[Diagnostic means for tuberculosis]. / Les moyens diagnostiques de la tuberculose.

Tuberculosis is a public health problem. In recent years, there is a change in the epidemiological profile of tuberculosis. The diagnosis of tuberculosis is based on clinical and radiological arguments but confirmation is bacteriological and/or histological. Culture remains the gold standard. Technological progress especially in molecular biology provides the clinician now new means of tuberculosis diagnostics.

[Association of pulmonary carcinoma and ductal breast cancer]. / Association d'un carcinome pulmonaire et d'un cancer canalaire du sein.

Multiple primary cancers are relatively rare. The association between lung and breast cancer is exceptional and requires genetic research and predisposing factors. We report the case of a female patient of 43years, hospitalized for atelectasis of the left lung with breast lumps. Bronchial biopsies have concluded a primary lung adenocarcinoma. Breast biopsy objectified ductal invasive breast cancer. The treatment was a palliative chemotherapy. The evolution is marked by the early death of the patient. Although the association of multiple cancers is rare, their discovery requires a particular treatment regimen depends on the staging of each cancer.

[Small cell lung cancer associated with paraneoplastic bullous pemphigoid]. / Cancer pulmonaire à petites cellules associé à une pemphigoïde bulleuse paranéoplasique.

The broncho-pulmonary small cell carcinoma is the most common cancer provider paraneoplastic syndrome especially neurological and endocrine but also cutaneous syndrome. Paraneoplastic dermatosis do not result from a direct extension of cancer and are not metastases, but their presence is suggestive of an underlying tumor. The evolution of the dermatosis is parallel to that of cancer: treating cancer results in the regression of cutaneous manifestations. We report an observation of a 44-year-old smoker, who was hospitalized for a tissue excavated process associated with bullous dermatosis. The transmural puncture biopsy finds small cell carcinoma. The skin biopsy objective bullous pemphigoid. The evolution under chemotherapy was marked regression of bullous lesions and the patient died later after metastatic extension. Cutaneous paraneoplastic syndrome appears only in a minority of cancer patients, but its recognition is very important for early diagnosis.

[The "DRESS" syndrome in antituberculosis drugs]. / Le « DRESS ¼ syndrome aux antituberculeux.

The DRESS syndrome is a serious drug reaction that may involve life-threatening. We have to think before any skin reaction after taking drugs. We report a clinical case of a 27-year-old patient treated for pleural tuberculosis with the DRESS syndrome induced by antituberculosis. Through this work, we underline the rarity of this syndrome to antituberculosis treatment, but it should not be underestimated.

[Diffuse infiltrative lung disease in scleroderma. Analysis of radio-clinical and functional semiology]. / Pneumopathie infiltrante diffuse (PID) de la sclérodermie. Analyse de la sémiologie radioclinique et fonctionnelle.

Scleroderma (SD) is a systemic disease that predominantly affects the skin. Diffuse infiltrative lung disease (DILD) is rare and occurs most often in the course of the disease. We analyzed seven cases of DILO of SD recorded between 2003 and 2010 among 196 PID (3.6%). Functional signs were limited to respiratory dyspnea, it was associated to dysphagia in six cases, dry syndrome in five cases and Raynaud's phenomenon in four cases. Clinical examination found crackles in the bases of the thorax in all cases and specific cutaneous signs in six cases. The chest radiograph showed that interstitial disease predominates at the lung bases in all cases with a large aspect of the pulmonary arteries in two cases. The chest CT scan confirmed the predominance of basal and peripheral damage with signs of fibrosis in six cases. The pulmonary function objectified a severe restrictive ventilatory defect in all cases. Bronchoscopy showed a normal macroscopic appearance in all cases, the broncho-alveolar lavage was predominated by neutrophilic formula in four cases. SCL 70 antibodies were positive in four cases. All patients were treated by steroids with improvement of dyspnea and stabilization of radiographs. A patient had died in an array of acute respiratory failure and one patient was lost to follow-up. DILD in scleroderma is rare and seldom reveals the disease, it affects the patient's prognosis especially when associated with arterial pulmonary hypertension.

[Imaging of hydatid cyst of the lung]. / Analyse de la sémiologie radioclinique du kyste hydatique pulmonaire.

The pulmonary hydatid cyst is frequent in Mediterranean countries such as Morocco. Our analytic study concerned 70 cases of lung hydatid cysts collected from 2007 to 2010. Mean age was 35years and we noted a male predominance (53%). Forty-seven percent of patients belong to rural environment where 64% of them were in contact with dogs. The respiratory symptomatology was made mostly by cough (86%) and chest pain (70%). Diagnosis was based on radioclinical arguments with positive hydatic serology in some cases. The cyst was single in 84% of the cases, safe in 55% of the cases. The location in the right lung was dominant with a major affection of the right lower lobe. Conventional surgery was indicated in 67 cases. The liver hydatid cyst was discovered in 20% of cases and treated at the same time phases in 71% of cases. The evolution was good in 73% of the cases and marked by a recurrence in three of the operated cases.

[Pott's disease (about 16 cases)]. / Mal de Pott (à propos de 16 cas).

INTRODUCTION: Pott's disease or spinal tuberculosis is rare, but represents the most common form of osteo-articular tuberculosis in endemic countries. MATERIAL AND METHODS: [corrected] From January 2000 to December 2010, we collected 16 cases of Pott's disease. We analyzed clinical and radiological profile, means of confirmation and treatment. RESULTS: Spinal and chest pain were the most frequent signs. Four patients had neurological signs. The diagnosis was made by the detection of bacillus in the pus of paravertebral abscess in six cases, by histological study of vertebral biopsy in five cases, biopsy of another associated lesion in one case and in front of radio-clinical arguments with good clinical evolution under antibacillary treatment in four cases. The antibacillary treatment associating four drugs was indicated and correctly followed by all patients. Surgical drainage was associated in five cases. The evolution was good in all cases. DISCUSSION: Diagnosis of Pott's disease is late when there is no neurological sign. Imaging allows to make early diagnosis with MRI. Prognosis is good when treatment is started early.

[Multicystic lung revealing a Sjogren's syndrome]. / Poumon multikystique révélant un syndrome de Gougerot-Sjögren.

The Sjogren's syndrome is a chronic inflammatory autoimmune disease that affects primarily the exocrine glands, but can affect other organs particularly the lungs. Cystic lung disease is very significant but exceptionally recounted in the literature. We report the case of a patient, 54 years old, whose disease was discovered incidentally after a routine chest radiograph. The diagnosis of cystic lung revealing a primary Sjogren's syndrome was held before a group of radio-clinical, immunological and histological arguments. Through our observation, the diagnosis of Sjogren's syndrome should be included in the list of diagnoses to raise in a multicystic lung.

[Scarf pin: a new intrabronchial foreign body]. / L'épingle à foulard: un nouveau corps étranger intrabronchique.

OBJECTIVES: The aim of this study was to illustrate the dangers of holding a scarf pin in the mouth and to describe the particular characteristics of the aspiration of a potentially penetrating foreign body and its management. PATIENTS AND METHODS: Sixteen cases of inhaled scarf pins were recorded in 2 years. They were all young girls, all veiled with a mean age of 16.6 years. The patients put the pin between their lips while fixing their scarves. Inhalation was accidental in all cases. RESULTS: The most common presentation after inhalation was a penetration syndrome (66.7 %). The localization of the foreign body was significantly more frequent in the right bronchial tree (68.7 %). The delay between inhalation and admission to the service ranged from some hours to 15 days with a mean of 2.6 days. Extraction using flexible bronchoscopy was successful in 10 cases. The use of rigid bronchoscopy was required in one case. A spontaneous expulsion of the scarf pin occurred in five cases. CONCLUSION: Scarf pin inhalation is a potential cultural hazard in women who wear the Islamic headscarf. Careful handling of these potentially sharp objects away from the mouth can prevent such accidents.

[Pleural fibroma revealed by hypoglycemia]. / Fibrome pleural révélé par une hypoglycémie.

Pleural fibroma or solitary fibrous tumor of the pleura (SFTP) is a rare tumor generally discovered fortuitously or in patients with non-specific respiratory symptoms, more rarely with hypoglycemia. We report the case of a 51-year-old man with a history of smoking (30 pack-years) and no other disease history whose chest x-ray revealed an enormous opacity occupying the lower two-thirds of the left hemithorax. This radiological anomaly had led to episodes of lipothymia three months earlier together with mental confusion in the morning as well as an episode of hypoglycemia (0.48 g/l) which rapidly resolved after administration of hypertonic dextrose. Ultrasonography and chest scan were performed later and confirmed the tissular nature of the opacity which was well limited with a left base. Minimally abundant homolateral pleural effusion was also noted. The diagnosis of SFTP revealed by hypoglycyemia was the most probably diagnosis. Emergency thoracotomy enabled removal of a hard tumor weighing 2115 g. Histology confirmed the diagnosis of benign SFTP. Hypoglycemia in the context of SFTP would be related to tumor secretion of insulin-like proteins. Complete emergency resection is required to avoid the risk of life-threatening hypoglycemia.