[An exotic non-tropical lung disease]. / Une pneumopathie exotique non tropicale.

We report a case of pulmonary blastomycosis in a young man recently returned from a journey in Canada. He had acute pneumonia resistant to various antibiotics. Blastomycosis is an endemic mycosis in Canada and the United States, most frequently affecting the lungs, although extrapulmonary dissemination occurs in approximately one third of cases. Diagnosis is made by identification of Blastomyces dermatidis at direct examination or in culture. The lack of precise knowledge concerning the natural habitat of this microorganism is an obstacle to effective prevention.

[A rare cause of superior vena cava syndrome: extramedullary plasmocytoma]. / Une cause rare de syndrome cave supérieur: le plasmocytome extramédullaire.

We report the case of a 79-year-old man for whom investigations of superior vena cava syndrome have revealed extramedullary plasmocytoma. Extramedullary plasmocytoma (EMP) is the less frequent form of plasma cell neoplasms. The mediastinal location of EMP is rare, and its compressive nature is exceptional. Another particular feature we observed is that the EMP was associated with an authentic kappa light chain multiple myeloma.

[American pulmonary histoplasmosis. Prospective study with 232 soldiers after a 2-year assignment in Guiana]. / Histoplasmose pulmonaire americaine. Etude prospective chez 232 militaires ayant effectue un sejour de 2 ans en Guyane.

The purpose of this report is to describe the results of a prospective study on pulmonary histoplasmosis in French Guiana. Chest radiographs were performed in 232 French legionnaires returning from a two-year assignment in French Guiana. Further examinations were performed in a total of 8 subjects in whom chest radiographs demonstrated the presence of nodules in the lungs. No evidence of cancer or tuberculosis was found. Findings confirmed histoplasmomas in two cases and demonstrated probable histoplasmosis nodules in 6 cases including three involving calcified lesions. Five of these eight patients had been in high-risk rain forest environments. Pulmonary histoplasmosis should be considered as a possible diagnosis in subjects returning from endemic zones. Confirmation depends on a spectrum of findings. Calcified nodules require only radiographic surveillance with follow-up at six months. Non-calcified nodules require further investigation including CT-scan, bronchoscopy, and serological tests. Surgical biopsy may be necessary to achieve exact histological and mycological identification of the lesion and is recommended in smokers.

[Disseminated histoplasmosis caused by Histoplasma capsulatum with cerebral involvement occurring 13 years after the primary infection]. / Histoplasmose disséminée à Histoplasma capsulatum avec atteinte cérébrale survenue 13 ans après la primo-infection.

A 49-year-old man with disseminated histoplasmosis (pulmonary and central nervous system involvement) successfully treated with ketoconazole and fluconazole combination is reported. Histoplasma capsulatum infection of the central nervous system is extremely rare in France partly because the organism is not endemic. Oral treatment with newer triazoles may be useful for central nervous system histoplasmosis, but additional information is needed to establish their effectiveness.

[Cyclophosphamide-induced interstitial pneumopathy. Course data of bronchoalveolar lavage apropos of a case and review of the literature]. / Pneumopathie interstitielle liée au cyclophosphamide. Données évolutives du lavage broncho-alvéolaire à propos d'un cas et revue de la littérature.

A patient treated with cyclophosphamide for breast cancer developed functional and clinicoradiological signs of sub-acute diffuse interstitial pneumopathy. Bronchoalveolar lavage revealed lymphocyte alveolitis. Differential diagnoses were excluded and the course was favorable after cyclophosphamide withdrawal. The bronchoalveolar lavage results obtained initially and at follow-up and two previous lavages reported in the literature demonstrate the importance of this examination in the diagnosis of drug-induced pneumopathy.

[Acute complication of a composite graft replacement of the aortic root]. / Complication aiguë d'une prothèse de l'aorte ascendante.

A 78-year old man operated for an acute aortic dissection 8 years ago was hospitalized for an unusual clinical presentation with acute cor pulmonale and superior vena caval syndrome. He had poorly controlled high blood pressure, and coronary artery disease with aorto-coronary by-pass 10 years ago. He underwent Bentall procedure 2 years later for type I acute aortic dissection, with vein graft reimplantation on the valvular conduit. A pseudoaneurysm was noted in the post-operative period, which remained stable at 45 mm during the follow-up. Thoracic CT-scan highlighted a 14.5 cm diameter pseudoaneurysm compressing the superior vena cava and right pulmonary artery. Detached right aorto-coronary by-pass, suspected on transesophageal echocardiography, was confirmed peri-operatively; the aortic anastomosis blood in the peri-prosthetic space, explaining the acute clinical picture. The severity of the lesions did not permit surgical repair and the patient died during operation. This observation evidences the complications observed after aortic root replacement and favors echographic and radiological follow-ups (J Mal Vasc 1999; 24: 381-383).

[An unusual tumor of the mediastinum]. / Une tumeur du médiastin inhabituelle.

We report a case of dual parathyroid adenoma associated with an ectopic gland in the right latero-esophageal region of the mediastinum revealed by asymptomatic hypercalcemia. Because of this dual localization and the lack of MBI uptake on the mediastinal scintigram, thoracotomy was used as the first line approach instead of cervicotomy.

[The eosinophilic lung]. / Le poumon eosinophile.

Eosinophilic lung disease comprises a diverse group of disorders characterized by eosinophilic pulmonary infiltration in association with other inflammatory cells. In patients with respiratory symptoms, usually associated with radiographically documented infiltrates, blood eosinophilia is a helpful but inconsistent diagnostic finding. Currently diagnosis is confirmed more often by bronchoalveolar lavage than by lung biopsy. Possible etiologies include parasites, mycotic agents, drugs, and angeitis. Remaining cases are classified as idiopathic eosinophilic lung disease including Carrington's disease, idiopathic hypereosinophilic syndrome, acute eosinophilic pneumonia, and Loeffler's syndrome. Mild eosinophilia is also a possible finding of bronchoalveolar lavage in several other disorders but the role of eosinophils is less important. The prognosis and treatment of eosinophilic lung disease varies depending on etiology. Corticosteroids are frequently used but treatment modalities also depend on etiology.

[Idiopathic chronic eosinophilic pneumonia]. / La pneumonie chronique idiopathique a eosinophiles.

Idiopathic chronic eosinophilic pneumonia is a rare disease first described by Carrington 30 years ago. The cause is unknown. As illustrated by the case described in this report, most cases occur in asthmatic patients in the fifth decade of life. Cardinal features are respiratory symptoms, altered general status, laboratory evidence of inflammation, blood eosinophilia in most cases, and x-ray images showing the presence of infiltrates in both lungs. Diagnosis can be confirmed by detection of eosinophils in broncho-alveolar lavage fluid. Extrapulmonary involvement is uncommon and is suggestive of Churg and Strauss syndrome. In atypical cases, diagnosis requires histological study demonstrating infiltration of interstitial tissue and alveolar spaces. Differential diagnosis can be difficult since several disorders identified within the last 10 years are nosologically similar, e.g. acute eosinophilic pneumonia. In many cases, diagnosis is based on response to corticosteroid treatment which is highly effective on idiopathic chronic eosinophilic pneumonia. Frequent recurrence leads to corticosteroid dependence in 20 to 30% of cases.

[American pulmonary histoplasmosis caused by Histoplasma capsulatum]. / L'histoplasmose pulmonaire américaine à Histoplasma capsulatum.

American pulmonary histoplasmosis is a deep mycosis imported from North America caused by the inhalation of Histoplasma capsulatum. It is endemic in several countries throughout the world and occasional cases have been reported in France, mainly imported from out lying French territories. The most frequent clinical forms observed in immunocompetent subjects are generally benign or silent and usually limited to a fortuitously discovered pulmonary nodule. Massive exposure may lead to an acute primary invasion producing a miliary aspect. Chronic forms simulating tuberculosis are exceptional. Inversely, opportunistic histoplasmosis in AIDS patients can produce an severe multiple organ disease. Ideally, mycelium should be isolated for diagnosis, a task which is easier in disseminated or operated nodular forms. More often, the epidemiological context, clinical and radiological features, the elimination of differential diagnoses and, retrospectively, serology are sufficient for diagnosis. The clinical course is usually favorable. Itraconazole is the treatment of choice for symptomatic or complicated forms.

[Benign mediastinal opacity: Castleman disease, apropos of a case and review of the current literature]. / Une opacité médiastinale bénign. Maladie de Castleman, á propos d'une observation et revue récente de la littérature.

We report a case of fortuitously observed Castleman's disease. An mediastinal opacity was observed on the chest x-ray. At surgery, the apparently benign tumor was well individualized. Pathology reported Castleman's disease. Pathogenesis is unknown. Recent data on localized and more diffuse forms of this disease are presented. Diffuse forms occur more readily in immunodepressed patients.

[Travel and patients with allergies]. / Le voyage du sujet allergique.

By changing their surroundings and lifestyle, travelers with allergic conditions exposed themselves to new risks. The main perennial allergens are house dust mites which thrive in tropical areas and can be especially sensitizing. The risk of seasonal reactions to grass-pollens varies from region to region. Reactions to some highly sensitizing respiratory allergens can occur in travelers who return to regions where they were previously exposed. Subjects with food allergies should beware of possible reactions to ingredients in exotic dishes. The bites of several insects can cause anaphylactic reactions. Some medications required for tropical travel (e.g. antimalarial drugs) can trigger severe hypersensitivity reactions. Avoidance of allergens is more difficult during travel. Travelers with allergic conditions should carry alert identification cards and medications for routine as well as emergency treatment including self-injectable adrenaline.

[Travel and chronic respiratory insufficiency]. / Le voyage de l'insuffisant respiratoire chronique.

Changes in climate, altitude and lifestyle during travel confronts patients presenting chronic respiratory insufficiency with special problems. A major challenge is related to high altitude during air travel. To limit risks, a preflight examination is necessary to ascertain respiratory status. Patients requiring oxygen therapy must ensure availability both during the flight and at the destination. Patients with asthma or chronic bronchitis must bring along a sufficient supply of usual inhalers. All patients should carry a doctor's letter describing their condition and listing medications. Using these elementary precautions, patients with chronic respiratory insufficiency can safely enjoy sightseeing and outdoor leisure activities.

[A tropical pulmonary nodule]. / Un nodule pulmonaire "tropical".

The authors report a case of american pulmonary histoplasmosis discovered by chance on a chest radiograph in a non immunocompromised patient, back from a stay in French Guyana. Confronted with the negativity of usual mycotic research, diagnosis has been made thanks to wedge excision by video-assisted thoracic surgery. The authors briefly sum up the recent facts regarding this imported infection, stressing the interest of a direct approach by surgical practices not very invasive that allow to eliminate with certainty neoplasm or tuberculosis.