[Idiopathic pulmonary fibrosis and right-to left shunt by patent foramen ovale]. / Fibrose pulmonaire idiopathique et shunt droit-gauche par foramen ovale perméable: amélioration clinique et gazométrique après fermeture percutanée.

INTRODUCTION: The association between idiopathic pulmonary fibrosis and patent foramen ovale has rarely been described. OBSERVATION: We report the cases of two patients, 72 and 59 years old, who presented with refractory hypoxemia in the context of pulmonary fibrosis. The hypoxemia was due to a right-to-left shunt through a patent foramen ovale (PFO), diagnosed by transoesophageal contrast echocardiography. The closure of the PFO allowed a decrease in the oxygen requirement in the first case: from 8 l/min to 3 l/min (PaO2 80 mmHg), and in the second case oxygen therapy could be stopped (PaO2 76 mmHg on room air). Right-to left shunts by PFO are usually associated with pulmonary arterial hypertension (systolic pulmonary arterial pressure at 70 mmHg for case 1), but in some cases the pulmonary artery pressure is normal (case 2), the shunt being due to an anatomical conformation. CONCLUSION: These two cases underline the importance of diagnosing right-to-left shunts in patients who have pulmonary fibrosis with severe hypoxemia, in order to reduce their oxygen needs.

[Severe varicella zoster pneumonia during the course of treatment with azathioprine for Crohn's disease]. / Pneumopathie varicelleuse sévère au cours d'un traitement par azathioprine pour une maladie de Cröhn.

INTRODUCTION: Disseminated varicella zoster infection has only rarely been reported in patients with inflammatory bowel disease, despite the frequent use of azathioprine for this disorder. CASE REPORT: We report the case of an 18-year-old woman who developed severe varicella zoster pneumonia 9 months after starting azathioprine for Crohn's disease. The patient recovered after prompt treatment with acyclovir and discontinuation of the azathioprine. CONCLUSIONS: Strategies concerning the treatment and the prevention of varicella infection in the immunocompromised patient are discussed.

Pleuropulmonary changes induced by ergoline drugs.

Classic ergolines, such as bromocriptine, methysergide and ergotamine, can induce chronic pleuropneumonitis. We present the cases of eight patients who developed similar changes whilst on other ergolines. In this retrospective case study spanning 1985-1995, clinical data, radiological material, pulmonary function, bronchoalveolar lavage and histopathology were reviewed. Earlier literature on ergoline-induced pleuropulmonary changes was reviewed. Eight middle-aged to elderly individuals of both sexes developed pleuropulmonary changes during long-term therapy with regular dosages of nicergoline (n = 4), dihydroergocristine (n = 3), or dihydroergotamine (n = 1). Bibasilar pleural thickening with or without pleural effusion was present on chest radiographs and computed tomographic (CT) scans in six cases. Increased erythrocyte sedimentation rate was seen in most. Pure interstitial pneumonitis developed in two patients on dihydroergocristine and was reversible in each. Bronchoalveolar lavage was performed in four cases and was abnormal in all, but demonstrated no consistent pattern. Most patients exhibited lung restriction. The outcome was favourable showing slow improvement in all cases following discontinuation of the ergoline. Slight residual pleural thickening was seen in five out of the six cases with pleural involvement. Nicergoline and dihydroergotamine can induce a syndrome of chronic pleural thickening/effusion that slowly improves after drug withdrawal. Dihydroergocristine can induce reversible interstitial pneumonitis.