La miliaire tuberculeuse : a propos de 29 cas

La miliaire tuberculeuse (MT) est une forme grave de tuberculose; secondaire a la dissemination hematogene de Mycobacterium tuberculosis. Le but de ce travail est d'evaluer les aspects epidemiologiques; cliniques et evolutifs des MT. Il s'agit d'une etude retrospective portant sur 29 malades atteints de MT et ages en moyenne de 38 ans. Les principaux facteurs favorisants ont ete le diabete (24) et l'ethylisme (17). Les principaux signes respiratoires ont ete la toux; les expectorations et la dyspnee ; et extra-thoraciques; les cephalees; les signes urinaires et les douleurs abdominales. Sur la radiographie thoracique; l'image de miliaire a ete notee chez 72des malades. D'autres aspects associes ont ete notes a type de cavernes (24); d'adenopathies mediastinales (17;3) et d'opacites sequellaires (10;3). Les recherches de bacilles de Koch (BK) dans les crachats se sont revelees positives dans 55des cas. Le diagnostic positif a ete porte sur des donnees bacteriologiques dans 17 cas; histologiques dans 4 cas; des arguments de presomption dans 9 cas ; un patient ayant une confirmation bacteriologique et histologique. Le traitement a comporte quatre antituberculeux; sauf dans trois cas ou elle a ete triple. La corticotherapie a ete prescrite dans 6 cas. L'evolution a ete bonne dans 28 cas avec amelioration clinique et negativation des recherches de BK dans les crachats. Un deces est survenu suite a une hepatite fulminante. La MT necessite une demarche diagnostique reflective et une prise en charge rapide afin d'ameliorer son pronostic

[A rare localization of solitary plasmocytoma]. / Une localisation rare de plasmocytome solitaire.

INTRODUCTION: Solitary bone plasmocytoma is rare, characterized by malignant plasmocyte proliferation, derived from a sole B lymphocyte clone located on a bony segment without medullar invasion. It, above all, affects the thoracolumbar spine. Costal involvement is rarely described. CASE REPORT: The authors report the case of a 60-year-old man who complained of dyspnea, dry cough, and thoracic pain four months before admission. Thoracic imaging revealed a left apical tissue mass with osteolysis of the first rib. A transparietal biopsy of the mass was not helpful. Surgical biopsy concluded as to the diagnosis of costal plasmocytoma. All of the examinations carried out to search for other localizations were negative confirming the solitary nature of the tumor. The treatment consisted of complementary radiotherapy at a dose of 45Gy. The patient was in remission after eight months. CONCLUSION: Solitary costal plasmocytoma should be called to mind when confronted with a lytic tumor of the rib. The treatment is based on surgery and radiotherapy. The prognosis is dominated by the risk of progression to multiple myeloma.

[An anterior mediastinal mass of rare etiology]. / Masse médiastinale antérieure d'étiologie rare.

Hydatid cyst of the mediastinum is very uncommon. The diagnosis, usually evident in endemic regions in the case of a typical clinical-radiological presentation, is rather more difficult in certain atypical forms. We report a case of a 19-year-old man who presented with a mass of tumour like appearance in the anterior mediastinum. The diagnosis of mediastinal hydatid cyst was established by transthoracic needle biopsy and endoscopic bronchial aspiration revealed hydatid membranous debris. The diagnosis was confirmed when the mediastinal cyst ruptured into a bronchus. Thoracotomy was carried out with an uneventful post-operative recovery. This observation illustrates the diagnostic difficulties when a mediastinal hydatid cyst presents the appearances of a tumour. This possibility must be included in the differential diagnosis of every mediastinal mass, particularly in endemic regions.

[Excavated pulmonary opacity in diabetes]. / Une opacité pulmonaire excavée chez un diabétique.

Mucormycosis or zygomycosis is a group of infections caused by filamentous fungi of the mucorales order belonging to the zygomycetes family. They generally appear in patients with uncontrolled diabetes or immunodepression, especially neutropenic immunodepression. Incidence has increased with progress in immunosuppressive therapy and chemotherapy and the absence of the use of antifungal prophylactic agents effective against mucors. We report the case of a diabetic patient presenting with an excavated opacity in the right lung which failed to improve after receiving non-specific antibiotic treatment. Direct examination of the bronchial washing specimen led to the diagnosis of pulmonary mucormycosis. Prognosis depends mainly on early diagnosis, enabling appropriate treatment with amphotericin B. Mortality remains high, around 80%; diagnosis is commonly established post-mortem.

[Thymoma associated with pure red cell aplasia and Kaposi's sarcoma]. / Association thymome, érythroblastopénie et sarcome de Kaposi.

INTRODUCTION: Thymoma is a rare tumor which represents about 20% of mediastinal tumors. It is associated with several parathymic conditions. A second cancer frequently occurs during long term follow up. CASE REPORT: We report the case of a 59 year-old woman who presented with a two month history of a dry cough. Thoracic imaging revealed a soft tissue mass in the anterior mediastinum with associated bilateral pleural effusion and mediastinal lymphadenopathy. Fibreoptic bronchoscopy was normal. CT guided-biopsy was not contributive. A diagnostic mediastinoscopy was carried out. Histological examination confirmed the diagnosis of thymoma. The patient was treated with 4 cycles of chemotherapy which led to a partial regression of the mass. The course was marked by the occurrence of a pure red cell aplasia requiring corticosteroid therapy which caused the disappearance of the anemia. However, bluish nodules appeared on the patients legs which when biopsied were found to represent Kaposi's sarcoma. The patient was treated with chemotherapy (vinblastine) without any improvement of the cutaneous lesions. CONCLUSION: Our case describes the association of a thymoma, pure red cell aplasia and Kaposi's sarcoma. Immunologic disorders seem to be in the origin of this association.