[The "DRESS" syndrome in antituberculosis drugs]. / Le « DRESS ¼ syndrome aux antituberculeux.

The DRESS syndrome is a serious drug reaction that may involve life-threatening. We have to think before any skin reaction after taking drugs. We report a clinical case of a 27-year-old patient treated for pleural tuberculosis with the DRESS syndrome induced by antituberculosis. Through this work, we underline the rarity of this syndrome to antituberculosis treatment, but it should not be underestimated.

[Diffuse infiltrative lung disease in scleroderma. Analysis of radio-clinical and functional semiology]. / Pneumopathie infiltrante diffuse (PID) de la sclérodermie. Analyse de la sémiologie radioclinique et fonctionnelle.

Scleroderma (SD) is a systemic disease that predominantly affects the skin. Diffuse infiltrative lung disease (DILD) is rare and occurs most often in the course of the disease. We analyzed seven cases of DILO of SD recorded between 2003 and 2010 among 196 PID (3.6%). Functional signs were limited to respiratory dyspnea, it was associated to dysphagia in six cases, dry syndrome in five cases and Raynaud's phenomenon in four cases. Clinical examination found crackles in the bases of the thorax in all cases and specific cutaneous signs in six cases. The chest radiograph showed that interstitial disease predominates at the lung bases in all cases with a large aspect of the pulmonary arteries in two cases. The chest CT scan confirmed the predominance of basal and peripheral damage with signs of fibrosis in six cases. The pulmonary function objectified a severe restrictive ventilatory defect in all cases. Bronchoscopy showed a normal macroscopic appearance in all cases, the broncho-alveolar lavage was predominated by neutrophilic formula in four cases. SCL 70 antibodies were positive in four cases. All patients were treated by steroids with improvement of dyspnea and stabilization of radiographs. A patient had died in an array of acute respiratory failure and one patient was lost to follow-up. DILD in scleroderma is rare and seldom reveals the disease, it affects the patient's prognosis especially when associated with arterial pulmonary hypertension.

[Imaging of hydatid cyst of the lung]. / Analyse de la sémiologie radioclinique du kyste hydatique pulmonaire.

The pulmonary hydatid cyst is frequent in Mediterranean countries such as Morocco. Our analytic study concerned 70 cases of lung hydatid cysts collected from 2007 to 2010. Mean age was 35years and we noted a male predominance (53%). Forty-seven percent of patients belong to rural environment where 64% of them were in contact with dogs. The respiratory symptomatology was made mostly by cough (86%) and chest pain (70%). Diagnosis was based on radioclinical arguments with positive hydatic serology in some cases. The cyst was single in 84% of the cases, safe in 55% of the cases. The location in the right lung was dominant with a major affection of the right lower lobe. Conventional surgery was indicated in 67 cases. The liver hydatid cyst was discovered in 20% of cases and treated at the same time phases in 71% of cases. The evolution was good in 73% of the cases and marked by a recurrence in three of the operated cases.

[Pott's disease (about 16 cases)]. / Mal de Pott (à propos de 16 cas).

INTRODUCTION: Pott's disease or spinal tuberculosis is rare, but represents the most common form of osteo-articular tuberculosis in endemic countries. MATERIAL AND METHODS: [corrected] From January 2000 to December 2010, we collected 16 cases of Pott's disease. We analyzed clinical and radiological profile, means of confirmation and treatment. RESULTS: Spinal and chest pain were the most frequent signs. Four patients had neurological signs. The diagnosis was made by the detection of bacillus in the pus of paravertebral abscess in six cases, by histological study of vertebral biopsy in five cases, biopsy of another associated lesion in one case and in front of radio-clinical arguments with good clinical evolution under antibacillary treatment in four cases. The antibacillary treatment associating four drugs was indicated and correctly followed by all patients. Surgical drainage was associated in five cases. The evolution was good in all cases. DISCUSSION: Diagnosis of Pott's disease is late when there is no neurological sign. Imaging allows to make early diagnosis with MRI. Prognosis is good when treatment is started early.

[Multicystic lung revealing a Sjogren's syndrome]. / Poumon multikystique révélant un syndrome de Gougerot-Sjögren.

The Sjogren's syndrome is a chronic inflammatory autoimmune disease that affects primarily the exocrine glands, but can affect other organs particularly the lungs. Cystic lung disease is very significant but exceptionally recounted in the literature. We report the case of a patient, 54 years old, whose disease was discovered incidentally after a routine chest radiograph. The diagnosis of cystic lung revealing a primary Sjogren's syndrome was held before a group of radio-clinical, immunological and histological arguments. Through our observation, the diagnosis of Sjogren's syndrome should be included in the list of diagnoses to raise in a multicystic lung.

[Multiple pulmonary hydatid disease with cardiovascular localisation]. / Hydatidose pulmonaire multiple avec localisation cardiovasculaire.

Multiple thoracic hydatid disease is rare. Cardiovascular localisation is exceptional. Clinical, radiological and even electrocardiographic signs are not specific. The diagnosis is often difficult. We report a case of multiple pulmonary hydatid disease associated to a hydatid cyst of the infundibulum of the pulmonary artery. This is presented in a young man, aged 21 years, in good physical health, with recurrent minimal haemoptysis dating back two years ago. The authors emphasise, throughout this case history, the difficulties of diagnosis and treatment of multiple hydatid cysts especially with cardiovascular localisation.

[Scarf pin: a new intrabronchial foreign body]. / L'épingle à foulard: un nouveau corps étranger intrabronchique.

OBJECTIVES: The aim of this study was to illustrate the dangers of holding a scarf pin in the mouth and to describe the particular characteristics of the aspiration of a potentially penetrating foreign body and its management. PATIENTS AND METHODS: Sixteen cases of inhaled scarf pins were recorded in 2 years. They were all young girls, all veiled with a mean age of 16.6 years. The patients put the pin between their lips while fixing their scarves. Inhalation was accidental in all cases. RESULTS: The most common presentation after inhalation was a penetration syndrome (66.7 %). The localization of the foreign body was significantly more frequent in the right bronchial tree (68.7 %). The delay between inhalation and admission to the service ranged from some hours to 15 days with a mean of 2.6 days. Extraction using flexible bronchoscopy was successful in 10 cases. The use of rigid bronchoscopy was required in one case. A spontaneous expulsion of the scarf pin occurred in five cases. CONCLUSION: Scarf pin inhalation is a potential cultural hazard in women who wear the Islamic headscarf. Careful handling of these potentially sharp objects away from the mouth can prevent such accidents.

Assessing allergic rhinitis in developing countries.

BACKGROUND: Allergic rhinitis (AR) affects 5% to 40% of the general population. In developing countries, AR is poorly documented and tracked due to a lack of appropriate diagnostic tools. OBJECTIVE: 1) To validate a questionnaire standardised in industrialised countries to ascertain AR, the Score For Allergic Rhinitis (SFAR), in developing countries; 2) to better understand AR prevalence previously reported from developing countries by comparing results from the SFAR and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires. METHODS: Six African countries were selected for their climates. In each country, 70 individuals with and 30 without nasal symptoms filled out the SFAR and the ISAAC questionnaires. Skin prick tests (SPTs) for allergens were performed by the physician if necessary. RESULTS: The SFAR presented a close match with the gold standard (the physician's diagnosis of AR backed up by SPT where necessary) in terms of various performance parameters. In particular, it showed high sensitivity (0.84) and specificity (0.81). Compared to the ISAAC questionnaire, the SFAR had greater sensitivity and equal specificity. CONCLUSIONS: In the absence of a medical visit, the SFAR is a useful standardised screening instrument for the collection of information needed for the identification of AR in developing countries.

[Recurrent pneumothorax revealing a tuberous sclerosis complex]. / Sclérose tubéreuse de Bourneville révélée par des pneumothorax à répétition.

Tuberous sclerosis complex (TSC) is an autosomal dominant phacomatosis. We report a 29-year-old woman who presented with recurrent pneumothorax in whom the diagnosis of TSC relied on the existence of family history (child with cardiac rhabdomyome), skin lesions, pulmonary lymphangiomyomatosis, hepatic lipomas, renal angiomyolipomas, uterine myomas and cerebral lesions on MRI. The diagnostic of TSC might be difficult as it could mimic pulmonary lymphangiomyomatosis.

[Audit of management of chronic obstructive pulmonary disease by general practitioner in Morrocco]. / Evaluation de la prise en charge des broncho-pneumopathies chroniques obstructives auprès des médecins généralistes marocains du secteur libéral.

OBJECTIVE: The purpose of this study initiated in January 2003 was to evaluate the awareness of general practitioners in Morrocco concerning the diagnosis and initial management of chronic obstructive pulmonary disease (COPD). METHOD AND RESULTS: Ten percent of the COPD patients, selected at random, participated in the study, i.e; 223 patients/2186. The proportion of COPD patients among patients attending consultations was 5 to 10% for 40% of general practitioners. Only 48.9% of the general practitioners were aware of international guidelines for the management of COPD. For 97.8%, chronic bronchial symptoms were the predominant reasons for suspecting the diagnosis of COPD; other symptoms included exercise induced dyspnea (95.1%). Only 10.8% of the general practitioners ordered a spirometry examination. Only 30.5% managed patients themselves. CONCLUSION: Our findings show that general practitioners should be implicated in the diagnosis and early management of COPD but that management practices could be improved.

[Disseminated erythematous lupus with bilateral diaphragmatic involvement]. / Lupus érythémateux disséminé avec atteinte diaphragmatique bilatérale.

The diaphragm is an unusual localization for disseminated erythematous lupus and is generally not recognized. We present the case of a 34-year-old woman who developed bilateral pain in the base of the thorax 15 days before hospitalization without any bronchial signs and NYHA stage II dyspnea. The patient's general health status remained satisfactory and the physical examination was normal except for diffuse inflammatory joint pain and cutaneous photosensitivization. The chest x-ray disclosed ascension of both hemidiaphragms with retracted lungs associated with bilateral basal atalectasia. The diagnosis of lupus with diaphragmatic involvement was retained due to the clinical presentation with diffuse joint pain, photosensitization with facial erythema, pericardial effusion and elevated antinuclear antibody and lymphopenia (1 100/mm3). Lung function tests revealed a restrictive syndrome. Oral corticosteroids 1 mg/kg/d enabled clinical and functional improvement. In light of this observation we discuss the pathogenic mechanisms of this uncommon localization of lupus and the difficulty of establishing a sure diagnosis.

Prevalence and trend of self-reported asthma and other allergic disease symptoms in Morocco: ISAAC phase I and III.

BACKGROUND: The prevalence of asthma and other allergic diseases is increasing in many parts of the world. OBJECTIVE: To determine the prevalence of asthma, rhinoconjunctivitis and skin allergy symptoms in Morocco as part of the International Study of Asthma and Allergic Diseases in Children (ISAAC). METHODS: The survey was conducted using the standardised method of ISAAC Phase III in four centres in Morocco-Casablanca, Marrakech, Ben Slimane and Boulmane-with respectively 1777, 1689, 1008 and 1254 13-14-year-old schoolchildren participating. A comparison of the results with ISAAC Phase I was carried out in two centres. RESULTS: The prevalence of self-reported symptoms of wheeze in the last 12 months (6.4-16.2%), nasal symptoms (27.9-52.8%), rhinoconjonctivitis (8.8-28%) and eczema (13.3-20.2%) varied between centres, and were highest in Casablanca, the largest city in Morocco. Significant increases in almost all symptoms were found in the two centres of Casablanca and Marrakech between ISAAC Phase I and Phase III. CONCLUSION: Morocco could be classified as a country with an intermediate burden of asthma (between 10% and 15%) and other allergic disorders. The prevalence of these symptoms has increased in the past 5 years.

[Pleural fibroma revealed by hypoglycemia]. / Fibrome pleural révélé par une hypoglycémie.

Pleural fibroma or solitary fibrous tumor of the pleura (SFTP) is a rare tumor generally discovered fortuitously or in patients with non-specific respiratory symptoms, more rarely with hypoglycemia. We report the case of a 51-year-old man with a history of smoking (30 pack-years) and no other disease history whose chest x-ray revealed an enormous opacity occupying the lower two-thirds of the left hemithorax. This radiological anomaly had led to episodes of lipothymia three months earlier together with mental confusion in the morning as well as an episode of hypoglycemia (0.48 g/l) which rapidly resolved after administration of hypertonic dextrose. Ultrasonography and chest scan were performed later and confirmed the tissular nature of the opacity which was well limited with a left base. Minimally abundant homolateral pleural effusion was also noted. The diagnosis of SFTP revealed by hypoglycyemia was the most probably diagnosis. Emergency thoracotomy enabled removal of a hard tumor weighing 2115 g. Histology confirmed the diagnosis of benign SFTP. Hypoglycemia in the context of SFTP would be related to tumor secretion of insulin-like proteins. Complete emergency resection is required to avoid the risk of life-threatening hypoglycemia.

[A rare and benign etiology of Pancoast-Tobias syndrome]. / Une étiologie rare et bénigne du syndrome de Pancoast-Tobias.

Although lung cancer is the leading cause of Pancoast-Tobias syndrome, benign etiologies have been rarely described in the literature. We report two cases of Pancoast-Tobias syndrome caused by hydatidosis of the apex. Outcome was favorable after surgical treatment.