La Revue de médecine interne
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Opsoclonus-myoclonus syndrome is a rare disorder. We report a 44-year-old patient with opsoclonus associated with a cerebellar syndrome revealing a small cell lung carcinoma. The treatment with chemotherapy initially improved the clinical symptoms but these eventually recurred. ⋯ When it is associated with other manifestations of the central nervous system (head myoclonus and ataxia), it constitutes a clinical picture known as opsoclonus-myoclonus syndrome. In adults, the most frequent causes are post-infectious, paraneoplastic and idiopathic. The symptomatic treatment is not defined, but the treatment of the underlying cause may improve the clinical features of this syndrome.
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We report a patient who presented a severe Panton-Valentine-secreting methicillin-susceptible Staphylococcus aureus pneumonia with threatening multi-organ failure including acute respiratory distress syndrome, cardiac failure, renal failure and disseminated intravascular coagulation. Clinical and biological disease course using empiric therapy with treatment directed against toxin production (linezolid, clindamycin and intravenous immunoglobulins) was found to be quickly effective.
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The incidence and morbimortality of immediate hypersensitivity reactions following iodinated contrast media (ICM) injection remain unknown. The diagnosis of an immediate hypersensitivity reaction relies on a triad associating the precise description of the initial clinical manifestations and their delay of onset, the results of the biological assessment performed after the reaction including histamine and tryptase serum level measurements, and the results of skin testing with the culprit agent. Analysis of these data allows identification of the pathophysiologic mechanism of the reaction and the allergen involved in case of allergic hypersensitivity. ⋯ Asthma and treatment with beta-blockers are not risk factors of immediate allergic reactions to ICM per se, but may increase their severity. The various published protocols of premedication do not prevent the occurrence of an allergic/anaphylactic reaction to an ICM. The avoidance of the culprit ICM is the only way to prevent further reactions.