[Pulmonary actinomycosis with chest wall fistula formation in a child]. / Actinomycose pulmonaire fistulisée à la paroi thoracique chez un enfant.

INTRODUCTION: Actinomycosis is a suppurative infection caused by bacteria of the Actinomyces genus. It is a rare cause of pulmonary infection and can be difficult to diagnose because its presentation may mimic tuberculosis or cancer. In the absence of treatment of pulmonary lesions fistulae can develop. We report a case of thoracic actinomycosis with chest wall involvement in a child, managed in the pediatric department at Moulay Youssef University Hospital in Rabat, Morocco. CASE REPORT: We report the case of a 13-year-old boy with a history of trauma to the right chest 1 year earlier, admitted with right-sided chest wall swelling with cutaneous fistulae. Physical examination identified a parietal mass with fistulization to the skin. Laboratory tests showed an inflammatory syndrome. The chest x-ray revealed moderate right pleural effusion. The thoracic computed tomography scan showed a right parietal pleural mass and the percutaneous biopsy confirmed the diagnosis of actinomycosis. The patient underwent antibiotic therapy with favorable evolution. CONCLUSION: The diagnosis, the clinical, radiological and histological pattern, and the therapeutic features are described in this report.

[Mantoux test: what threshold? For what purpose?]. / Test de Mantoux: quel seuil? Pour quel but?

The tuberculin skin test (TST) is a widely used diagnostic test, but its interpretation depends on the cut-off used for positivity. This study determined the threshold value of positivity of TST when screening for tuberculosis infection and when directly diagnosing tuberculosis disease. We conducted a prospective study over 2 years among 174 patients with confirmed tuberculosis and 205 healthy controls recruited at Moulay Youssef Hospital, Rabat, Morocco. Participants underwent the TST and the diameter of induration was measured after 72 hours. A second reading was made after 5 and 7 days in patients > 65 years when the test was negative. Using the ROC curve we determined 2 thresholds of positivity for TST: 9 mm had a 68% sensitivity and 78% specificity, and 13 mm a 54% sensitivity and 90% specificity. Thus 9 mm is sufficient to diagnose tuberculosis infection, but 13 mm is needed to diagnose tuberculosis disease.

[An unusual cause of hemoptysis: a leech]. / Cause inhabituelle d'hémoptysie: la sangsue.

We report an exceptional case of hemoptysis observed in a 71-year-old woman with an uneventful past history. After 48 hours of admission, the patient spontaneously expelled a leech from the nose. The parasite was examined in parasitology laboratory, which confirmed the hemiptera. The infestation of the airway by a leech is not uncommon; however, this diagnosis is rarely mentioned. The clinical symptoms are variable depending on location and the diagnosis should be made rapidly to prevent complications. Whatever the localization, removing the parasite is difficult. Evolution after treatment is rapidly favorable, with complete disappearance of symptoms.

Mantoux test: what threshold? For what purpose?

The tuberculin skin test [TST] is a widely used diagnostic test, but its interpretation depends on the cut-off used for positivity. This study determined the threshold value of positivity of TST when screening for tuberculosis infection and when directly diagnosing tuberculosis disease. We conducted a prospective study over 2 years among 174 patients with confirmed tuberculosis and 205 healthy controls recruited at Moulay Youssef Hospital, Rabat, Morocco. Participants underwent the TST and the diameter of induration was measured after 72 hours. A second reading was made after 5 and 7 days in patients > 65 years when the test was negative. Using the ROC curve we determined 2 thresholds of positivity for TST: 9 mm had a 68% sensitivity and 78% specificity, and 13 mm a 54% sensitivity and 90% specificity. Thus 9 mm is sufficient to diagnose tuberculosis infection, but 13 mm is needed to diagnose tuberculosis disease

Mantoux test: what threshold? for what purpose?

The tuberculin skin test [TST] is a widely used diagnostic test, but its interpretation depends on the cut-off used for positivity. This study determined the threshold value of positivity of TST when screening for tuberculosis infection and when directly diagnosing tuberculosis disease. We conducted a prospective study over 2 years among 174 patients with confirmed tuberculosis and 205 healthy controls recruited at Moulay Youssef Hospital, Rabat, Morocco. Participants underwent the TST and the diameter of induration was measured after 72 hours. A second reading was made after 5 and 7 days in patients > 65 years when the test was negative. Using the ROC curve we determined 2 thresholds of positivity for TST: 9 mm had a 68% sensitivity and 78% specificity, and 13 mm a 54% sensitivity and 90% specificity. Thus 9 mm is sufficient to diagnose tuberculosis infection, but 13 mm is needed to diagnose tuberculosis disease

[A rare form of rifampicin-induced skin toxicity: bullous pemphigoid]. / Une forme rare de toxidermie induite par la rifampicine: la pemphigoïde bulleuse.

INTRODUCTION: Rifampicin is an antituberculous drug causing minor cutaneous reactions. Rifampicin-induced bullous skin reactions are rare. CASE REPORT: We describe a 48-year-old man who was given rifampicin, streptomycin, isoniazid and pyrazinamide for pulmonary tuberculosis. Seventy-two hours later, he developed generalized pruritus, and an urticarial eruption developed 5 days later. He was admitted to hospital and the drugs were discontinued. He could remember no history of previous administration of antituberculous drugs and no other drugs had been taken recently. General physical examination yielded no relevant findings. On dermatological examination, Nikolsky's sign was negative. There were tiny symmetrical cutaneous vesicles overlying normal skin of all four limbs. These rapidly became confluent, forming large tense bullous lesions containing clear fluid, suggesting bullous pemphigoid. Blood tests showed a neutrophil leukocytosis and mild eosinophilia. Other biological tests were normal. Skin biopsy was refused by the patient. He was given intravenous antihistamine and dry bandages were applied to the forearms and legs. The antituberculous drugs were discontinued for two weeks and the lesions healed spontaneously. The drugs were then progressively reintroduced, streptomycin being excluded initially. A few hours after the first dose of rifampicin, a recurrence was noted and it was substituted by ethambutol. Subsequent introduction of streptomycin was uneventful. No recurrence occurred over 18 months follow up. CONCLUSION: The authors describe a rare case of rifampicin-induced skin toxicity and the related diagnostic and therapeutic difficulties.

[The pseudoalveolar form of sarcoïdosis: a diagnostic pitfall]. / La forme pseudo-alvéolaire de la sarcoïdose: un piège diagnostique à ne pas méconnaître.

BACKGROUND: Sarcoïdosis is a benign systemic granulomatosis whose aetiology remains unknown. Lung is the most frequently involved organ. The pseudoalveolar form of this disease is known to have an acute onset and is quite uncommon. Therefore, diagnosing such a rare variety of sarcoidosis is rather often challenging. OBSERVATIONS: In the present article, the authors report two cases of pseudoalveolar sarcoidosis. The patients, both young adults, showed no suggestive signs of sarcoidosis at first presentation. This resulted in a considerable delay to diagnosis and to the corticosteroid therapy. CONCLUSION: The authors emphasize the rarity of the pseudoalveolar form of sarcoidosis. They insist on its roentgenographic characteristics and demonstrate the functional benefits allowed by the precocious medical management. They also propose a current review of the literature.

[Multifocal tuberculosis (palpebral and pleural) in an immunocompetent woman]. / Tuberculose multi-focale (palpébrale et pleurale) chez une immunocompétente.

INTRODUCTION: Tuberculosis of the eyelid and its development in the setting of multifocal tuberculosis is exceptionally rare. CASE REPORT: The authors report a new observation of multifocal tuberculosis in a non-immunosuppressed woman of 28 years with histologically confirmed pleural and palpebral involvement. A paradoxical reaction was seen following the initiation of anti-tuberculous treatment with appearance of new manifestations (thoracic cold abscesses). CONCLUSION: The authors draw attention to this rare localisation and to the paradoxical reactions during treatment, emphasising the need for early diagnosis to avoid local and remote complications.

[Congenital esophagobronchial fistula in an adult. Case report]. / Fistule oeso-bronchique congénitale chez l'adulte. A propos d'un cas.

Congenital esophagobronchial fistulae are uncommon anomalies generally discovered during the neonatal period due to overt symptoms. Rarely symptoms are discrete, leading to discovery in adulthood; exceptionally the patients are totally symptom free or present minimal signs such as coughing at ingestion of fluids. Less than 200 adult cases have been reported in the literature. We report a new case of this type II congenital esophagobronchial fistula. A 59-year-old woman was hospitalized for exploration of cough at ingestion of fluids. The radiographic work-up reveal dilatation of the left bronchial tree and suspected esophagobronchial fistula. An esophago-gastro-duodenal barium study demonstrated a fistula between the mid esophagus and the left posterobasal bronchus. Fistulectomy and left lower lobectomy were performed. Outcome was favorable. The diagnosis of adult esophagobronchial fistula should be entertained in patients with an uneventful history who present localized bronchial dilatation associated with cough induced by fluid ingestion.

[Associated rhinosinus and pleural sarcoidosis]. / Association de localisations rhino-sinusienne et pleurale au cours d'un cas de sarcoïdose.

Sarcoidosis manifestations in the upper airways and pleura are exceptional, observed in 5% and 1% of cases. We report an exceptional observation of an association of these two localizations in addition to mediastinopulmonary involvement. After confirmation of the diagnosis obtained on bronchial biopsies and nasal mucosa biopsies, pleural sarcoidosis was retained because of the clinical context and the spontaneous resolution of the effusion. The major problem is the absence of a therapeutic consensus on proper management, oral corticosteroid therapy being proposed by some for these particular forms of sarcoidosis.

[Chronic atrophic polychondritis. A case report]. / Manifestations respiratoires de la polychondrite atrophiante.

Chronic atrophic polychondritis is a rare systemic disease characterized by recurring inflammation of cartilage of the ear, nose, larynx and of the tracheobronchial tree. Nowadays, it is considered to be an autoimmune disease. The case of a 25-year-old female patient hospitalized in our department for treatment of a dyspnea is herein presented. ORL laryngoscopic examination revealed a small sized larynx with a pronounced narrowing of its lumen and very "floppy" cartilage. Bronchoscopic findings were a circumferential stenosis along the entire trachea and the right major bronchi. Results from biopsies performed on the trachea and thyroid cartilage were in favor of chronic atrophic polychondritis. The course of the disease was characterized by an aggravation of the dyspnea with episodes of asphyxia resulting in a tracheotomy. The tracheotomy has not been closed to this day, due to the underlined disease of the patient.

[Epithelioid malignant peripheral nerve sheath tumor. A case report]. / Tumeur maligne des gaines des nerfs périphériques type épithélioïde. A propos d'un cas.

Malignant peripheral nerve sheath tumors (MPNST) are exceptional and painful. The typical localization along a peripheral nerve is not always present. Prognosis is very poor. Diagnosis is particularly difficult because of the variable pathological presentation and unpredictable differentiation. We report an exceptional case of epithelioid differentiation in a 43-Year-old patient who complained of right thoracic pain for one and a half Years. Physical examination revealed weight loss and a paravertebral mass under the scapula. The chest x-ray showed a suprahilar opacity suggestive of parietal involvement and lysis of the sixth rib. Surgical biopsy of the parietal mass led to the diagnosis of epithelioid MPNST.

[Cystic adenoid carcinoma of the trachea]. / Carcinome adénoïde kystique trachéal. A propos de trois cas.

Cystic adenoid carcinoma (CAC) of the trachea, also called cylindroma, is a rare malignant tumor accounting for 1 per thousand of all respiratory tract cancers. We report three cases of cylindroma in patients hospitalized for inspiratory dyspnea due to a tracheal tumor. Bronchoscopy using a rigid tube revealed a smooth tumor of the trachea. Pathology analysis of the biopsy specimen diagnosed CAC. The three patients underwent resection with end-to-end anastomosis. Adjuvant radiotherapy was given in one patient. The short-term outcome was good but one patient developed local recurrence and lung metastasis at six years.

[Pulmonary leptospirosis. Two cases]. / Atteinte pulmonaire au cours de la leptospirose. A propos de deux cas.

Leptospirosis is a systemic infection transmitted to man by a variety of animals. Classical manifestations include fever, liver and renal involvement, meningoencephalitis and hemorrhage. Pulmonary involvement is less common, generally expressed by hemoptysis and bilateral reticulonodular infiltration on the chest x-ray. Pulmonary disease is one of the principal causes of mortality. We report the cases of two patients aged 22 and 32 years who were hospitalized for moderately abundant hemopysis and fever. The diagnosis of leptospirosis with pulmonary involvement, strongly suggested by the classical extrapulmonary signs and was confirmed later. The patients were given antibiotics (amoxicillin, cycline). Clinical, biological and radiological outcome was favorable.