[Co-infection with Mycobacterium tuberculosis and Pneumocystis jiroveci in a patient without HIV infection]. / Co-infection à Mycobacterium tuberculosis et Pneumocystis jiroveci chez une patiente non infectée par le VIH.

INTRODUCTION: Co-infection with Pneumocystis jiroveci and Mycobacterium tuberculosis is rarely reported in patients without HIV infection. CASE REPORT: We report the case of a 30 year old woman admitted to hospital for respiratory distress associated with a diffuse infiltrative pneumopathy. Corticosteroid therapy had been started two months earlier for suspected pulmonary sarcoidosis. Fibreoptic bronchoscopy and broncho-alveolar lavage produced evidence of Mycobacterium tuberculosis and cysts of Pneumocystis jiroveci. HIV serology was negative. Clinical progress was satisfactory following anti-tuberculous and anti-fungal therapy. CONCLUSION: Pneumocystis pneumonia is rare in subjects without HIV infection and is most often associated with a pathology or treatment leading to depression of cellular immunity. Corticosteroid treatment, even of short duration, presents the greatest risk. Systematic antibiotic prophylaxis should be considered in relation to the immune status of the patient. Co-infection with the tubercle bacillus as reported here is exceptionally rare.

[Pneumoperitoneum and pneumomediastinum complicating non-invasive ventilation]. / Un pneumoperitoine compliquant un pneumomediastin au cours de la ventilation non invasive.

INTRODUCTION: Pneumoperitoneum is known to be a rare complication of invasive mechanical ventilation. However it has not previously been described as a consequence of non-invasive ventilation. CASE REPORT: The authors report a case of pneumoperitoneum associated with pneumomediastinum occurring in a 64-year-old patient treated for 3 years with bilevel ventilation via a nasal mask (expiratory pressure = 9 cm H2O, inspiratory pressure = 15 cm H2O) for obesity hypoventilation syndrome. Respiratory and gastroenterological investigations did not demonstrate a cause for this complication which resolved spontaneously following the cessation of ventilation. Nine months later, clinical deterioration and a worsening of blood gas parameters led to a recommencement of non-invasive mechanical ventilation at the same levels as previously. Over two years of follow up there have been no clinical or radiological signs of a recurrence of pneumomediastinum or pneumoperitoneum. CONCLUSION: In the absence of any other explanation, barotrauma due to nasal ventilation appears to be the most likely explanation for this complication.

[A case of atypical cryptogenic organising pneumonitis during pregnancy]. / Un cas atypique de pneumopathie organisée cryptogénique au cours d'une grossesse.

Cryptogenic organising pneumonitis (COP) is now a well defined clinico-pathological entity. It may be idiopathic or secondary to infection, a drug reaction or a connective tissue disorder. Corticosteroid treatment is remarkably effective. We describe a case of COP occurring during the course of an acute respiratory distress syndrome in a pregnant woman. The unusual association of blood and pulmonary eosinophilia leads us to envisage a borderline form of COP and eosinophilic pneumonitis. Other unusual features were the poor response to steroids and the rapid improvement following death of the foetus.

Rapid diagnosis of alcoholic ketoacidosis by proton NMR.

In alcoholic patients, metabolic acidosis can be related to lactate acidosis associated with sepsis or thiamine deficiency, ketoacidosis, methanol or ethylene glycol poisoning. High resolution proton nuclear magnetic resonance (NMR) can be used to detect abnormal organic acid metabolites in urine or serum from patients with various metabolic disorders. In the present case, a 26-year-old patient was admitted for a coma associated with severe metabolic acidosis. Alcoholic ketoacidosis (AKA) was identified by urine proton NMR. Her metabolic disorders rapidly improved. Persisting associated neurological alteration was related to extrapontine myelinolysis as shown by imaging cerebral NMR.