Drug rash with eosinophilia and systemic symptoms to antituberculosis treatment

Drug Rash with Eosinophilia and Systemic Symptoms [DRESS] syndrome reflects a serious hypersensitivity reaction to drugs. This syndrome is an uncommon adverse reaction due to antituberculosis drugs and is sometimes difficult to identify the culprit agent. We report a case of a 45-year-old woman who received combined antituberculosis drugs [RHZE] for lymph node tuberculosis. Clinical manifestations included fever, dyspnea, rash, hypereosinophilia and visceral involvement [liver involvment]. After symptom resolution and biology normalization, anti-tuberculosis drugs were reintroduced successively one after another. Systemic symptoms reappeared with the four anti-tuberculosis drugs. The clinical outcome was favorable with second line antituberculosis treatment

[Influenza A [H1N1]: about 189 cases]

Influenza A [H1N1] is a contagious acute respiratory infection caused by a subtype influenza virus A [H1N1]. The later had caused a pandemic in 2009. Despite its low mortality, the disease was more severe in some subgroups. Describe confirmed cases of influenza A [H1N1] addressed to the pulmonary department of the Rabta hospital and identify risk factors. During the pandemic influenza A [H1N1], pulmonary department of Rabta hospital was identified among the centers to receive and detect new cases in addition to hospitalization of severe ones. All subjects had nasal and pharyngeal swabs. The authors distinguished non-severe and severe cases; hospitalization was indicated for severe forms. From September 2009 to March 2010, influenza A [H1N1] has been confirmed in 189 patients. The average age was 27.3 years [2-72 years]. Sex ratio was 1.2. Contagion was found in all patients. Twenty-two patients were hospitalized for the severe form. Mean age was 56 years, sex ratio was 0.47. Among them, 20 patients had at least one co-morbidity. Most frequently found risk factors were diabetes [9 cases], chronic respiratory disease [9 cases] and pregnancy [6 cases]. All patients received ozeltamivir. The dose was doubled in severe cases. Nonspecific antibiotic therapy was prescribed in 11 cases. Seven patients were hospitalized in intensive care unit, among whom 4 died. Mortality in severe forms was 18% and overall mortality 2.1%. Through this Tunisian series, we emphasize the potential severity of influenza A [H1N1]. This justifies a systematic vaccination of subjects at risk even away from pandemic period

[Diagnosis approach of pulmonary embolism]

Pulmonary embolism [PE] is a fairly common condition that can be fatal. The variability of presentation sets clinician up for potentially missing the diagnosis. Routine laboratory findings are nonspecific and are not useful in diagnosis of PE. Diagnosis is based on clinical prediction rule in combination with laboratory tests such as the D-dimers test leading to the realization of a confirming examination. To precise the confirming examinations of PE and propose an algorithm based on clinical prediction rules in combination with D dimmers. A Pub Med search was conducted using the following key words: pulmonary embolism computed tomography pulmonary angiography, scintigraphy and D Dimer. The study was based on a review of 18 studies including meta analysis, reviews and original articles referring recent strategy diagnosis of pulmonary embolism. Ventilation/ perfusion scan is a type of examination that is used less often because it is not a widespread technology. However, it may be useful in patients who have an allergy to iodinated contrast. Ultrasonography of the legs, also known as leg doppler, in search of deep venous thrombosis [DVT] may help the diagnosis approach particularly when other exams are not available or contraindicated. This may be a valid approach in pregnancy. The gold standard for diagnosing PE is pulmonary angiography. It is used less often due to wider acceptance of multi detector CT scans, which are non-invasive. A normal ventilation/perfusion scan rules out the diagnosis of PE with negative predictive value of 97%. There is no consensus in pregnancy. Finally, the MRI has a low and insufficient sensibility to diagnose PE. D Dimers, multidetector CT, ventilation/ perfusion scintigraphy and ultrasonography of the legs are the most useful examinations to diagnose PE. Many algorithms were established depends on medical experience and examination availability

Sugar tumor

Clear cell tumor of the lung is a rare and very unusual benign pulmonary tumor. This tumor is called sugar tumor because of the abundance of glycogen on its cells. To report a case of sugar tumor and discuss clinical, evolutive features and diagnosis difficulties of this tumor. A case of 75 years old woman presenting as a round pulmonary opacity. Computed tomography [CT] scans showed in the left lower lobe a solitary pulmonary solid tumor with central calcifications. The patient underwent tumor resection. Pathologic examination, including immunohistochemical studies, revealed a benign clear cell tumor, so-called [sugar tumor]. It's the second case reported in Tunisia. This very rare tumor of the lung is characterized by some immunohistological features. Its evolution is favourable after surgery

Transitory, spotaneously recovering, peripheral facial nerve palsy after vionorelbine administration

Vinorclbine is a semi-synthetic vinca alkaloid that has demonstrated a broad spectrum of activity. It is widely used in non small cell lung cancer. We report the case of a 50 year old man, having stage IV lung carcinoma with a unique cerebral metastasis in the right hemisphere. Focal cerebral radiotherapy was first administrated followed by intravenous chemotherapy associating vinorelbine to cisplatin. He has developed multiple subsequent and transitory episodes of monolateral peripheral facial nerve palsy in the left side during vinorelbine administration. The palsy has completely and spontaneously resolved at a short interval, around twenty minutes, after the end of the drug infusion. Obvious cerebral tumor progression was excluded by means of CT scan; the drug was thereby administrated as scheduled until the end of the treatment. We describe an unusual side effect, until now reported in only two cases, having brain-stem gliomas, among English and French literature, dealing with vinorelbine as adjuvant treatment. We discuss possible neurological and oncnlogical implications

[Exercise induced anaphylaxis]

Exercise-induced anaphylaxis [EIA] is a rare physical allergy, sometimes severe, triggered by exertion following specific food intake. Although described several years ago, this condition is not well known; the diagnosis is frequently made several years after follow up. The aim is to describe the physiopathologic mechanism, etiologic factors, clinical manifestations and diagnostic means. Review of the literature. It is likely that exercise induce the release of a sufficient amount of mediators from mast IgE dependant cells exceeding a certain threshold. A number of food trigger have been suggested in EIA, the most commonly reported agent is wheat which has to be systematically looked for. A range of physical activities have been associated with EIA. Intensive physical activities are more likely to provoke an attack than less strenuous ones. The recognition of specific food causative role do not indicate the avoidance of food intake but exercise is forbidden within the four hours following specific aliment ingestion. Further studies seem to be necessary to clarify the mechanism of food dependent exercise-induced anaphylaxis

[Pulmonary tuberculosis in child]

Pulmonary tuberculosis is a major public health problem in the world and particularly in Tunisia. Child is not saved by this illness. The pulmonary tuberculosis present epidemiological and diagnosis specificity in child, especially characterized by difficulty diagnosis at this age. It is also characterized by therapeutic difficulties

Impact des emissions diesel sur l'appareil respiratoire

Adverse effects of diesel exhaust is being now a subject of many recent studies. These various outcomes and especially respiratory changes are due to high concentration of different pollutants within diesel exhaust particles. To date, it has been demonstrated that diesel emission increase the airway allergic reaction as rhinitis and asthma. In addition, to those side effects, it is proved that diesel exhaust is a probable human carcinogen based on evidence. Many epidemiologic evidence found a significant increase in lung cancer risk. However, some studies have provided contradictory results due to concomittant exposure to other pollutants, tobacco exposure and difficulties to extrapolate findings in animal models into humans