Life threatening hepatotoxicity induced by Nilotinib.

INTRODUCTION: Tyrosine kinase inhibitor had changed the prognosis of chronic myeloid leukemia (CML) and the overall survival had reached 95%. Unfortunately, adverse events (AEs) remain an obstacle to following successful treatment in CML impairing the quality of life and sometimes endangering the lives of patients. To this end, we show this clinical case to discuss strategies to deal with rare AEs in a way to preserve the patient's life and to maintain not only a good response to treatment but also confidence and compliance of the patient. CASE REPORT: We report the case of a 57-year-old woman diagnosed with CML at the chronic phase who developed rare life-threatening hepatotoxicity (major cytolysis and prothrombin time fall) secondary to Nilotinib used as second-line treatment. This complication settled despite an optimal molecular response. MANAGEMENT AND OUTCOME: We discuss below the follow-up and management in our center and according to the literature with more sophisticated pharmacological methods. DISCUSSION: Although we used to monitor disease molecular response to treatment, we need solutions and manuscripts for monitoring drug dose parameters to avoid unusual dangerous effects risking the patient life. We conclude that monitoring the disease as well as the treatment pharmacokinetics is mandatory to better carry on CML patients.

[Epidemiological and chronological profile of the parturientes in the extreme ages in the monastir region between 1994 and 2003]. / Caracteristiques epidemiologiques et chronologiques des parturientes aux ages extremes dans la région de monastir entre 1994-2003.

BACKGROUND: Pregnancy outside 19 - 34 years interval is risk factors of the maternal and fetal morbidity and mortality. Tunisia, witch known an epidemiological transition, implanted the national program of perinatality since 1990 and one of its objectives is the surveillance of the high risk pregnancies. AIM: The aim of this study is to draw up the epidemiological profile of the parturient in extreme ages in the region of Monastir and to study the chronological tendencies of the associated factors during a decade (1994 - 2003). METHOD: In all, the study interest 13225 extreme ages parturient, representing 22.5% of all women admitted for delivery in the public maternities of the district. RESULTS: The means age was 18.6 ± 0.6 years for the parturient less than 20 years and 37 ± 2 years for the older than 35 years and more, among them 40% were older primipara. The prenatal care was inadequate for 35.4% of younger women and 47.6% of aged women. During the decade, we notice a significant decrease of the frequency of pregnancy for teenager parturient (from 3 in 1994 to 1.99% in 2003), and increase for the aged parturient (from 14.7 in 1994 to 17.7% in 2003) (p < 0.001). Adequate prenatal care increased and the frequency of parturient without any follow-up decreased (from 17.2 to 2%) (p < 0.001). CONCLUSION: Given to this demographic and social transition, our healthcare system is called for greater vigilance and a more rigorous application of the recommendations of the national program of perinatality.