[Acute eosinophilic pneumonia. Possible role of chloroquine]. / Pneumopathie éosinophilique aiguë: rôle possible de la chloroquine.

We report the case of a patient aged 49 who presented with a picture of an acute respiratory distress syndrome developing over several days after the preventative treatment of a burn using chloroquine (Nivaquine). The combination of clinical data, radiological and clinical as well as the broncho-alveolar lavage, enabled a diagnosis of acute eosinophilic pneumonia to be made according to Allen's criteria. The outcome after stopping the cloroquine and treating with corticosteroids was rapidly favourable and without any relapse. Based on this observation, we recall the characteristics of acute eosinophilic pneumonia as well as the causes which are currently established. Their potentially serious nature should encourage people to report similar cases to ours because even if we have not made identical observations to other cases. Chloroquine seems to us responsible for the clinical picture presented by our patient.

[Neoplastic pulmonary embolism. An uncommon cause of acute respiratory distress with normal pulmonary radiography]. / L'embolie pulmonaire néoplasique. Une cause inhabituelle de détresse respiratoire aiguë avec radiographie pulmonaire normale.

The incidence of neoplastic pulmonary embolism is certainly underestimated Necroscopy series report figures varying from 2.9 to 26. The clinical manifestations are similar to those observed in cruoric pulmonary embolism. We report two cases of acute respiratory failure with normal chest X-ray in which the diagnosis was neoplastic pulmonary embolism. The difficulties encountered for diagnosis resulted from the diffuse microvascular nature of the lesions. Perfusion scintigraphy and Swan-Ganz catheterism can be contributive, but certain diagnosis requires pathology examination. Prognosis is very poor. Clinicians should be aware of this pathology and entertain the diagnosis in all cor pulmonale patients with acute respiratory failure and a normal chest X-ray.

Neurologic complications in a group of 86 bacterial endocarditis.

Criteria defined by von Reyn were applied to 86 cases of bacterial endocarditis. Neurologic complications (NC) were categorized according to Pruitt definitions. Neurologic accidents were observed in 48 cases. They were the first clinical manifestation in 20 patients. Neurologic events were of poor prognosis in BE, mortality increasing from 26% in patients without NC to 83% in patients with NC (P less than 0.01). Two factors affect the incidence of NC: first, the location of endocarditis with 76% of NC in mitral valve endocarditis compared with 37% in other cases (P less than 0.005); and second the infecting organism: 71% of NC in staphylococcus aureus endocarditis versus 45% in endocarditis with other bacteria (P less than 0.02). Cerebral embolism was the most common NC (25 cases) related to an occlusion of the middle cerebral artery in 21 cases with a fatal outcome in 19 patients. Other NC included 15 intracranial hemorrhages with the evidence of an aneurysm in 4 cases, 6 septic meningitis, 2 macroscopic abscesses, and 2 multiple microscopic abscesses. This study emphasizes the high rate and severity of NC in staphylococcal mitral endocarditis despite antibiotic therapy and supports early surgery in this group of bacterial endocarditis.

[Shock during leptospirosis icterohaemorrhagica. Four cases (author's transl)]. / Etats de choc au cours des leptospiroses ictéro-hémorragiques. Quatre observations.

Four patients with leptospirosis icterohaemorrhagica (LH) were admitted to an intensive care unit in a state of shock. Haemodynamic studies showed that the shock was due to three different mechanisms which were often associated or successive in the same patient: (1) septic shock with fall of systemic vascular resistance (SVR) and no widening of arteriovenous oxygen difference (AVDO2); (2) cardiogenic shock, probably due in part to specific myocarditis, with reduced left ventricular work and normal or high pulmonary wedge pressure; and (3) hypovolaemic shock with the increased SVR and widened AVDO2. These data suggest that haemodynamic studies are required in patients with LIH associated with shock in order to determine its mechanism and provide guidelines for its treatment.

[Horseshoe kidney and hypertension (author's transl)]. / Rein en fer à cheval et hypertension artérielle.

The authors report a case of horseshoe kidney responsible for hypertension through a one-sided renal dysplasia. The part of the renal malformation in the development of the hypertension is attested by the activities of renin from renal veins, by the isotopic nephrogram and by the disappearance of the hypertension following the heminephrectomy. The hypertension seems an exceptionnal complication of the horseshoe kidney, which can be surprising given the frequency of this malformation and associated urologic anomalies.