Les Toxidermies Sévères à l’Hôpital de Référence de Talangaï à Brazzaville(Congo)

Résumé

RESUME Introduction. Les toxidermies severes sont des affections graves. L’objectif etait de determiner les formes cliniques et decrire le profil etiologique et evolutif des toxidermies severes admises dans un hopital de district a Brazzaville, au Congo. Patients et methodes. Il s’agissait d’une etude retrospective menee de juin 2015 a mai 2019 a l’hopital de reference de Talangai, incluant les patients hospitalises pour toxidermie severe repondant aux criteres de l’OMS et du RegiSCAR. Les donnees demographiques et cliniques ont ete recueillies et traitees avec Microsoft Excel 2016. Resultats. Dix huit patients ont ete inclus d’âge moyen 31,4 ans et sex ratio 1. Quatre etaient des enfants. Les antecedents de toxidermie etaient retrouves dans 6 cas. Il s’agissait de quatre cas de syndrome d’hypersensibilite medicamenteuse (SHM), huit cas de syndrome de Stevens-Johnson (SSJ), quatre cas de necrolyse epidermique toxique (NET) et deux cas de pustulose exanthematique aigue generalisee (PEAG). Cinq patients etaient seropositifs pour le VIH. Les sulfamides etaient responsables dans 12 cas, la nevirapine dans 3 cas, l'amoxicilline dans 2 cas et l'allopurinol dans un cas. La duree moyenne du sejour hospitalier etait de 14 jours. Les sequelles pigmentaires etaient constatees chez 14 patients et les complications ophtalmologiques chez 3 patients. Conclusion. Le SSJ/NET est la forme dominante de toxidermie severe. Les sulfamides, le plus souvent automediques, sont les principaux medicaments inducteurs. L’evolution est favorable en termes de mortalite. Des actions vivant la limitation de l’acces aux medicaments et l’adaptation des protocoles de traitement sont a mener. ABSTRACT Introduction. Severe adverse cutaneous reactions are life-threatening conditions resulting from the use of systemic medications. The objectives were to determine the clinical forms and describe the etiological and evolutionary profile of severe adverse cutaneous reactions (SCAR) admitted in a district hospital in Brazzaville, Congo. Patients and methods. This was a retrospective study conducted from June 2015 to May 2019 at the Talangai Reference Hospital, including inpatients with SCAR, meeting the WHO’s criteria and RegiSCAR criteria. Demographic and clinical data was collected and processed with Microsoft Excel 2016. Results. Eighteen patients were included, average age 31.4 years. Four were children. The sex ratio was 1. The history of cutaneous adverse reaction was found in 6 cases. These included four cases of drug-induced hypersensitivity syndrome (DHS), eight cases of Stevens-Johnson syndrome (SJS), four cases of toxic epidermal necrolysis (NET), and two cases of acute generalized exanthematous pustulosis (AGEP). Five patients were HIV positive. Sulfonamides were responsible in 12 cases, nevirapine in 3 cases, amoxicillin in 2 cases and allopurinol in 1 case. The mean inpatient stay was 14 days. Pigmentary sequelae were found in 14 patients and ophthalmological disorders were found in 3 patients. Conclusion. SSJ and NET are the dominant forms of SCAR. Sulfonamides, most often in self-medication, are the main causative drugs. The evolution is favorable as regards mortality. Actions living limiting access to drugs and adaptation of treatment protocols are to be conducted.

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