Rheumatoid arthritis-associated lung disease in black Africans: Descriptive study of 28 cases in Lomé.

BACKGROUND: Several studies have shown that lung disease is a common extra-articular manifestation of rheumatoid arthritis (RA). OBJECTIVES: To describe the lung manifestations in the RA population in Lomé, Togo. METHODS: The study was conducted from October 2018 to July 2019 at the pulmonology unit of the Sylvanus Olympio University teaching hospital, in collaboration with rheumatology centres in Lomé, Togo. Patients meeting the American College of Rheumatology criteria for RA were prospectively enrolled. They underwent clinical examination, spirometry, a 6-minute walk test (6MWT) and a chest X-ray (CXR). All information collected and surveys gathered were subjected to statistical analysis. RESULTS: Twenty-four out of 28 patients were women (85.7%). The mean (standard deviation (SD)) duration of illness was 4.1 (2.8) years. Thirteen patients out of 28 (46.4%) had respiratory symptoms. On CXR, interstitial lung disease was the only pleuropulmonary lesion (17.8%). Spirometry was abnormal in 25% of cases, with a predominance of restrictive ventilatory disorder (21.4%). The 6MWT was abnormal in 25% of patients. A total of 20 patients (71.4%) had at least one lung manifestation. We noted that there were significantly more patients with respiratory symptoms and no radiographical abnormalities than those with both respiratory symptoms and radiographical abnormalities (p=0.013). CONCLUSION: Lung changes affect a significant proportion of RA patients in Lomé. Studies conducted with appropriate respiratory investigations and combining cardiovascular explorations will bring us closer to an understanding of the effects of RA-associated lung disease.

[A case of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) syndrome]. / Un cas clinique de syndrome d'hyperplasie neuroendocrine pulmonaire diffuse idiopathique (DIPNECH).

INTRODUCTION: DIPNECH is a strictly histological entity according to the WHO 2015 classification and is considered to be at pre-neoplastic risk. It has been proposed that DIPNECH syndrome should be used to describe patients have clinical symptoms, an obstructive ventilatory disorder and compatible radiological abnormalities. The diagnosis is histological and usually based on a surgical lung biopsy. CASE REPORT: We report the case of a 58-year-old woman with a chronic cough for over 20years who had an obstructive airway pattern on spirometry. Diagnoses of asthma and COPD had been discussed. After 7years of follow-up, the DIPNECH hypothesis was evoked on the scanning aspect of mosaic attenuation, expiratory trapping and micronodules, which was subsequently confirmed by surgical pulmonary biopsy. CONCLUSION: It is necessary to consider the possibility of this rare disease in order to avoid inappropriate treatments and in the hope that future therapeutic advances (somatostatin analogs, mTOR inhibitors) improve patients' experience and the progression of respiratory function.

[Becoming new pulmonary tuberculosis patients with sputum smear-positive at the end of second month of anti tubercular treatment in Lome]. / Devenir des nouveaux patients tuberculeux pulmonaires a bacilloscopie positive a la fin du deuxieme mois de traitement antituberculeux a Lome.

AIMS: To determine the frequency of the new smear-positive pulmonary tuberculosis patients at the end of the second month of anti-tuberculosis treatment and to analyze the outcomes of their treatment. PATIENTS AND METHOD: It was a retrospective comparative study from January 2006 to June 2008, based on the analysis of the records and treatment cards from the diagnosis and treatment centers of Lome. New sputum smear-positive tuberculosis patients at the end of the second month (smear positive 2 months) constituted the study population. A comparison group consisted of the new tuberculosis patients with sputum smear-negative at the end of the second month (negative smear 2 months). RESULTS: The proportion of sputum smear-positive at 2 months was 5.34% (163/3050). Cure and failure rates were respectively 69.3% and 17.2% for smear-positive 2 months versus 79.1% and 3.7% for control group. The death rate was similar in both groups (3% and 3.7%). CONCLUSION: The smear positive 2 month's patients have a high risk of failure and must receive special attention during their follow-up to improve the results of treatment.

BUT: Déterminer la fréquence des nouveaux patients tuberculeux pulmonaire à bacilloscopie positive à la fin du 2ème mois de traitement antituberculeux et analyser les résultats de leur traitement. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective comparative de janvier 2006 à juin 2008, basée sur l'analyse des registres et les cartes de traitement de tuberculose des centres de diagnostic et de traitement de Lomé. Les nouveaux patients tuberculeux à bacilloscopie positive à la fin du deuxième mois (frottis mois 2 positif) constituaient la population de l'étude. Un groupe de comparaison était constitué avec les nouveaux patients tuberculeux à bacilloscopie négatif à la fin du deuxième mois (frottis mois 2 négatif). RÉSULTATS: La proportion des frottis mois 2 positif était de 5,34 % (163/3050). Les taux de guérison et d'échec étaient respectivement de 69,3% et de 17,2% chez les frottis 2 positif contre 79,1% et 3,7 % chez les frottis 2 négatif. Le taux de décès était similaire dans les deux groupes (respectivement 3% et 3,7%). CONCLUSION: Les patients à frottis 2 positif ont un risque élevé d'échec et doivent bénéficier d'une attention particulière au cours de leur suivi afin améliorer les résultats de leur traitement.