[Extended pulmonary tuberculosis and immunocompetence: causes and consequences]. / La tuberculose étendue de l'mmunocompétent: causes et consequences.

BACKGROUND: Despite scientific advances, extended forms of pulmonary tuberculosis are still relevant. The aim of our study was to determine clinical features and outcome of extended pulmonary tuberculosis in immunocompetent patients. METHODS: Retrospective comparative study including 100 patients HIV negative, presenting pulmonary tuberculosis divided into 2 groups of 50 patients (group1: extended tuberculosis and group2: localized tuberculosis). Tuberculosis was considered extended when reaching above one lobe. RESULTS: The average age was comparable in the 2 groups (p = 0.138). In group1, we noted a higher incidence of diabetes (p = 0.037) and malnutrition (p = 0.045). Clinically, patients in group1 had more general signs (p=0.033) and dyspnoea (p=0.037). Biologically, anemia (p<0.001), leukocytosis (p=0.05), elevated CRP (p=0.031), thrombocytosis (p=0.023), hyponatremia (p = 0.001) and liver disturbances (p = 0.001) were significantly more frequent in group1. Concerning the evolution, time to smear negativity was significantly longer (p=0.012). Similarly, radiological sequelae were more frequent (p = 0.02) and more extensive (p = 0.012). Positive predictive value of radiological extent in disease evolution was 62% with a confidence interval between 47.2% and 75%. CONCLUSIONS: The extent of pulmonary tuberculosis is an important factor in clinical and biological presentation and disease evolution. Indeed, patients with extended tuberculosis develop more severe presentation and are more likely to develop parenchymal sequelae.

Castleman's disease: an intrapulmonary form with intrafissural development.

Castleman's disease (CD) is an uncommon, mainly benign, lymphoproliferative disorder of unknown etiology, mostly involving the mediastinum. Parenchymal lung involvement of the disease is exceedingly rare. We describe a case of CD in a 23-year-old woman with a 4-year history of recurring dyspnea and nonproductive cough, whose chest X-ray showed an abnormal shadow of the right hilum. Chest computed tomography confirmed the presence of a tissue-density mass of the right lower lobe, demonstrating poor contrast enhancement, associated with multiple laterotracheal and mediastinal lymphadenopathies. The patient underwent curative surgery, revealing a right hilar compressive mass, with an intrafissural development between the superior and middle lobes. Pneumonectomy was performed due to profuse bleeding. This case of CD is particular because of its unusual intrapulmonary location and its intrafissural development. Poor contrast enhancement is atypical in CD.

Pulmonary blastomycosis: a case from Africa.

Pulmonary blastomycosis is an uncommon pathologic condition that is quite rare in Africa compared to endemic regions of Canada and the upper Midwest of the U.S. We describe a 45-year-old patient who complained of productive cough, hemoptysis, and dorsal rachiodynia. Chest imaging revealed a necrotic tissue-density pulmonary mass involving both the upper and lower right lobes. Chest MRI showed signal abnormality of the third thoracic vertebral body and the greater trochanter, consistent with metastatic lesions. Clinical and radiological findings were strongly suggestive of lung cancer. Diagnosis of pulmonary blastomycosis was made by visualization of yeast in bronchial biopsies and further confirmed by culture of bronchoalveolar lavage specimens. The patient was treated with itraconazole and his clinical condition improved markedly. Pulmonary blastomycosis is unusual in Africa and that fact caused a considerable delay in diagnosis. We suggest that this disease may be more common in Africa than has been previously suspected.

Synchronous mantle cell lymph node lymphoma and pulmonary adenocarcinoma: a case report with literature review.

BACKGROUND AND AIMS: Coexistence of mantle cell lymphoma and lung adenocarcinoma is extremely rare. The aim of this study is to present the first case of incidental discovery of primary lung adenocarcinoma associated to lymph node mantle cell lymphoma. METHODS: A 45 year-old man, admitted for inguinal mass appeared since three months. Physical examination showed a 1 cm axillary and 3 cm inguinal adenopathies which were hard and fixed. A biopsy of inguinal mass revealed mantle cell lymphoma. Assessment of disease extension found a right superior lobe tumor with mediastinal lymphadenopathies. Fibreoptic bronchoscopy was normal. A fine needle biopsy of lung tumor was performed to determinate the nature of the pulmonary lesion. Histopathological findings were consistent with primary poor differentiated pulmonary adenocarcinoma with TTF-1 expression. A first mediastinoscopy was realized to verify mediastinal lymphadenopathies; frozen section showed a mantle cell lymphoma. A right lobectomy was then performed confirming the diagnosis of lung adenocarcinoma. Then, the patient was treated for the mantle cell lymphoma by 6 cures of alternating RCHOP and RDHAP (dexamethasone, high-dose Ara-Cytarabine and cisplatin) regimens followed by autologous stem cell transplantation. RESULTS: The patient died because of treatment complications 3 years after diagnosis. CONCLUSION: Progresses are necessary to understand the pathogenesis of of synchronous occurrence of both diseases.

[Pulmonary tuberculosis in smokers]. / Particularités de la tuberculose pulmonaire chez le tabagique.

INTRODUCTION: Tobacco smoking and tuberculosis (TB) are two major public health problems, and the former may affect the morbidity and mortality rates for the latter. This study sought to compare the clinical and radiologic aspects of pulmonary TB, as well as outcome, in smokers and nonsmokers. METHODS: This retrospective case control study examined the files of 90 patients in our pulmonary department with active pulmonary TB, 45 of them smokers and 45, nonsmokers. To analyze the seriousness of the radiologic lesions, we used a score based on the International Labour Organization classification for simple pneumoconiosis, rating lesions in 4 grades according to severity and extent. RESULTS: The mean age of the patients, all men, was 29 years (range: 16-50 years). Symptoms were similar in both groups, with no significant clinical or bacteriological differences between the two groups. However, the highest severity score was found in 81% of the smoking group compared with 15% of the nonsmokers (p<0.001). Moreover, after patients were cured, only smokers had severe radiological sequelae (13.8% versus 0%, p<0.05). CONCLUSION: Our study is one of the few to compare the radiological appearance of TB in smoking and nonsmoking patients. Smoking is associated with much more extensive and severe radiological TB lesions and sequelae and increases the risk of morbidity and mortality in TB patients. Therefore smoking prevention and cessation should be a priority in TB prevention programs.

Tuberculosis due to resistant Haarlem strain, Tunisia.

Multidrug-resistant tuberculosis was diagnosed in 21 HIV-negative, nonhospitalized male patients residing in northern Tunisia. A detailed investigation showed accelerated transmission of a Mycobacterium tuberculosis clone of the Haarlem type in 90% of all patients. This finding highlights the epidemic potential of this prevalent genotype.