[Bronchectasia and microscopic polyangeitis]. / Bronchectasies et polyangéite microscopique.

Microscopic polyangeitis is a necrosing vascularitis with pulmonary and renal tropism. Localized in the lung, microscopic polyangeitis leads to intra-alveolar hemorrhage. We report our observations in two patients who presented with concomitant bronchectasia. The parallel course of these two conditions suggests a possible relationship. We propose a pathophysiological approach involving a direct role of polymorphonuclear neutrophils and neutrophilic proteases secreted in response to activation of anti-polymorphonuclear cytoplasm anti-bodies (ANCA) during microscopic polyangeitis aggravating bronchectasia.

Pneumorachis and pneumomediastinum caused by repeated Müller's maneuvers: complications of marijuana smoking.

Pneumomediastinum may occur during marijuana inhalation but only rarely has pneumorachis (epidural pneumatosis or aerorachia) been reported. The usual mechanisms that produce pneumomediastinum include severe acute asthma, toxic-induced bronchial hyperreactivity, and barotrauma caused by Valsalva's maneuver (expiration through resistance). We report a case in which barotrauma resulted from repeated deep inspiration through a device with airflow resistance equivalent to Müller's maneuver. Inspiration occurred through a homemade apparatus resembling a narrow outlet bong with 2 piled compartments. Pneumomediastinum combined with subcutaneous emphysema and pneumorachis occurred, without identified pneumothorax. There were no neurologic complications. Because of the absence of bronchospasm, expiration either through the apparatus or actively against a closed glottis, or apnea, this phenomenon is likely a result of repeated Müller's maneuvers. Successive inhalation through resistance could have resulted in extreme negative intrathoracic pressure, which would have caused a transmural pressure gradient inducing barotrauma and release of extrarespiratory air. High-concentration oxygen therapy to achieve nitrogen washout was used.

[Thoracic nocardiasis associated with macrophage activation syndrome]. / Nocardiose thoracique associée à un syndrome d'activation macrophagique.

Nocardiasis is an uncommon bacterial disease often observed in immunodepressed patients. Its interactions with the immune system remain poorly known. We report a case of Nocardia asteroides thoracic nocaridiasis in an African subject who also had macrophage activation syndrome. We recall the classic data on nocardiasis in Africa and emphasize the importance of emergence in HIV-infected subjects. The association between nocardiasis and macrophage activation syndrome suggest a possible pathogenic mechanism involving the immune system (lymphocytes and macrophages) and Nocardia asteroides.