[Thoracic nocardiasis associated with macrophage activation syndrome]. / Nocardiose thoracique associée à un syndrome d'activation macrophagique.

Nocardiasis is an uncommon bacterial disease often observed in immunodepressed patients. Its interactions with the immune system remain poorly known. We report a case of Nocardia asteroides thoracic nocaridiasis in an African subject who also had macrophage activation syndrome. We recall the classic data on nocardiasis in Africa and emphasize the importance of emergence in HIV-infected subjects. The association between nocardiasis and macrophage activation syndrome suggest a possible pathogenic mechanism involving the immune system (lymphocytes and macrophages) and Nocardia asteroides.

[Cutaneous nodular infection with hemopathy]. / Infection nodulaire cutanée au cours d'une hémopathie.

A 36-year-old man with treated hairy cell leukemia developed a skin infection due to Mycobacterium marinum. A spectrum of atypical cutaneous mycobacteriosis presentations with immunosuppression can be found. The recognition of the disease needs cutaneous biopsies for histopathology and its identification by specific laboratory methods to adapt treatment.

[Lobomycosis: a mycosis seldom observed in metropolitan France]. / La lobomycose: une mycose rarement observée en France métropolitaine.

We report a case of lobomycosis presenting like a cutaneous tumoral lesion in a patient living in Guyana. The causative agent is Loboa loboi. The illness is seldom observed in metropolitan France. The epidemiology, the clinical features, the course and the treatment are studied. The diagnosis is histological, with the morphological features of yeast-like cells.

[Non-Hodgkin lymphoma mimicking renal carcinoma: apropos of 1 case of follicular lymphoma]. / Lymphome non hodgkinien simulant un carcinome rénal. A propos d'un cas de lymphome folliculaire.

Primary renal non-Hodgkin's lymphoma (NHL) is unusual, in contrast to the frequent renal involvement in disseminated NHL. We report a case of follicular lymphoma presenting initially as a renal mass. In the literature, twenty-seven similar cases have been described since 1980. The median age at diagnosis is 64 years with a male predominance. Clinical and radiological findings generally evoke renal carcinoma. Histologically, tumors are usually large B-cell lymphomas. The existence of renal non-Hodgkin lymphoma mimicking renal carcinoma must be recognized. Such lymphomas can either be primitive or be nodal with a renal presentation. Nephrectomy followed by chemotherapy permits long disease free survival.

[Granulomatous gastritis. Apropos of 2 cases]. / Gastrite granulomateuse. A propos de deux cas.

We report two cases of granulomatous gastritis, one unexplained, one in the setting of Crohn's disease. Granulomatous gastritis is an uncommon entity. An etiopathogenetic diagnosis can be reached only by combining the morphological examination with clinical and laboratory investigations. Isolated granulomatous gastritis is a diagnosis of exclusion, distinct from Crohn's disease, sarcoidosis, infections, foreign bodies, malignancy or vasculitis.

[Oral terbinafine-induced plantar pustular psoriasis]. / Psoriasis pustuleux plantaire déclenché par la terbinafine (Lamisil).

BACKGROUND: Cutaneous reactions may occur in patients receiving terbinafine therapy, mainly rash and urticaria. More exceptionally, development of psoriasis has been described. We describe the development of plantar pustular psoriasis in a patient who took oral terbinafine. CASE REPORT: A 70-year-old man, without previously known history of psoriasis, was treated with terbinafine, 250 mg/day, for onychomycosis. Ten days later, a plantar pustular psoriasis appeared. The psoriasis cleared up after discontinuation of terbinafine and institution of antipsoriatic therapy. DISCUSSION: Terbinafine is an antifungal agent widely use in the treatment of onychomycosis. A skin reaction occurs in 3 p. 100 of patients. Only 24 cases of flare-up of previous psoriasis or psoriasis de novo after terbinafine have been described. The psoriasis generally clears after discontinuation of terbinafine. So, terbinafine is perhaps not the best first line therapy for onychomycosis in patients with psoriasis.

[Bronchiolitis obliterans organizing pneumonia or BOOP. Report of a new case, reflections on the concept of BOOP]. / Bronchiolite oblitérante avec pneumopathie organisée ou BOOP. A propos d'une nouvelle observation, réflexion sur le concept de BOOP.

A new case of bronchiolitis obliterans with organizing pneumonia (BOOP) is reported. The clinical, radiographical and histological characteristics of the BOOP are reviewed. It is a rare affection which has been described for a long time but the nosological situation of which among diseases of bronchioles has been only recently established. It corresponds to an unspecific inflammatory answer to a pulmonary aggression and can therefore be observed in numerous circumstances. It may represent a model for the understanding of the mechanisms of pulmonary fibrosis.

Bacillus thuringiensis serotype H34 isolated from human and insecticidal strains serotypes 3a3b and H14 can lead to death of immunocompetent mice after pulmonary infection.

In 1995, we isolated a strain of Bacillus thuringiensis serotype H34 from severe human tissue necrosis. This bacterium was able to induce myonecrosis in immunosuppressed mice after cutaneous infection. Its potential pathogenicity for immunocompetent hosts was investigated in a mouse model of pulmonary infection. Mice infected intranasally by a suspension containing 10(8) spores died within 8 h in a clinical toxic-shock syndrome. In the same conditions, infection with a mutant without crystalline toxin, with the supernatant from a culture containing 10(8) bacteria ml(-1) and by the insecticidal strain serotypes 3a3b or H14 led to identical results. Lower inocula simply induced a local inflammatory reaction with bacterial persistence observed during the course of 10 days.

[Scytalidium dimidiatum pseudodermatophyte, agent of superficial mycoses and phaehyphomycosis]. / Scytalidium dimidiatum pseudodermatophyte agent de mycoses superficielles et de phaehyphomycoses.

Scytalidium dimidiatum is a fungus found mainly in tropical and subtropical zones. Infection can cause a benign disease closely resembling dermatophytosis. In immunocompromised hosts, Scytalidium dimidiatum can also lead to phaehyphomycosis. Although awareness of these hyphae remains limited in developed countries, their incidence is growing due to increasing immigration and tourism. The rising incidence is well illustrated by three patients who presented onyxis and squamous-like manifestations on the arch of the foot upon returning from trips overseas and in whom various treatments were unsuccessful. In all three cases, culture in non-selective Sabouraud medium identified Scytalidium dimidiatum. These findings underline the need for laboratory testing before undertaking local or systemic treatment of onyxis especially since this pathogen can cause systemic disease. Study of ribosome genes showed that Scytalidium hyalinum is an homologous unpigmented mutant form of Scytalidium dimidatum. No antifungal agent has been effective for management of superficial manifestations and prevention depends mainly on the use of appropriate footwear in endemic areas.

[Lymphoepithelial tumor of the skin]. / Tumeur lympho-épithéliale cutanée.

The authors report an additional case of lympho-epithelial tumor. First described in 1987 by Santa-Cruz et al., this tumor, also called cutaneous lymphadenoma, is rare. The mean age is 44. The lesion is generally located on the face and the clinical diagnosis of basal cell carcinoma is most often evoked. The tumor has a peculiar histological feature with cyst-like cavities composed by an epithelial proliferation and intraepithelial lympho-histiocytic cells. It is considered as a benign tumor. Its origin is still discussed but a pilosebaceous nature seems to be accepted.

[Endobronchial granular cell tumor. A report of two cases in the course of staging of ORL cancers]. / Tumeur à cellules granuleuses endobronchique. A propos de deux cas de découverte systématique dans le cadre d'une surveillance de cancers ORL.

We report two new observations of endobronchial granular cell tumor discovering by bronchoscopy, during the staging of head and neck cancers. This site remains exceptional; the histologic features are well known. The ultrastructural and especially the immunohistological criteria trend to indicate a neurogenic histogenesis. Although the course is benign in this site and no malignant forms have been reported, local relapses are possible. However, some benign cases may have disturbing endoscopic and histologic features.

[Phrenic nerve malignant schwannoma: an exceptional diagnosis]. / Schwannome malin du phrénique: un diagnostic d'exception.

We report a case of malignant schwannoma of left phrenic nerve in a 65-year-old man. This uncommon diagnosis was suggested by radiological features and confirmed by histological findings on a needle biopsy and surgery specimens. We discuss management, follow-up and prognosis of malignant schwannomas.

[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.

[Parasitic eosinophilic lungs]. / Les poumons éosinophiles parasitaires.

The eosinophilic lung is a term used to identify a heterogeneous group of parasitic diseases leading to common manifestations including alveolar or tissular pulmonary eosinophilia and, classically, radiological visible lesions of the lung. The different clinical presentations--Löffler's syndrome, larva migrans syndrome and tropical pulmonary eosinophilia are analyzed in this article and the particular features of the different causal parasites are discussed. Positive and differential diagnostic procedures in patients with pulmonary eosinophilia due to mycoses, drugs, vasculitis or an unknown cause are detailed.