Lupus and pulmonary nodules consistent with bronchiolitis obliterans organizing pneumonia induced by carbamazepine.

Carbamazepine-induced lupus is uncommon; its frequency is less than 0.001% of the cases of lupus treated. Herein we describe a 52-year-old woman who had development of facial erythema, arthralgia, dyspnea, and multiple pulmonary rounded masses and nodules while she was taking carbamazepine for epilepsy. Pulmonary histologic examination showed bronchiolitis obliterans organizing pneumonia. Antinuclear antibodies and antihistone antibodies were present without antibodies to double-stranded DNA. Thirteen months after carbamazepine had been withdrawn, all symptoms had disappeared without the use of anti-inflammatory drugs. Even though pulmonary involvement is possible during carbamazepine treatment, to our knowledge, bronchiolitis obliterans organizing pneumonia on its own or associated with carbamazepine-induced lupus has not been previously described.

[Mechanisms of cardiac involvement in systemic scleroderma, apropos of 3 cases]. / Mécanismes de l'atteinte cardiaque dans la sclérodermie systémique (à propos de trois observations).

We studied myocardial manifestations of systemic sclerosis in three patients. Two patients were symptomatic. A transthoracic echocardiography, a coronary angiography, a cardiac catheterization, thallium scans with dipyridamol completed by thoracic cold exposure and endomyocardial biopsy with immunohistological study were performed. None of them have coronary stenosis. In the three cases abnormalities of myocardial perfusion were detected, two of them have fibrosis. The immunohistological study always showed an anusual expression of HLA DR on cardiac fibroblasts.

[Mechanisms of cardiac involvement in systemic scleroderma. Apropos of 3 cases]. / Mécanismes de l'atteinte cardiaque dans la sclérodermie systémique. A propos de trois observations.

To investigate myocardial manifestations in progressive systemic sclerosis, we studied three patients with transthoracic echocardiography, cardiac catheterization with coronary angiography, thallium scans with dipyridamol completed by thoracic cold exposure and endomyocardial biopsy with immunohistology. Two patients were symptomatic. In the three cases, abnormalities of myocardial perfusion were detected without coronary stenosis. Two patients had myocardial fibrosis with a coronary spasm in one case. The immunohistological study always showed an unusual expression of HLA class II antigen on cardiac fibroblasts.

[Semi-invasive diffuse pulmonary aspergillosis with antineutrophil cytoplasmic antibodies. 2 cases]. / Aspergillose pulmonaire semi-invasive avec anticorps anti-cytoplasme des polynucléaires de type diffus. Deux observations.

We report two cases of semi-invasive pulmonary aspergillosis with a thoracic wall extension in the first case and a parietal vasculitis without Aspergillus invasion in the second. Semi-invasive pulmonary aspergillosis is an identifiable entity. It is characterized by impairment of local pulmonary defense mechanisms and/or a mild systemic immunosuppression as well as a slowly progressive course. Pulmonary symptoms are not specific. The thoracic wall involvement subsequent to a contiguous pulmonary lesion occurs rarely and indicates poor prognosis. CT scan improves diagnosis significantly, confirmed by histology and/or by the biopsy growth of Aspergillus. Itraconazole, tolerated better than amphotericin B, is an efficient treatment though prognosis remains poor (28% of deaths). Detection of anti-neutrophil cytoplasmic antibodies (diffuse cytoplasmic staining) evolving conversely to this disease seems to be associated with infectious vasculitis. These antibodies are found in vasculitis and especially in Wegener's granulomatosis with a high specificity. They have also been described in a few patients with infectious diseases.