Boerhaave's syndrome initially presented with sore throat and cough complicated by a bilateral pneumothorax.

A 14-year-old male was admitted to the Emergency Department with sore throat and cough. One hour after his admission, he presented a hemodynamic compromise with a respiratory failure. The thoracic tomodensitometry highlighted a tension bilateral pneumothorax and mediastinum consecutive to an esophageal rupture in the left posterolateral wall also known as Boerhaave's syndrome which was treated successfully with a non-operative management. To avoid a recurrence of bilateral pneumothorax, a left pleuroscopy with talc pleurodesis was performed.

[Bacterial endotoxin as a trigger for eosinophilic asthma]. / Une injection d'endotoxine bactérienne comme facteur déclenchant d'un asthme éosinophilique.

INTRODUCTION: Lipopolysaccharide is a component of the outer membrane of gram-negative bacteria. It plays an important role in asthma as an adjuvant to allergens in activating the airway epithelium. CASE REPORT: Following treatment of a cutaneous mycosis by injection of endotoxin from Salmonella (Pyrogenalum), a 49-year-old non-smoking man developed an acute bronchitis followed by persistent cough, sometimes productive of sputum. Clinical examination was unremarkable. Lung function tests showed airway obstruction, FEV1 54% predicted, partly reversible with salbutamol, and exhaled NO was increased to 73.5 ppb. There was a moderate blood eosinophilia ranging from 540 to 890 per mm(3) (7.4 to 9.6%). Lung CT scan showed no parenchymal or bronchial abnormalities, and ENT examination showed nasal polyposis. CONCLUSION: Besides its critical adjuvant role in the development of asthma when inhaled, this case suggests that endotoxin can also provoke asthma when administered systemically.