ABSTRACT
INTRODUCTION: Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the joints but which frequently includes extra articular effects, including pulmonary nodules, which grow faster under immunosuppressive treatment. CASE REPORT: A 74 years old man, with mild asbestosis, underwent treatment with methotrexate then leflunomide (LEF) for seropositive RA. In February 2014, during monitoring of his asbestosis, chest CT scan showed the appearance of thick-walled cavitating lung nodules, with a central and sub pleural distribution. The patient was asymptomatic. Bronchoalveolar lavage excluded infection and tumor. LEF was stopped but in May 2014, the patient was admitted with respiratory infection and a pyopneumothorax which required surgical management. The postoperative course was complicated with a persistent pneumothorax. CONCLUSIONS: We describe a case of RA complicated by a pyopneumothorax after treatment with LEF. The risk of this complication could be reduced by regular chest imaging.
Subject(s)
Arthritis, Rheumatoid/complications , Pneumothorax/etiology , Aged , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/surgery , Asbestosis/complications , Asbestosis/diagnosis , Asbestosis/surgery , Diagnosis, Differential , Empyema, Pleural/diagnosis , Empyema, Pleural/etiology , Empyema, Pleural/surgery , Humans , Male , Multiple Pulmonary Nodules/diagnosis , Multiple Pulmonary Nodules/surgery , Pneumothorax/diagnosis , Pneumothorax/surgeryABSTRACT
Erdheim-Chester's disease is a rare form of visceral xanthogranulomatosis. We report a case of a patient aged 50 presenting with a diffuse interstitial pneumonia which revealed Erdheim-Chester's disease with localisation in the bones, peri-aortic region and also with neurological involvement. The diffuse interstitial pneumonia which progressed chronically was characterised by a diffuse thickening of the septa with subpleural cysts and bilateral apical bullae with thickening of the pleura. Respiratory function tests showed a restrictive ventilatory defect with resting hypoxaemia which was aggravating by exercise. Broncho-alveolar lavage showed a lymphocytosis (26%) also with polymorpho neutrophils (11%). The pathological diagnosis was confirmed by transbronchial lung biopsy showing an excess of foamy histiocytes in the interstitium which are characteristic of the disease. The progress of this interstitial pneumonia is stabilised without immunosuppressive drugs.
Subject(s)
Bone Diseases/diagnosis , Histiocytosis, Non-Langerhans-Cell/diagnosis , Lung Diseases, Interstitial/diagnosis , Nervous System Diseases/diagnosis , Adrenal Cortex Hormones/therapeutic use , Biopsy , Bone Diseases/complications , Bone Diseases/drug therapy , Chronic Disease , Female , Histiocytosis, Non-Langerhans-Cell/complications , Histiocytosis, Non-Langerhans-Cell/drug therapy , Humans , Lung Diseases, Interstitial/blood , Lung Diseases, Interstitial/drug therapy , Middle Aged , Nervous System Diseases/complications , Nervous System Diseases/drug therapy , Tomography, X-Ray ComputedABSTRACT
The aim of this study was to provide further insight into the phenomenology and pathophysiology of monophasic and biphasic dyskinesias induced by levodopa in Parkinson's disease. For this purpose, the type, localization, severity, and timing of dyskinesias were evaluated in 15 parkinsonian patients in relation to motor disability after administration of levodopa using a video-electromyographic recording device. Foot-dystonia, myoclonus, and akathisia were observed in most patients. The dyskinesias started in the foot, usually on the side most affected by the disease, and spread in an "ascending wave" to the contralateral side, the trunk, and upper extremities. In a few patients, onset was axial, spreading almost instantaneously to all limbs. The dyskinesias were dystonic and ballistic at the start, and became increasingly choreic as they attained the upper limbs. Their intensity was maximal in the lower limbs, then progressively decreased, while increasing in upper limbs and head. The results indicate that there is no strict dichotomy between biphasic and monophasic dyskinesias. In other words, there is a "continuum" between the first dyskinesias and those observed during the period of maximal clinical improvement. These dyskinesias can also appear in reverse order, as if there were an "oscillator" determining a sequence of alternating patterns.
Subject(s)
Dyskinesia, Drug-Induced/etiology , Levodopa/adverse effects , Parkinson Disease/drug therapy , Activities of Daily Living/classification , Adult , Aged , Chorea/chemically induced , Chorea/physiopathology , Dose-Response Relationship, Drug , Drug Administration Schedule , Dyskinesia, Drug-Induced/physiopathology , Dystonia/chemically induced , Dystonia/physiopathology , Electromyography/drug effects , Female , Humans , Levodopa/administration & dosage , Male , Middle Aged , Motor Activity/drug effects , Motor Activity/physiology , Motor Skills/drug effects , Neurologic Examination/drug effects , Parkinson Disease/physiopathology , Parkinson Disease, Secondary/chemically induced , Parkinson Disease, Secondary/physiopathology , Receptors, Dopamine D1/drug effects , Receptors, Dopamine D1/physiology , Video RecordingABSTRACT
Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the accumulation of lipoproteinaceous material within the alveoli. Though many studies addressed biochemical data in bronchoalveolar lavage (BAL) effluent, poor attention was payed to cell profile in PAP. We report the case of a 40 year old woman, presenting with progressive respiratory failure and bilateral pulmonary infiltrates. BAL and transbronchial biopsy confirmed PAP. Therapeutic whole lung lavage led to full clinical and radiological remission. Sequential BAL follow-up was started over a 4-year period. As previously reported, lymphocytes were increased prior to whole lung lavage. This pattern subsequently remained, whereas recurrence or superinfections did not occur. The mechanism of this disorder is unclear and deserves further investigation.
