite à une prise d'énalapril. A propos d'un cas

L'angiœdème bradykinique est une maladie rare et grave qui constitue une complication exceptionnelle du traitement aux Inhibiteurs de l'Enzyme de Conversion (IEC). Elle engage le pronostic vital des patients dans 75% des cas et représente une urgence médicale majeure. L'évolution de cette affection est totalement imprévisible avec un risque de décès par asphyxie. Les auteurs rapportent l'observation d'une patiente de 70 ans hypertendue qui a présenté un angiœdème bradykinique d'évolution fatale deux jours après l'initiation de son traitement antihypertenseur par les IEC. Au travers cette observation, les auteurs voudraient mettre en lumière cette affection mortelle, de diagnostic difficile souvent méconnue

Tetanus after application of traditional topical treatment to a severe burn.

A 2-year-old child was accompanied by his parents to the pediatric emergency room for refusal to eat, trismus and generalized contractures four days after the application of a traditional topical treatment (Cassava leaves) on lesions of a severe thermal burn. A temperature of 38̊C, a heart rate of 114 beats/min, and a blood pressure of 90/60 mm Hg were recorded. The tetanus vaccination was not up to date. The diagnosis of tetanus was immediately suggested. Antitetanus serum (immunoglobulin), an antibiotic (amoxicillin and clavulanic acid), and a myorelaxant (benzodiazepine) were administered. Local treatments were also performed. The child died within 24 hours.

[Acute respiratory distress syndrome secondary to a viper envenomation in children]. / Syndrome de détresse respiratoire aiguë secondaire à une envenimation vipérine chez l'enfant.

Viper envenomation is responsible for inflammatory disorders, hemorrhagic complications, and local or extended necrosis. The occurrence of respiratory complications such as Acute Respiratory Distress Syndrome (ARDS) is exceptional. We report on the case of a 15-year-old with no particular history who had, 24h after a viper bite, swelling of the right lower limb associated with blood dyscrasia. Despite the administration of antivenom treatment, the progression was marked by the onset of ARDS and the patient's death within 48h.

[Rectal and colonic injuries induced by enemas: a 10-case series at the university hospital center in Bouake, Ivory Coast]. / Les rectocolites par les lavements à propos de 10 cas au CHU de Bouake (RCI).

The purpose of this study is to report our experience in the management of rectal and colonic injuries induced by enemas. A retrospective analysis was carried out in a series of 10 patients treated at the Bouake, Ivory Coast University Hospital Centre for rectal and colonic injuries induced by enemas between January 1, 1997 and December 31, 2001. There were 6 men and 4 women with a mean age of 26.2 +/- 5.6 years. Based on history taking five enemas involved criminal intent. The other five were carried out for abortion (n=3), therapy (n=1) or autolysis (n=1). The injurious product was known in 7 cases, i.e., sulphuric acid (n=4) and hot pepper (n=3). The mean quantity administered was 158 +/- 64 ml. The presenting picture involved diffuse acute peritonitis in 7 cases and abdominal pain with bloody mucoid rectal discharge in 3. One patient died at the time of admission. The remaining patients underwent either operative (n=6) or medical (n=3) treatment. Prognosis was unfavourable. Four patients died and one patient required colostomy that could not be removed due to sclerosis of the anal sphincter. Management of rectal and colonic injuries induced by enemas requires differential diagnosis to distinguish patients that require emergency laparotomy from patients that can be treated medically. For patients treated medically, close surveillance based on imaging and repeated clinical examination is of paramount importance to allow diagnosis of complications requiring surgical treatment.

[Severe malaria in native adults in Abidjan (Côte d'Ivoire)]. / Paludisme grave de l'adulte autochtone à Abidjan (Côte d'Ivoire).

Our retrospective study carried out from 1985 to 1998 in the Unit of Infectious Diseases in Abidjan aimed at describing the epidemiological, clinical and prognosis features of severe malaria among native adults. Within 14 years, we have listed 274 cases of severe malaria for 54 098 hospitalizations (0.5%). 164 men and 110 women were recorded (sex-ratio = 1.5), aged of 33 years (16-86), among them 48% were HIV positive. 23% of the patients had already received an antimalarial treatment. The main clinical presentation was cerebral malaria (78%). The other manifestations were respiratory symptoms (13%), kidney failure (11%), anaemia (11%), macroscopic haemoglobinuria (6%), hypoglycaemia (9%), cardiovascular shock (4%). The average parasite load in blood was 27 222 plasmodium/microl (25 000 - 180200). The treatment used was quinine IV (172 patients), and arthemeter (102 patients). The outcome was favourable in 232 cases (84%) and 42 patients died. Prognosis factors identified were age > 65 years, Glasgow coma score < 7, convulsions, cardio-vascular shock, macroscopic haemoglobinuria. HIV infection has not been identified as a pejorative factor Our results confirm that severe malaria in native adult is a reality in tropical area. This study shows how difficult it is to have an adequate care management regarding this pathology in our context.