[Tuberculosis, mycobacterium infection and hairy cell leukemia]. / Tuberculose, infection à mycobactéries et leucémie à tricholeucocytes.

OBJECTIVES: Diagnosis of tuberculosis and/or mycobacteria infection is particularly difficult in immunocompromised patients. PATIENTS AND METHODS: We examined the clinical presentation, means of diagnosis, treatment and outcome of tuberculosis in a retrospective study of 6 patients among 75 with hairy cell leukemia diagnosed from 1982 to 1995. RESULTS: Hearlding symptoms of tuberculosis diagnosis were: fever (6/6), weight loss (4/6), pleural effusion (1/6), superficial adenopathy (1/6), persistence of cytopenia or splenomegaly during the treatment of hairy cell leukemia. Pulmonary symptoms were present in only two cases. Diagnosis was obtained by positive culture of mycobacteria in 2 cases (Mycobacterium tuberculosis in pleural effusion, Mycobacterium kansaii in adenopathy). Microbiological diagnosis was never obtained from sputum (6/6). Diagnosis was obtained by histopathology in all cases: from bone marrow (2 cases), lymph nodes (2 cases), liver (1 case), spleen (1 case), umbilical fat (1 case). Tuberculosis was disseminated in all cases. By clinical, biological, microbiological histopathological means and response to treatment, tuberculosis was considered as: hematopoietic in all cases, hepatic (in 4/6), pleural (1/6), pulmonary (1/6). A favorable outcome of tuberculosis was observed in all cases. No death was observed. CONCLUSIONS: Tuberculosis was found in 8% of hair cell leukemia patients. In hairy cell leukemia, tuberculosis is characterized by few pulmonary symptoms and scarse microbiological documentation. In contrast, histopathology is very interesting to confirm diagnosis. Tuberculosis is in most cases disseminated and in particular hematopoietic diffusions is always present. In spite of existensive localization, the prognosis remains excellent and all patients can be cured. In our opinion, this good prognosis may be linked to the improvement of hairy cell leukemia treatment observed since the advent of interferon pentostatin and 2cdA.

[Bilateral Torulopsis glabrata pneumonia]. / Pneumopathie bilatérale à Torulopsis glabrata.

In a 48-year old male patient hospitalized for evaluation of fatigue with non-productive cough and dyspnoea, standard radiography and computerized tomography of the chest showed nodular opacities in both lung apices. Examination of intrabronchial specimens revealed mycelial filaments, and Torulopsis glabrata grew in culture. Under antifungal treatment the clinical signs rapidly improved and the radiological abnormalities disappeared more slowly, which confirmed the diagnosis of T. glabrata pneumonia. The authors recall the pathogenic role of this yeast-like fungus, closely related to Candida albicans, which mainly causes severe opportunistic infections. The diagnostic criteria, the part played by immunodepression in the disease and the therapeutic problems encountered are also discussed.