[Pulmonary tuberculosis in immunocompetent: causes and consequenses]

Background: Despite scientific advances, extended forms of pulmonary tuberculosis are still relevant. The aim of our study was to determine clinical features and outcome of extended pulmonary tuberculosis in immunocompetent patients

Methods: Retrospective comparative study including 100 patients HIV negative, presenting pulmonary tuberculosis divided into 2 groups of 50 patients [group1: extended tuberculosis and group2: localized tuberculosis]. Tuberculosis was considered extended when reaching above one lobe

Results:The average age was comparable in the 2 groups [p = 0.138]. In group1, we noted a higher incidence of diabetes [p = 0.037] and malnutrition [p = 0.045]. Clinically, patients in group1 had more general signs [p=0.033] and dyspnoea [p=0.037]. Biologically, anemia [p<0.001], leukocytosis [p=0.05], elevated CRP [p=0.031], thrombocytosis [p=0.023], hyponatremia [p = 0.001] and liver disturbances [p = 0.001] were significantly more frequent in group1. Concerning the evolution, time to smear negativity was significantly longer [p=0.012]. Similarly, radiological sequelae were more frequent [p = 0.02] and more extensive [p = 0.012]. Positive predictive value of radiological extent in disease evolution was 62% with a confidence interval between 47.2% and 75%

Conclusions: The extent of pulmonary tuberculosis is an important factor in clinical and biological presentation and disease evolution. Indeed, patients with extended tuberculosis develop more severe presentation and are more likely to develop parenchymal sequelae

[Isolated bilateral pulmonary occlusion]

Takayasu's arteritis [TA] is an unusual cause of bilateral and isolated pulmonary artery occlusion that may be difficult to distinguish from other aetiologies. Report a new case of isolated bilateral pulmonary occlusion. A 19 year-old girl presented to the hospital with a 2-year history of dyspnoea and recurrent hemoptysis. She was in respiratory distress on physical examination Clinical investigations revealed a total occlusion of the right pulmonary artery on perfusion lung scan. Pulmonary angiogrphy confirmed these data and revealed further more a partially occluded left lower lobe artery. Diagnosis of Takayasu's arteritis was suspected and a complete aortogram was made but proved to be normal. Corticosteroid therapy was prescribed but interrupted within 2 months for absence of clinical improvement. Patient's assessment revealed worsening of the clinical condition and she became oxygendependant. Early diagnosis of isolated involvement of pulmonary arteries in TA while systemic arteries are normal may prove to be difficult. In spite of insufficient data to confirm TA, the latter seems to be the most probable diagnosis in our patient regarding clinical [young age] and angio graphic arguments

Last discovery of a congenital broncho-oesophageal fistula

Broncho-oesophageal fistula is rare and occurs mostly in acquired condition. Report of a new case. We report a case of a 58-years-old woman which has, since 38 years ago, a chronic cough, recurrent bronchopulmonary suppurations and hemoptysis. Clinical examination let to the diagnosis of a broncho-oesophageal fistula. Surgical treatment resulted in complete recovery. There was no evidence of any aetiology. Congenital origin of the fistula was deduced