Can Coronavirus Disease 2019 Induce Sarcoidosis: A Case Report.

Since the emergence of coronavirus disease 2019, a large spectrum of clinical manifestations following this acute viral infection has been reported especially autoimmune manifestations and inflammatory disorders. However, a causal link has not yet been established. Herein, we reported a case of pulmonary mediastinal sarcoidosis following coronavirus disease 2019 infection. A 41-year-old woman with no clinical or radiographic symptoms or signs of sarcoidosis prior to coronavirus disease 2019 infection developed dyspnea, cough, and fatigue, a few months after discharge. A chest thoracic scan performed 3 months after hospital discharge showed regression of groundglass opacities with the appearance of pulmonary micronodules. Clinical examination and spirometry were normal. The evolution was marked by progressive worsening of dyspnea and significant weight loss. A chest thoracic scan performed 6 months after discharge showed bilateral and symmetrical hilar and mediastinal and paratracheal lymphadenopathy. Bronchoalveolar lavage with cell count showed a lymphocytosis of 19.5% and a CD4/CD8 T cell ratio of 2.2. Endobronchial lung biopsy revealed noncaseating epithelioid granulomas. Sputum culture excluded tuberculosis. The diagnosis of pulmonary-mediastinal sarcoidosis was made. She was treated with an oral corticosteroid. The patient showed significant improvement during the 3-month follow-up period. Post-coronavirus disease sarcoidosis is very rare. Complementary studies are needed to discern the link between these diseases.

Idiopathic double tracheal stenosis mimicking asthma: a case report.

Idiopathic tracheal stenosis (Idio-SS) is an extremely rare disease. Its diagnosis is of exclusion and could be misdiagnosed as asthma. Herein, we report the case of a 39-year-old woman who had been treated for asthma for several months. She has no history of endotracheal intubation or granulomatous disease. Flexible fiberoptic bronchoscopy and thoracic computed tomography revealed double tracheal stenosis. The patient had rigid bronchoscopy; the upper tracheal stenosis was dilated with insertion of a silicone airway stent at the level of the distal stenosis. The diagnosis of idiopathic stenoses was made according to the clinico-radiological features. Symptoms were completely relieved and no recurrence was observed after one year of follow-up. This case highlights the importance of clinical suspicion and early diagnosis of Idio-SS in patients with unexplained wheezing and dyspnea. It also illustrates the role of endoscopic procedures in this situation.

ABO blood groups and risk of covid-19.

INTRODUCTION: Coronavirus pandemic has been the subject of a large number of publications, some of which have shown an increased risk of contracting Covid-19 in carriers of blood group A. AIMS: In this study we looked at the profile of blood group phenotype of a series of Tunisian patients with covid-19 admitted to Abderrahman Mami hospital in Ariana . METHODS: Our study included 51 Tunisian patients with SARS-CoV-2 infection admitted to Abderrahmane Mami hospital between late march 2020 and early May 2020. The distribution of blood groups in Covid-19 patients was compared with that of a control group of 1506 patients with no Covid-19 infection as well as with the distribution of blood groups in a population of 63375 voluntary blood donors. RESULTS: Our series, although limited in size, showed a higher prevalence of blood group A among Covid-19 patients, statistically significant compared to ABO blood group distribution among Tunisian blood donors and among a control group of patients without Covid -19. CONCLUSION: these results are in line with data from the literature, particularly on larger series in China.

Development and validation of a prognostic index for survival in non-small cell lung cancer: Results from a Tunisian cohort study.

INTRODUCTION: Despite the continuous efforts made with the TNM system, the issue of heterogeneity of prognosis within the stages of non-small cell lung cancer (NSCLC) could not be resolved. Our aim was to identify prognostic factors and develop an index to predict NSCLC survival with greater accuracy. METHODS: We conducted a survival study over 5 years on patients with NSCLC. Kaplan-Meier analysis followed by Cox regression modelling were used. Prognostic indices were derived, using either an additive or a multiplicative pattern, and were compared by their receiver operating characteristics (ROC) curves. We then proceeded to a risk stratification and validation of the index on the derivation cohort. RESULTS: Two hundred and sixty-two NSCLC patients were included. Two models were constructed, using the following nine variables as prognostic factors: age, performance status, haemoglobin level, leucocyte count, calcium, lactate dehydrogenase, alkaline phosphatase levels, histological type and TNM stage. Four prognostic indices were derived, and the best one was picked and validated on a population of five risk groups. The higher the risk group, the shorter the survival. CONCLUSIONS: This novel and simple prognostic tool could predict survival more accurately in patients with NSCLC.

[Extended pulmonary tuberculosis and immunocompetence: causes and consequences]. / La tuberculose étendue de l'mmunocompétent: causes et consequences.

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.

Castleman's disease: an intrapulmonary form with intrafissural development.

Castleman's disease (CD) is an uncommon, mainly benign, lymphoproliferative disorder of unknown etiology, mostly involving the mediastinum. Parenchymal lung involvement of the disease is exceedingly rare. We describe a case of CD in a 23-year-old woman with a 4-year history of recurring dyspnea and nonproductive cough, whose chest X-ray showed an abnormal shadow of the right hilum. Chest computed tomography confirmed the presence of a tissue-density mass of the right lower lobe, demonstrating poor contrast enhancement, associated with multiple laterotracheal and mediastinal lymphadenopathies. The patient underwent curative surgery, revealing a right hilar compressive mass, with an intrafissural development between the superior and middle lobes. Pneumonectomy was performed due to profuse bleeding. This case of CD is particular because of its unusual intrapulmonary location and its intrafissural development. Poor contrast enhancement is atypical in CD.

Pulmonary blastomycosis: a case from Africa.

Pulmonary blastomycosis is an uncommon pathologic condition that is quite rare in Africa compared to endemic regions of Canada and the upper Midwest of the U.S. We describe a 45-year-old patient who complained of productive cough, hemoptysis, and dorsal rachiodynia. Chest imaging revealed a necrotic tissue-density pulmonary mass involving both the upper and lower right lobes. Chest MRI showed signal abnormality of the third thoracic vertebral body and the greater trochanter, consistent with metastatic lesions. Clinical and radiological findings were strongly suggestive of lung cancer. Diagnosis of pulmonary blastomycosis was made by visualization of yeast in bronchial biopsies and further confirmed by culture of bronchoalveolar lavage specimens. The patient was treated with itraconazole and his clinical condition improved markedly. Pulmonary blastomycosis is unusual in Africa and that fact caused a considerable delay in diagnosis. We suggest that this disease may be more common in Africa than has been previously suspected.

[Last discovery of a congenital broncho-oeso-phageal fistula]. / Fistule broncho-oesophagienne congenitale de revelation tardive.

BACKGROUND: Broncho-oesophageal fistula is rare and occurs mostly in acquired condition. AIM: Report of a new case. 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.

[Isolated bilateral pulmonary occlusion]. / Sténose bilatérale isolée des artères pulmonaires.

BACKGROUND: Takayasu's arteritis (TA) is an unusual cause of bilateral and isolated pulmonary artery occlusion that may be difficult to distinguish from other aetiologies. AIM: Report a new case of isolated bilateral pulmonary occlusion. OBSERVATION: 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 oxygen-dependant. CONCLUSION: 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 angiographic arguments.

Inflammatory process of CD8+ CD28- T cells in induced sputum from asthmatic patients.

Previously unreported CD8(+) CD28(-) and CD8(+) CD28(+) T-cell subsets occur in healthy individuals and expand in patients suffering from autoimmune disease. Here we studied, for the first time, the expression of CD8(+) CD28(+) , CD8(+) CD28(-) , and CD8(+) CD56(+) subpopulations in induced sputum from asthmatics. Using sputum samples, purified CD8(+) T cells were stained for surface antigen CD28, CD56, FITC-conjugated anti-perforin, and anti-IFN-gamma. Cytotoxic activity was evaluated in a chromium releasing test. Induced sputum CD8(+) CD28(-) T cells were found to be more expanded and expressed low levels of IFN-gamma in severe asthmatics than mild asthma and age-matched healthy controls. The predominance of CD8(+) CD28(-) T cells can be in part explained by the expansion of CD8(+) CD56(+). CD8(+) CD28(-) T cells from severe asthmatics produced high intracytoplasmic perforin and exerted a potent cytotoxic activity. Considering their phenotyping and functional properties, the CD8(+) CD28(-) T-cell subset may constitute an intermediate phenotype in the process of CD8(+) T-cell differentiation of effector-type cells in severe asthmatics. Functional studies showed that CD8(+) CD28(-) T cells had cytotoxic function.