Pneumocystis pneumonia can complicate medical treatment of hypercortisolism even in outpatients with Cushing's disease.

Several cases of Pneumocystosis pneumonia (PCP) have been reported in patients with hypercortisolism, mainly in patients with severe ectopic ACTH syndrome (EAS). We report 2 cases of PCP that did not develop until after starting treatment with metyrapone, one of which occurred in an outpatient with Cushing's disease (CD) without pulmonary symptoms before medical treatment for CD. Patient 1 presented as an outpatient with CD and severe hypercortisolism but nonetheless in good general condition. Treatment with metyrapone was started before pituitary surgery. Patient 2 had EAS due to prostate cancer. Respiratory failure in the two patients occurred 4 days and 30 days, respectively, after the start of metyrapone treatment. In both cases, chest CT showed bilateral interstitial infiltrates, and Pneumocystis jirovecii was found on bronchoalveolar lavage (BAL). A literature review was performed to identify risk factors for PCP in patients with CD: we identified 20 other cases of PCP in patients treated for hypercortisolism, including 16 patients with EAS. Ninety percent of patients had free urinary cortisol greater than 6 times the upper limit of normal (ULN). In conclusion, onset of PCP after initiation of anticortisolic therapy is not limited to patients with EAS, and may occur in CD patients with elevated cortisol levels, even if the patient remains in good general condition and has no pulmonary symptoms before treatment. In such patients, routine prophylactic treatment with trimethoprim/sulfamethoxazole (TMP/SMX) should be considered.

[Dysthyroidism with anti-VEGF treatment, a class effect? about one case report]. / Dysthyroidie sous anti-VEGF, effet indésirable de classe ? à propos d'un cas.

Tyrosine-kinase inhibitors are recent therapy used in different neoplastic diseases. Dysthyroidism seems to be a class effect of these drugs with a potentially cross cumulative effect. We describe here the case of a man who first developed dysthyroidism with sunitinib, then a deep and permanent hypothyroidism when axitinib was introduced.

[Antidepressants and tamoxifen: an unrecognized interaction]. / Antidépresseurs et tamoxifène : une interaction méconnue.

The interaction between tamoxifen and antidepressants which are CYP2D6 inhibitors is unknown, as shown in our study in which these antidepressants are prescribed to 11% of women receiving tamoxifen.

[Not Available]. / Dysthyroidie sous anti-VEGF, effet indésirable de classe ? À propos d'un cas.

Tyrosine-kinase inhibitors are recent therapy used in different neoplastic diseases. Dysthyroidism seems to be a class effect of these drugs with a potentially cross cumulative effect. We describe here the case of a man who first developed dysthyroidism with sunitinib, then a deep and permanent hypothyroidism when axitinib was introduced.

[Mephedrone: a designer drug of recent use in France]. / La méphédrone : une designer drug d'usage récent en France.

Designer drugs are currently marketed as substitutes for stimulant drugs as cocaine, amphetamine, MDMA...Unlike compounds listed as narcotics, these new substances are deliberately synthesized to avoid anti-drug laws. Among them, mephedrone (4-methylmethcatinone) that belongs to cathinone family, has been recently introduced in France. Users report positive euphoric and entactogenic effects. They also describe negative effects such as increased dependence towards the drug itself and larger craving for tobacco and alcohol. The numerous and various described adverse effects include psychoactive, digestive, cardiovascular... effects. Some fatality cases have been reported in scientific literature or in press and attributed to mephedrone often in association with other substances. Mephedrone has been listed as narcotic in several European countries and more recently in France.

[Bisphosphonates-associated osteonecrosis of the jaw: review on reported cases]. / Les ostéonécroses de la mâchoire associées aux biphosphonates: synthèse bibliographique.

Osteonecrosis of the jaws associated with the use of bisphosphonates (alendronate, pamidronate, risedronate et zoledronate) are described as an avascular necrosis. We have listed 184 cases of bisphosphonates-associated osteonecrosis of the maxillary in the literature. Many mechanisms are discussed in bisphosphonates-associated osteonecrosis: a disturbing bone turnover, an accumulation of bone's microdamage or an antiangiogenic effect. Other risk factors seem however to be involved: cancer, chemotherapy, glucocorticoids, infection and renal insufficiency.

[Adverse effects of marijuana]. / Effets somatiques liés à la consommation de cannabis.

When admitted in an emergency unit, young patients often present acute neurological effects of smoked marijuana. Other chronic adverse effects of marijuana are probably underestimated: postural syncope, arteritis, chronic bronchitis, amnesia. Marijuana may trigger a myocardial infarction and have a vasospastic effect. Marijuana has impairing effects on driving ability. Smoked marijuana is a potential respiratory tract carcinogen.