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Mhammedi Alaoui O, Douqchi B, Bella I, Ghazi I, Benaini I, El Kadiri Boutchich I, Laaribi I, El Aidouni G, Bkiyar H, Bouziane M, Housni B. Severe Sepsis Secondary to Toxic Megacolon Revealing an Inflammatory Bowel Disease. Cureus 2024; 16:e51459. [PMID: 38298320 PMCID: PMC10829693 DOI: 10.7759/cureus.51459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/02/2024] Open
Abstract
Patients with inflammatory bowel disease can present with numerous infectious complications, including intra-abdominal abscess, perforations of the intestine, fistula formation, and the occurrence of septicemia. Toxic megacolon (TM) is a potentially fatal complication of inflammatory bowel disease (IBD) and is associated with high morbidity and mortality. In this case report, we report a 49-year-old male patient who was admitted to the intensive care unit for the management of severe sepsis that was secondary to an inaugural toxic megacolon complicating a silent inflammatory bowel disease, with a Lichtiger score of 11. Nonresponse to anti-bacterial therapy, noradrenaline, and intravenous corticosteroid therapy required an emergency total colectomy. After surgery, the patient died because of his unresolved septic shock. Correct management of this condition requires an accurate assessment of the patient's history, a correct physical examination, abdominal radiographs, and sigmoid coloscopy, and frequently requires surgery. The indications for surgery in cases of toxic megacolon, massive hemorrhage, perforation, peritonitis, or non-response to medical therapy are the most important ones. Patients with a history of inflammatory bowel disease are particularly prone to infectious complications since therapy for these inflammatory diseases is based on the use of immunosuppressive drugs and frequent abdominal surgeries.
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Affiliation(s)
- Omar Mhammedi Alaoui
- Intensive Care Unit, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, MAR
- Intensive Care Unit, Mohammed VI University Hospital, Oujda, MAR
| | - Badie Douqchi
- Intensive Care Unit, Mohammed First University, Oujda, MAR
- Intensive Care Unit, Mohammed VI University Hospital, Oujda, MAR
| | - Islam Bella
- Intensive Care Unit, Mohammed VI University Hospital, Oujda, MAR
- Intensive Care Unit, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, MAR
| | - Imane Ghazi
- Intensive Care Unit, Mohammed VI University Hospital, Oujda, MAR
- Intensive Care Unit, Mohammed First University, Oujda, MAR
| | - Ilias Benaini
- Intensive Care Unit, Mohammed VI University Hospital, Oujda, MAR
- Intensive Care Unit, Mohammed First University, Oujda, MAR
| | - Ilias El Kadiri Boutchich
- Intensive Care Unit, Mohammed VI University Hospital, Oujda, MAR
- Intensive Care Unit, Mohammed First University, Oujda, MAR
| | - Ilyass Laaribi
- Intensive Care Unit, Mohammed VI University Hospital, Oujda, MAR
| | | | - Houssam Bkiyar
- Anesthesiology - Critical Care Unit, Mohammed VI University Hospital, Oujda, MAR
| | | | - Brahim Housni
- Intensive Care and Anesthesiology, Mohammed VI University Hospital, Oujda, MAR
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El Aissaouy M, Douqchi B, El Aidouni G, Bkiyar H, Housni B. Chemotherapy-Induced Leukoencephalopathy Revealed by Seizure and Alteration of the Mental Status. Cureus 2023; 15:e39364. [PMID: 37362474 PMCID: PMC10285338 DOI: 10.7759/cureus.39364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Leukoencephalopathy is progressive demyelination of the white matter, induced by a variety of factors. Among the causes of leukoencephalopathy, chemotherapy is an uncommon cause that generates potentially reversible lesions. The clinical presentation is classically made of alterations in mental status, hallucinations, hypertension, seizures, and acute visual changes. Imaging plays an important role in the diagnosis of this entity, especially by conventional and diffusion-weighted magnetic resonance imaging which enables an accurate diagnosis by identifying symmetric white matter lesions, especially in the parietal and occipital lobes. Herein, we report a 54-year-old female patient, newly diagnosed with non-metastatic moderately differentiated adenocarcinoma of the cecum. The patient received her first cancer chemotherapy (5-fluorouracil at 300 mg/m2). Five days later she was admitted to the intensive care unit for confusion following two generalized seizures. Conventional and diffusion-weighted magnetic resonance imaging was performed and showed diffuse white matter lesions of the parietal and occipital lobes. A diagnosis of 5-fluorouracil-induced leukoencephalopathy was established. The diagnosis of leukoencephalopathy should be considered in patients receiving cancer chemotherapy with alterations in mental status and seizures.
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Affiliation(s)
- Mohammed El Aissaouy
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, MAR
- Anesthesiology, Mohammed I University, Oujda, MAR
| | - Badie Douqchi
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, MAR
- Intensive Care Unit, Mohammed I University, Oujda, MAR
| | | | - Houssam Bkiyar
- Anesthesiology/Critical Care Unit, Mohammed VI University Hospital Center, Oujda, MAR
| | - Brahim Housni
- Anesthesiology/Critical Care Unit, Mohammed VI University Hospital Center, Oujda, MAR
- Intensive Care Unit/Anesthesiology, Mohammed I University, Oujda, MAR
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Berrichi S, Bouayed Z, Berrajaa S, Bahouh C, Oulalite AM, Douqchi B, Bella I, Bkiyar H, Housni B. Acute Disseminated Encephalomyelitis: A rare form of COVID-19's neurotropism. Ann Med Surg (Lond) 2021; 71:102940. [PMID: 34659750 PMCID: PMC8504072 DOI: 10.1016/j.amsu.2021.102940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/09/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction the COVID-19 pandemic still accounts for thousands of cases every day. It's neurological involvement has been well documented most likely due to auto-immune mechanisms than the virus itself. Case report we report the case of a 38 years old women who developed an Acute Disseminated Encephalomyelitis following a COVID-19 infection, with a favorable outcome after immunosuppressive therapy. Discussion In this chapter, we discuss ADEM's pathogenesis as well as its clinical and radiological features before detailing its relationship with infectious and vaccination episodes. We also discuss how our patient disease evolved. Conclusion Acute Disseminated Encephalomyelitis is an immune-mediated disorder in which the widespread inflammation of the brain and spinal cord is responsible for a variety of symptoms. The novel COVID-19 virus and its vaccine are both a newly incriminated etiologies of this demyelinating disorder. COVID-19 neurotropism has been well established and its neurological manifestations are varied. Demyelinating disorders are immune-induced disease most likely due to an antigenic analogy between the virus and myelin constituents. COVID-19 induced ADEM is extremely rare, only a dozen cases have been reported worldwide, and ours is the only case reported in our country.
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Affiliation(s)
- Samia Berrichi
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
- Corresponding author. Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco.
| | - Zakaria Bouayed
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
- Corresponding author. Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco.
| | - Sara Berrajaa
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Choukri Bahouh
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Amine Mohammed Oulalite
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Badie Douqchi
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Islam Bella
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Houssam Bkiyar
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Brahim Housni
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
- Simulation Center, Faculty of Medicine and Pharmacy, Oujda, Morocco
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