Résumé
Background. Pleural effusions of diverse aetiologies are encountered in patients with chronic kidney disease (CKD). The objectives of the present study were to examine the frequency of occurrence, causes, clinical features and management strategies of pleural effusion in patients with CKD including renal transplant recipients. Methods. A prospective cross-sectional observational analysis of pleural effusion in adult patients with CKD (stages 3 to 5) attending the Departments of Nephrology and Respiratory Medicine of a tertiary care institution in Eastern India was performed over a period of one year (February 2010 to January 2011). Results. Pleural effusion was found in 29 out of 430 patients with CKD (6.7%) and in two out of 34 post-renal transplant recipients (5.9%) evaluated during the study period. The mean age was 37.35±1.8 (mean±SEM [standard error of mean]) with a male to female ratio of 2:1. Exudates and transudates were found in equal frequencies. Heart failure was the single most common cause (41.9%, 13 of 31). Tuberculosis (TB) (n=8, 25.8%) and uraemic effusions (n=6, 19.4%) were responsible for the majority of exudates. Unilateral effusion with a normal heart size had a positive predictive value of 83.3% for nonheart failure aetiology. Conclusions. Symptomatic pleural effusion was present in a small proportion of 6.7%; (n=29) patients with CKD including post-renal transplant recipients. Heart failure, TB and uraemic effusions accounted for most of the cases. Differentiating TB from uraemic effusion requires a combined clinico-pathological approach and this differentiation is absolutely necessary for proper management.
Sujets)
Adulte , Études transversales , Prise en charge de la maladie , Exsudats et transsudats , Femelle , Humains , Inde/épidémiologie , Transplantation rénale/effets indésirables , Mâle , Acuité des besoins du patient , Épanchement pleural/diagnostic , Épanchement pleural/épidémiologie , Épanchement pleural/étiologie , Épanchement pleural/physiopathologie , Prévalence , Études prospectives , Insuffisance rénale chronique/complications , Insuffisance rénale chronique/épidémiologie , Insuffisance rénale chronique/physiopathologie , Insuffisance rénale chronique/chirurgie , Facteurs de risqueRésumé
We report a case of a patient suffering from multidrug-resistant pulmonary tuberculosis (MDR-PTB) who later developed an invasive infection of the respiratory tract with a rapidly growing non-tuberculous mycobacteria (NTM), recently identified as Mycobacterium massiliense, closely related to M. abscessus. To the best of our knowledge, this is the first case of M. massiliense infection being reported from India.
Sujets)
Antituberculeux/pharmacologie , Antituberculeux/usage thérapeutique , Résistance microbienne aux médicaments , Femelle , Humains , Adulte d'âge moyen , Infections à mycobactéries non tuberculeuses/traitement médicamenteux , Infections à mycobactéries non tuberculeuses/microbiologie , Mycobacterium tuberculosis/effets des médicaments et des substances chimiques , Mycobactéries non tuberculeuses/effets des médicaments et des substances chimiques , Mycobactéries non tuberculeuses/isolement et purification , Expectoration/microbiologie , Tuberculose multirésistante/microbiologie , Tuberculose pulmonaire/traitement médicamenteux , Tuberculose pulmonaire/microbiologieRésumé
Adenoid cystic carcinoma, an uncommon malignant salivary gland neoplasm, is known for its long clinical course, indolent growth, local recurrence and late distant metastasis. We report an unusual case of adenoid cystic carcinoma of the palate in a 64-year-old woman, undiagnosed for more than 15 years, who presented as malignant pleural effusion.
Sujets)
Carcinome adénoïde kystique/diagnostic , Carcinome adénoïde kystique/anatomopathologie , Carcinome adénoïde kystique/secondaire , Femelle , Humains , Adulte d'âge moyen , Tumeurs du palais/diagnostic , Tumeurs du palais/anatomopathologie , Épanchement pleural malin/étiologie , Tumeurs de la plèvre/anatomopathologie , Tumeurs de la plèvre/imagerie diagnostique , Tumeurs de la plèvre/secondaireRésumé
A 30 year-old housewife presented with cough and shortness of breath which progressed during her ensuing pregnancy, culminating in a still-birth at 9 months of gestation and requiring her hospitalisation in the immediate postpartum period. HRCT scan of the thorax showed thin-walled cysts and open lung biopsy confirmed the clinical impression of lymphangioleiomyomatosis. She was put on oral medroxyprogesterone acetate. After disease flare-up in the postpartum period her symptoms have stabilised.