Psychotic depression is a high-risk clinical entity associated with increased morbidity, mortality, and suicide risk, yet it remains frequently underdiagnosed. We report the case of a patient hospitalized for a depressive episode that evolved into psychotic symptoms and a catatonic episode in the context of vitamin B12 deficiency without anemia. This case highlights the difficulty of differentiating psychotic depression from neuropsychiatric manifestations related to cobalamin deficiency, which may mimic, trigger, or exacerbate depressive, psychotic, and catatonic symptoms. Diagnostic investigations revealed vitamin B12 malabsorption associated with neurological involvement. Combined treatment with vitamin B12 supplementation and antidepressant-antipsychotic therapy led to clinical improvement. This vignette underscores the importance of targeted screening for vitamin B12 deficiency in atypical, treatment-resistant, or neurologically associated psychiatric presentations.

Chronic low back pain is one of the leading causes of disability worldwide and generates substantial socioeconomic costs. In Belgium, a specific reimbursement framework allows hospitals to offer multidisciplinary rehabilitation programs consisting of 36 sessions. The aim of this study is to compare the structure and content of the programs offered in French-speaking Belgian centers and to assess the degree of heterogeneity among these programs. A descriptive cross-sectional study was conducted using semi-structured interviews with the centers. Of the 37 centers contacted, 31 participated (83.8 %). Despite the presence of common components, significant variability was observed in the organization of the programs, particularly regarding session assessment, the number of hours devoted to education and physical reconditioning, and the content of the sessions. These results highlight the need for greater harmonization of practices in order to optimize patient care and facilitate multicenter research.

Mitochondrial diseases can lead to highly heterogeneous clinical manifestations, including optic neuropathies, the prototypical form of which is Leber's hereditary optic neuropathy. We report the case of a 47-year-old man carrying a mitochondrial DNA mutation (m.13513G>A in the MT-ND5 gene), who, after exclusion of differential diagnoses, including Leber's hereditary optic neuropathy, presented with unilateral non-arteritic anterior ischemic optic neuropathy in the absence of cardiovascular risk factors. In this context, the hypothesis of a pathophysiological link between mitochondrial cytopathy and ischemia of the optic nerve head is discussed. Indeed, mitochondrial angiopathy, known to be associated with certain mitochondrial diseases, could represent a contributory mechanism through the microcirculatory disturbances it induces. This case suggests that certain mitochondrial mutations may represent an independent vascular risk factor and highlights the importance of considering a mitochondrial etiology in cases of atypical ischemic optic neuropathy, particularly in young patients without cardiovascular risk factors.

This article reports two pediatric cases of anaphylaxis to the M-M-RVaxPro® vaccine, attributable to porcine gelatin used as a stabilizer (14.5 mg/dose). Both patients developed severe reactions after the booster dose, with positive skin and blood tests for gelatin. The first case had hereditary alpha-tryptasemia as an aggravating factor. Investigations ruled out the responsibility of neomycin, latex, and chlorhexidine. Key recommendations include avoidance of gelatin-containing vaccines and medications, substitution with gelatin-free alternatives (Priorix®), evaluation of food tolerance through an oral challenge test, and provision of an emergency kit with epinephrine. Hospital monitoring is recommended for future vaccinations in patients with mast cell disorders. The study highlights gelatin as the primary culprit in vaccine anaphylaxis, emphasizing the importance of systematic testing for vaccine components and proper management of sensitized patients.

Virtual reality hypnosis (VRH) is a promising tool for managing pain and anxiety during medical procedures. This study evaluated the feasibility of using VRH instead of intravenous sedation (IVS) for implanting a Port-a-cath® (PAC) under local anesthesia in oncology patients. Methods : twenty adults were randomly assigned to receive either IVS (n = 10) or VRH (n = 10) during the procedure. The primary outcome was the successful implantation of the PAC, while secondary outcomes included the need for rescue medication, procedure duration and levels of anxiety. PAC implantation was successful in all patients, with no significant differences in perceived or actual procedure duration between groups. All IVS patients required sedation without rescue medication, while only one patient in the VRH group requested rescue medication. There was no significant difference in procedural anxiety reduction between the two groups and no post-operative complications were reported. VRH is a feasible and safe alternative to IVS for PAC placement under local anesthesia in oncology patients. This innovative tool may become essential in clinical practice by avoiding the potential side effects associated with pharmacological sedation while ensuring a similar patient experience.

Type 1 diabetes (T1D) is an autoimmune disease characterized by the destruction of pancreatic β-cells, leading to lifelong insulin dependence. Although significant advances have been made in insulin therapy and glucose monitoring, these approaches are implemented at a late stage of the disease, when β-cell destruction is already well underway. Recent advances in the understanding of its pathophysiology have highlighted the complexity of interactions between genetic, environmental, and immunological factors, as well as the existence of distinct endotypes that may influence disease progression. These developments have paved the way for innovative therapeutic strategies aimed at modulating the immune response at early stages of the disease to preserve residual β-cell function. Maintaining endogenous insulin secretion may help delay disease progression and improve clinical outcomes. These new approaches mark a paradigm shift in the management of type 1 diabetes, moving from a purely substitutive strategy toward a preventive and disease-modifying approach.

Locoregional anesthesia (LRA) techniques play an important role in the perioperative management of patients, providing benefits in terms of analgesia and postoperative recovery. Their main risk is hematoma, which is rare but potentially devastating, particularly during neuraxial techniques and deep peripheral nerve blocks. In patients receiving antithrombotic medications, this risk is higher. Recent recommendations on the management of these antithrombotic agents in the context of LRA distinguish between superficial blocks, which are at low risk, and deep or neuraxial blocks, for which drug-induced coagulopathies require appropriate interruption of treatment. This narrative review describes the preoperative discontinuation times of antithrombotic medications in patients coming from home, before neuraxial or deep peripheral LRA. These delays vary depending on the molecules, their dose, as well as the age, weight and renal function of patients. The different classes of antithrombotic medications and medicinal plants are considered. Possible antidotes will be discussed but have no indication to authorize an elective LRA. In the absence of absolute consensus, the discontinuation of antithrombotic medications before an LRA must be individualized, according to the type of surgery, block, treatment, age and comorbidities. The risk/benefit ratio guides the decision.

Congenitally corrected transposition of the great arteries (ccTGA) represents a complex anomaly of cardiac embryogenesis, posing significant challenges in both diagnosis and management within congenital cardiology. This review examines the latest literature in ccTGA, spanning from embryological origins to contemporary treatment strategies. Through an analysis of recent literature, the pathophysiological mechanisms underlying ccTGA, including the associated anomalies and their implications for patient prognosis are analysed. Furthermore, diagnostic modalities are discussed, emphasizing advanced imaging techniques. Importantly, this review synthesizes recent evidence on therapeutic interventions, highlighting the evolving landscape of surgical and interventional approaches tailored to individual patient needs.

In Europe, cases of deliberate pesticide poisoning are rare and account for only a small percentage (around 4 %) of total suicides. This ratio differs greatly from that in developing countries. Agricultural populations and rural residents are more vulnerable. Symptoms vary depending on the type of pesticides and the route of administration, ranging from mild irritation to serious and potentially fatal neurological consequences. This article discusses the case of a 60-year-old man who administered Cycocel®, a growth regulator used in agriculture, intramuscularly. This poisoning induces a cholinergic crisis via direct action on nicotinic and muscarinic receptors but does not result in inhibition of cholinesterase activity, unlike organophosphate poisoning.

Severe asthma refers to uncontrolled asthma despite optimal inhaled treatment combining high-dose inhaled corticosteroids and a long-acting β2 agonist. This condition is characterized by significant clinical and pathophysiological heterogeneity, particularly in terms of inflammation. Understanding the role of type 2 inflammation ("T2-high") has led to the development of biologic therapies targeting cytokines or their receptors, such as interleukin 5 (IL-5), IL-4/IL-13, thymic stromal lymphopoietin (TSLP) and immunoglobulin E (IgE), the impact of which varies depending on the asthma phenotype. Phenotyping is based on the identification of biomarkers such as fractional exhaled nitric oxide, blood eosinophilia and serum IgE levels. Biotherapies have demonstrated a significant reduction in exacerbations, as well as improved symptom control and quality of life. Six molecules are available on the market. The choice of treatment is based primarily on the biomarker profile and associated comorbidities.

A 27-year-old woman presented with right proximal pulmonary embolism associated with thrombosis of the right inferior pulmonary vein extending into the left atrium as an atrial mass. The etiological work-up revealed a BCOR-rearranged endometrial stromal sarcoma. Clinical evolution was favorable under anticoagulation, except for the atrial lesion, whose thrombotic or tumoral nature could not be definitively established despite multimodality imaging. This clinical case highlights the limitations of noninvasive characterization of intracardiac masses in an oncologic setting and their impact on therapeutic decision-making.

This issue of the Revue Médicale de Liège brings together diverse contributions reflecting the reality of clinical practice, from rare conditions and emergencies to chronic diseases and organizational innovations. Beyond this diversity, a common thread emerges: the need for rigorous assessment and individualized care, integrating scientific evidence, clinical experience and patient expectations.

Breast cancer is often treated with tamoxifen, a drug that can cause ocular side effects, including toxic retinopathy. Multimodal imaging, particularly optical coherence tomography (OCT), has improved the detection of early lesions such as foveal pseudocysts, thus increasing the prevalence of this complication. We present a case of tamoxifen-induced retinopathy in a patient treated for four years who developed decreased visual acuity with irreversible retinal lesions in the right eye despite discontinuation of the treatment. OCT was essential in characterizing the lesions. The pathophysiology remains poorly understood, but involvement of Müller cells and glutamate accumulation in the retinal pigment epithelium are suspected. Toxicity depends on cumulative dose, duration of treatment, and individual factors. Initial ophthalmologic screening and regular OCT monitoring are recommended to detect retinal damage early. In case of lesions, substitution with an aromatase inhibitor is often considered to limit lesion progression and preserve vision.

Poisoning with Taxus baccata (common yew) is a life-threatening emergency due to its major cardiotoxicity. The taxines it contains block cardiac sodium channels, rapidly leading to severe arrhythmias, cardiogenic shock, and often cardiac arrest. Management is exclusively symptomatic and relies on intensive hemodynamic support, including advanced resuscitation and, in some cases, the use of extracorporeal circulatory support (ECMO). The administration of antidotes such as DigiFab®, although experimental and not formally validated for this indication, may be considered based on pharmacological analogies with digoxin.

Total hip arthroplasty (THA) is the standard treatment for osteoarthritis of the hip, aseptic osteonecrosis of the femoral head and specific hip fracture. Adverse tissue reactions to metal debris are feared in total hip replacements using the metal-on-metal bearing surfaces. They can result in local and systemic toxicity or local hypersensitivity to metal. Additional investigations, including blood tests, radiography and nuclear magnetic resonance imaging (RMN), are essential to establish the diagnosis. Surgical revision of the prosthesis or the friction torque could be necessary.