[Drug fever among Swiss' most sold drugs in primary care]. / Fièvre médicamenteuse en médecine de premier recours liée aux médicaments les plus vendus en Suisse.

Drug fever is a little known side effect and should be considered as a differential diagnosis in the presence of fever. Its early recognition is important to avoid unnecessary investigations. Among the 70 most prescribed drugs in primary care in Switzerland, 8 have been linked to drug fever : amoxicillin, atorvastatin, rosuvastatin, esomeprazole, pantoprazole, rivaroxaban, salbutamol and trazodone. There are no specific criterias to distinguish a drug-induced fever. The diagnosis is confirmed with a positive rechallenge test. If a drug fever is suspected, it is recommended to stop the offending agent.

La fièvre d'origine médicamenteuse fait partie du diagnostic différentiel de toute fièvre et est un effet secondaire peu reconnu. Son évocation précoce est importante et permet d'éviter des examens secondaires inutiles. Parmi les 70 substances les plus vendues en ambulatoire en Suisse de 2008 à 2016, 8 médicaments peuvent provoquer de la fièvre : l'amoxicilline, l'atorvastatine, la rosuvastatine, l'esoméprazole, le pantoprazole, le rivaroxaban, le salbutamol et la trazodone. Il n'y a pas de critère défini de la fièvre médicamenteuse et aucun signe clinique ou valeur de laboratoire n'est spécifique à un état fébrile secondaire à un médicament. Seul un test de réexposition positif permet de confirmer définitivement le diagnostic. En cas de suspicion de fièvre médicamenteuse, l'arrêt immédiat de la substance est recommandé.

Blinded by Zika? A missed HIV diagnosis that resulted in optic neuropathy and blindness: a case report.

BACKGROUND: Typical symptoms of an acute human immunodeficiency virus (HIV) infections like fever and rash are not specific and can be caused by a multitude of other pathogens, such as Zika or rickettsiosis. Up to 30% of primary HIV infection do not present with the typical flu-like symptoms and thus represent a diagnostic challenge. In this report, we describe a rare case of optic neuropathy as the initial presentation of primary HIV infection, which resulted in irreversible blindness. To our knowledge, only four cases of optic neuropathy resulting from a recent HIV seroconversion have been reported. CASE PRESENTATION: In January 2015, a 72-year-old man presented with a rash, fever and diffuse myalgias after returning from a fortnight in Cuba. In the context of the current polemic, Zika was considered likely. A diagnostic work-up, including dengue fever and Zika, was negative. Symptoms resolved spontaneously. In March, the patient experienced a sudden loss of vision first on one, a few days later on the other eye. Magnetic resonance imaging showed optic nerve enhancement suggesting neuritis. Numerous infective causes were sought and the patient was diagnosed with HIV. Corticosteroids and antiretroviral therapy were initiated but vision did not improve. Four weeks later an optic atrophy developed. After more than a year of follow-up the patient remains blind. Stored serum from January revealed a detectable viremia with a negative Western blot assay, typical of acute HIV infection. CONCLUSIONS: Optic neuritis is a rare complication of early HIV infection. Only four others cases have been described, some of which recovered their vision after the administration of corticosteroids and/or ARV treatment. The balance between ischemic and neuroimmune processes may play a role in recovery. Delayed diagnosis, due to an unjustified focus on the Zika virus may have contributed to the tragic outcome.