Can Coronavirus Disease 2019 Induce Sarcoidosis: A Case Report.

Since the emergence of coronavirus disease 2019, a large spectrum of clinical manifestations following this acute viral infection has been reported especially autoimmune manifestations and inflammatory disorders. However, a causal link has not yet been established. Herein, we reported a case of pulmonary mediastinal sarcoidosis following coronavirus disease 2019 infection. A 41-year-old woman with no clinical or radiographic symptoms or signs of sarcoidosis prior to coronavirus disease 2019 infection developed dyspnea, cough, and fatigue, a few months after discharge. A chest thoracic scan performed 3 months after hospital discharge showed regression of groundglass opacities with the appearance of pulmonary micronodules. Clinical examination and spirometry were normal. The evolution was marked by progressive worsening of dyspnea and significant weight loss. A chest thoracic scan performed 6 months after discharge showed bilateral and symmetrical hilar and mediastinal and paratracheal lymphadenopathy. Bronchoalveolar lavage with cell count showed a lymphocytosis of 19.5% and a CD4/CD8 T cell ratio of 2.2. Endobronchial lung biopsy revealed noncaseating epithelioid granulomas. Sputum culture excluded tuberculosis. The diagnosis of pulmonary-mediastinal sarcoidosis was made. She was treated with an oral corticosteroid. The patient showed significant improvement during the 3-month follow-up period. Post-coronavirus disease sarcoidosis is very rare. Complementary studies are needed to discern the link between these diseases.

Idiopathic double tracheal stenosis mimicking asthma: a case report.

Idiopathic tracheal stenosis (Idio-SS) is an extremely rare disease. Its diagnosis is of exclusion and could be misdiagnosed as asthma. Herein, we report the case of a 39-year-old woman who had been treated for asthma for several months. She has no history of endotracheal intubation or granulomatous disease. Flexible fiberoptic bronchoscopy and thoracic computed tomography revealed double tracheal stenosis. The patient had rigid bronchoscopy; the upper tracheal stenosis was dilated with insertion of a silicone airway stent at the level of the distal stenosis. The diagnosis of idiopathic stenoses was made according to the clinico-radiological features. Symptoms were completely relieved and no recurrence was observed after one year of follow-up. This case highlights the importance of clinical suspicion and early diagnosis of Idio-SS in patients with unexplained wheezing and dyspnea. It also illustrates the role of endoscopic procedures in this situation.

Unicentric Castleman's disease: an uncommon cause of chronic cough.

Castleman disease (CD) or angiofollicular lymph node hyperplasia is a rare lymphoproliferative disorder characterized by lymph node hyperplasia of uncertain etiology. CD is divided clinically into unicentric (localized to one region of the body) considered as a benign disease and multicentric with less favourable prognosis. We describe a case of intrathoracic unicentric CD revealed by a chronic non-productive cough in a 50-year-old non-smoker female. Chest computed tomography revealed a bulky right hilar mass with intense homogenous contrast enhancement. The patient underwent a right upper lobectomy and mediastinal lymphadenectomy. Histopathology was consistent with hyaline-vascular (HV) type CD. The patient remained asymptomatic throughout the subsequent 6-months of follow-up.

Chronic arthritis revealing sarcoidosis in a patient exposed to silica.

Sarcoidosis is a systematic, granulomatous disease of unknown cause which can affect any organ in the body. Pulmonary involvement is the most common. Musculoskeletal manifestations of sarcoidosis are less common affecting 10-25% of patients and chronic arthritis occurs rarely. We report the case of sarcoidosis revealed by left knee chronic and destructive monoarthritis with only asymptomatic pulmonary involvement in a Caucasian male miner exposed to silica. The patient was treated with corticosteroids during 2 years after diagnosis. In addition, arthroplasty with total left knee prosthesis was performed. The patient is well without any recurrence of symptoms of the musculoskeletal system for a 2 years follow-up period after surgery.

Impact of malnutrition in advanced non-small cell lung cancer.

BACKGROUND: Malnutrition is so commonly associated with cancer disease. Our work aims to highlight the impact of malnutrition on the survival and toxicity of chemotherapy in patients with advanced stages of non-small cell lung cancer (NSCLC). METHODS: A retrospective study including 60 patients followed for NSCLC stage IIIB and IV, between January 2007 and December 2013. An evaluation of the impact of malnutrition was carried out according to different markers (weight loss, body mass index (BMI), albumin and NRI score). RESULTS: The mean age was 59. Taking Weight loss> 10 % as a criterion of malnutrition, 22% of patients were malnourished. Based on a BMI lower than 18.5 Kg/m², 14% of patients were malnourished. Ganglionic extension, anemia and hypoalbuminaemia were associated with malnutrition (p=0.016; p=0.02 and p=0.03 respectively). The Overall survival (OS) was 2.65 months and 6.95 months (p <0.0003) in malnourished and non-malnourished groups. The definition of malnutrition can also be based on an albumin level <35 g/l. According to this criterion, 55% of the patients were undernourished. Anemia and lymphopenia were associated with malnutrition respectively (p=0.002; p=0.001). The OS was 4.45 months and 8.42 months respectively in malnourished and non-malnourished groups (p <0.0002). NRI score<100 and <97.5 (moderate to severe malnutrition) was found in respectively 100% and 74 % of patients. The OS was 4.67 months and 9.12 months respectively in moderate to severe malnutrition (NRI<97.5) and mild malnutrition groups (NRI≥97.5) (p<0.001). CONCLUSION: Malnutrition was common in patients with advanced stage of NSCLC and was associated with poor prognosis.

Brain metastases of non-small cell lung cancer: prognostic factors and management.

BACKGROUND: The prognosis of patients with non-small cell lung cancer (NSCLC) with brain metastasis (BM) is dark. The aim of our study was to analyze the prognostic factors after the onset of BM and to evaluate the current management of BM. METHODS: We conducted a retrospective study that included 100 patients diagnosed with primary NSCLC with BM. Survival was analysed using Kaplan Meier curve.Univariate survival analysis was performed to assess the prognostic value of sex, age, gender, performance status, histologic type, tumor size, BM features and treatment modality of primary lung tumor and BM. RESULTS: The median age was 57 years; 94% of the patients were male. Most patients (85%) had a PS of (0-1). BM were unique in 54% of cases, symptomatic in 40% of cases and synchronous in 72% of cases. Chemotherapy was administered to 78% of patients; pulmonary tumor surgery was performed in 5% of patients. BM surgery and panencephalic irradiation were performed in 13% and 86% of patients, respectively. The median overall survival after NSCLC diagnosis was 13.33 months. The median overall survival after BM was 10.6 months. The Control of the primary tumor was the only factor associated with better overall survival (64.95 months Vs 10.6 months (p=0.02)). CONCLUSION: Pulmonary tumor control with complete surgical excision is predictive of better overall survival in patients with NSCLC and BM.

Prognostic factors for second-line chemotherapy of metastatic non-small-cell lung cancer.

BACKGROUND: Few studies have been conduct¬ed to determine prognostic factors of second-line chemotherapy. The aim of this study was to determine the prognostic factors for survival in patients receiving second-line treatment for advanced NSCLC. METHODS: We retrospectively reviewed the records of 71 patients with metastatic NSCLC who received second-line chemotherapy from January 2006 to January 2013. RESULTS: The mean age was 57 years. All patients were male. The performance status was 0 or 1 in 90.1% of cases. Sixty-four patients received a first line platinum-based chemotherapy. The second line chemotherapy regimen was docetaxel in 31 cases and pemetrexed in 18 cases. Fourteen patients (19.71%) had received third-line chemotherapy. The median overall survival was 13.5 months. Age older than 65 years (p=0.025), advanced T stage (T4 versus T3 and T2; p=0.01), advanced N stage (N3 versus N2 and N1; p=0.001), lower level hemoglobin (p=0.05) and non-responders who showed progression with first-line chemotherapy (p=0.04) were significant negative predictors in univariate analysis for overall survival (OS). The multivariate analysis showed that age≥ 65 years (HR=2.15; 95% CI[1.26-2.44]), advanced N stage (HR=2.273; 95% CI [1.26-2.44]) were independent prognostic factors for OS. CONCLUSION: Age and advanced N stage were important factors in predicting the outcome of advanced NSCLC patients who were undergoing second-line chemotherapy.

Advanced Lung Cancer Inflammation index: a prognostic score in patients with metastatic non-small cell lung cancer.

INTRODUCTION: Recent studies have identified that inflammation had a significant association with cancer development and progression. AIM: To explore the relationship between ALI score and prognosis of metastatic non-small cell lung cancer (NSCLC). METHODS: we conducted a retrospective study of 41 patients with metastatic NSCLC diagnosed between January2010 and January2012. ALI was calculated as body mass index x serum albumin/neutrophil to lymphocyte ratio. Patients were divided as low inflammation (ALI≥23.2) and high inflammation (ALI<23.2) groups. RESULTS: Mean age was 56.3 years, 100% were male, and 49% had adenocarcinoma. The overall survival was 8.9months. Median ALI was 23.2. The median overall survival was 6.7 months and 11.3 months respectively in patients with ALI score<23.2 and ≥23.2 (p=0.043). On multivariate analysis, ALI score < 23.2 remained significantly associated with worse outcome. CONCLUSION: Lower ALI (<23.2) was significantly associated with worse overall survival in metastatic NSCLC. The assessment of the ALI is inexpensive and widely available; it could help in identifying patients with poor prognosis in clinical routine practice.

Combined C-reactive protein and Neutrophil to Lymphocyte ratio use predict survival innon-small-cell lung cancer.

BACKGROUND: Inflammation markers have been shown to predict prognosis during cancer including non-small cell lung cancer (NSCLC). In particular, C-reactive protein (CRP) and Neutrophil to Lymphocyte Ratio (NLR) have been investigated. The aim of our work is to study the combination of these two markers in optimizing prognostication in advanced NSCLC. METHODS:   We conducted a retrospective study that included all patients diagnosed with primary NSCLC stage IIIB or IV in our respiratory department from January 2005 to January 2013. RESULTS: A total of 142 male patients were included. Most of them (80.3%) had a Performance Status (PS) 0-1. Median progression-free survival (PFS) was 4.6 months (95% confidence interval (CI) 3.9-5.3) and median overall survival (OS) was 8.9 months (95%CI7.7-10.1). Survival analysis showed that CRP<10 mg/l and NLR<3.87 were predictive of better prognostic (respectively p= 0.015 and 0.049), along with chemotherapy use (p<0.0001), PS <2 (p=0.009) and age<65 (p=0.013). In addition, combined use of NLR and CRP was significantly associated with OS (p=0.0009). Median OS for patients having both high NLR (≥3.87) and CRP (≥10 mg/l) was 6.7 months. It was significantly shorter than patients having only one elevated inflammatory marker (8.8 months; p=0.025). CONCLUSIONS: High CRP and NLR (≥10 mg/l and ≥ 3.87 respectively) were associated with poorer survival in advanced NSCLC. Their combined use maximizes their prognostic value.

Particularities of community- acquired pneumonia in the elderly.

BACKGROUND: Acute community-acquiredpneumonia in olderadults has averysevereprognosiswith a mortality rate whichcanreach 10%. Knowing the clinical, etiological, therapeutic and progressive features of thisdiseasecan help to establish management rulesthatcanimprove the prognosis. The aim of ourstudywas to compare the community-acquiredpneumonia profile in olderadults and youngerthem. METHODS: Retrospective comparative studyincluding patients hospitalized for community-acquiredpneumonia. Two groups of patients weredefined: group 1 subjectsagedbetween 18 and 64 years and group 2 subjectsaged 65 years and older. RESULTS: The meanage of elderlywas 76±6,18. COPD was five times more common in group 2 (p = 0.0001). Symptomsweredifferent in the two groups withpredominance of dyspnea in the group of elderly. Prognosisfactors scores (PSI and CURB_65) in elderlywerehighercompared to youngersubjects. Sputum culture wascontributory in third cases in both groups. Pseudomonas aeruginosawas the mostcommonpathogenidentified in the elderly. Empiricaltreatmentwas the mostprescribed in both groups. Evolution was more favorable in group 1 (p = 0.006). Complications, hospitalization in ICU and delay of recoveryweremostcommon in the group 2. CONCLUSION: Our studyconfirmedsomecharacteristics of community-acquiredpneumonia in elderly; it has mostlyrevealed the importance of microbiological tests in this population.

Pulmonary embolism and tuberculosis.

Tuberculosis has a high prevalence in Tunisia, but pulmonary embolism is rarely reported in Mycobacterium tuberculosis infection. We describe 3 cases of pulmonary embolism associated with severe pulmonary tuberculosis. Pulmonary embolism occurred within 2 to 13 days of pulmonary tuberculosis diagnosis. Clinical, bacteriological, and radiological evolutions were noted within 6 months for pulmonary tuberculosis, but controlling the international normalized ratio was difficult in 2 cases, and low-molecular-weight heparin was prescribed for 6 months in one case. The association between tuberculosis and pulmonary embolism is rare, but it should be systematically investigated, particularly in those with severe pulmonary or disseminated tuberculosis.

Primary sarcomatoid lung cancer: clinical and evolutive features: about five cases.

BACKGROUND: Primary sarcomatoid carcinoma of the lung are rare non small cell lung cancers (NSCLC) recently individualized by the World Health Organization. Their clinical, radiological and evolutive features are not well known but they seem to have bad prognosis with rapid progression and early metastases. Although they are felt to be chemo-refractory they must be treated as the other subtypes of NSCLC. AIM: To evaluate clinical, radiological and evolutive features of primary sarcomatoid carcinoma of the lung. METHODS: We report the cases of five patients presenting sarcomatoid carcinomas and assess their clinical and evolutive data. RESULTS: One patient had stage IIB cancer underwent surgical resection and adjuvant chemotherapy, he is alive 18 months later; another had stage IIIB was treated by radio and chemotherapy and is alive 6 months later; and three other patients had stage IV in whom one had chemotherapy, the two others did not because of they had performance status. They died 1 to 3 months after the diagnosis. CONCLUSION: Lung sarcomatoid carcinomas are of bad prognosis. Their treatment is nowadays not well established. Much more good studies are therefore needed.