[An unusual case of pulmonary infiltrates with hepatic involvement in a woman with eosinophilia]. / Un caso inusuale di infiltrati polmonari con interessamento epatico in una donna con eosinofilia.

The literature reports many cases of eosinophilic pulmonary infiltrations, with different etiology. In our case clinical pictures were not very clear and specific at first and the clinical course was altered by an ex adjuvantibus steroid treatment before admission to hospital. It was new and unusual because it presented some characteristics of chronic eosinophilic pneumonia and idiopathic hypereosinophilic syndrome, with hepatic involvement as in the former, but without serious heart disease as in the latter. This confirms the difficulties in making a classification of the different clinical pictures because of their indistinct margins, which might appear as different forms of a single disease. In our case the patient refused transbronchial lung biopsy which is commonly considered a minimum diagnostic requirement. Some authors are not in agreement and think it is sufficient to find eosinophils in BAL to start steroid treatment, avoiding biopsy risks. Another interesting finding is the need for a long-term low-dose steroid treatment, to avoid relapses.

Treatment of hemodialysis-related porphyria cutanea tarda with small repeated phlebotomies.

Phlebotomy is generally thought to be contraindicated in porphyria cutanea tarda (PTC) associated with hemodialysis for the anemia which is often present in uremic patients. We report a patient with a severe form of hemodialysis-related PTC and biochemical parameters suggestive of iron overload in whom treatment with small repeated phlebotomies was well tolerated without any significant worsening of the anemia and gave marked biochemical improvement and complete clinical remission.