[Isolated pleural actinomycosis. Apropos of 2 cases]. / Actinomycose pleurale isolée. A propos de 2 observations.

Two cases of isolated pleural actinomycosis are reported. This form is much less frequent than the pulmonary form, and it accounts for only 20% of thoracic actinomycoses. The bacteriological diagnosis is easily obtainable by pleural puncture, provided it has not been obscured by previous antibiotic therapy and provided the organism has systematically been cultured under anaerobic conditions. Pleural actinomycosis has a very favourable prognosis. Local treatment, sometimes surgical, is indispensable. If the condition is diagnosed at an early stage, systemic antibiotic therapy can be reduced to 6 to 12 weeks.

[Respective frequency and radioclinical features of 150 lung diseases observed in 125 patients with human immunodeficiency virus infection]. / Fréquence respective et aspects radiocliniques de 150 pneumopathies observées chez 125 malades infectés par le virus de l'immunodéficience humaine.

Seventy out of 125 patients with HIV infection had diffuse alveolo-interstitial pneumonia usually caused by an opportunistic infection, notably pneumocystosis. Nineteen patients had only localized lung opacities due either to usual or tuberculous bacterial infections or to Kaposi's sarcoma. In 10 patients with pleural effusion or mediastinal adenopathy, the condition was due to Kaposi's sarcoma (n = 4) or to mycobacteriosis (n = 3). An opportunistic or usual infection was demonstrated in 17 of the 51 patients with normal radiography of the chest. Finally, 37 patients free from infectious or tumoral pathology had isolated lymphocytic alveolitis.

Use of bronchoalveolar lavage in the evaluation of methotrexate lung disease.

The results of bronchoalveolar lavage in three patients with a presumptive diagnosis of methotrexate induced lung disease are presented. Lavage fluid was characterised by the presence of large numbers of lymphocytes, which in two patients were predominantly lymphocytes of the T8 phenotype. These findings further support the hypothesis that immune mediated mechanisms may play a part in the pathogenesis of this disorder in some patients, and indicate that bronchoalveolar lavage may be helpful in the evaluation of patients suspected of having methotrexate induced lung disease.

Pulmonary Kaposi's sarcoma in patients with acquired immune deficiency syndrome: a clinicopathological study.

Pulmonary Kaposi's sarcoma may contribute to respiratory dysfunction in patients with acquired immune deficiency syndrome (AIDS) and features of pneumonitis. Opportunistic infections are readily recognised in endoscopic material, but pulmonary Kaposi's sarcoma is easily missed, so that patients are deprived of specific treatment. The clinical and pathological findings from nine cases of pulmonary Kaposi's sarcoma have been reviewed; these were found among 84 patients with AIDS and pneumonitis undergoing fibreoptic bronchoscopy and bronchoalveolar lavage. Diagnosis was established before death in eight patients (in five by bronchial biopsy and in three by open lung biopsy). Examination of lavage fluid showed alveolar haemorrhage in six patients. It is concluded that: (1) fibreoptic bronchoscopy may be useful in the diagnosis of endobronchial lesions of Kaposi's sarcoma; (2) alveolar haemorrhage in patients with AIDS is suggestive of pulmonary Kaposi's sarcoma. Factors that may cause difficulties in diagnosis include the focal nature of some lesions and the pleural or parenchymatous location of others. In addition, in the lung as in the skin, the early stages of Kaposi's sarcoma resemble granulation tissue. Such lesions are far more difficult to recognise than is the late nodular stage.

Extensive T8-positive lymphocytic visceral infiltration in a homosexual man.

Lymphocytic visceral infiltration has recently been noted in association with lymphadenopathy-associated virus infection. A homosexual man, who had clinical and immunologic features of the acquired immune deficiency syndrome (AIDS)-related complex, is described. The patient presented not only with peripheral blood lymphocytosis but also with extensive lymphocytic infiltration involving lungs, lymph nodes, nerves, muscles, and esophagus. Lymphocyte subset immunostaining analysis showed that the lymphocytes were T8-positive. Thirty months after the clinical onset of the disease, no evidence of progression to AIDS was seen. Moreover, clinical improvement was observed, even though the patient did not receive long-term treatment. The clinical history of this patient suggests that lung T8-positive lymphocytic infiltration is associated with an increased risk of infectious episodes such as pneumonia and bronchitis.

Leukocyte migration inhibition in methotrexate-induced pneumonitis. Evidence for an immunologic cell-mediated mechanism.

Methotrexate-induced pneumonitis is a well-known clinical entity, but the mechanism for the induction of the pulmonary disease is ill defined. In three patients with this disorder, evidence was obtained for elaboration of a lymphokine, leukocyte inhibitory factor (LIF), by peripheral blood lymphocytes after incubation with methotrexate (MTX) in the direct leukocyte migration inhibition test. Control lymphocytes from normal subjects, as well as from patients receiving methotrexate but without pneumonitis, failed to elaborate LIF in the presence of the drug in this test. Along with these results, we obtained bronchoalveolar lavage (BAL) cell data displaying high grade lymphocyte alveolitis with a lymphocyte subset inverted ratio. This production of LIF suggests that pneumonitis associated with methotrexate therapy is also associated with a specific cellular immune response to the drug.

[Isolated pulmonary lymphoma in a patient with acquired immunodeficiency syndrome]. / Lymphome pulmonaire isolé chez un patient atteint de syndrome d'immunodépression acquis.

We report the case of a male patient with AIDS who had been hospitalized for various opportunistic infections, from which he recovered, and was readmitted on account of a round opacity in the lower lobe of his right lung. There was no evidence of extrapulmonary pathology. Transtracheal aspiration, alveolar lavage and transbronchial biopsy failed to identify the lesion. Lung biopsy after thoracotomy resulted in a diagnosis of malignant lymphoma type B with anti-IgA and anti-kappa antibodies. Despite chemotherapy the patient died within one month, the lymphoma having spread to both lungs.

[Value of the cytological examination of the bronchoalveolar lavage fluid in patients with acquired immunodeficiency syndrome and related syndromes]. / Apport de l'examen cytologique du liquide de lavage bronchoalvéolaire chez les patients atteints de syndrome d'immunodéficience acquise et de syndrome associé.

In AIDS a variety of severe pulmonary disorders may occur. The authors report 110 cases of bronchoalveolar lavage (BAL) in 43 AIDS and 41 ARC. In AIDS P. carinii pneumonia is the major cause of respiratory illness. BAL alone is a safe and valuable tool for diagnosis of P. carinii pneumonia and others opportunistic infections. Moreover, pulmonary hemorrhage diagnosed by the finding of hemosiderin laden macrophages, is very suggestive of broncho-pulmonary Kaposi' sarcoma. Finally, BAL demonstrates a severe depletion of T4 lymphocytes and an increased number of T8 lymphocytes. The T8 lymphocytosis is observed whatever the pulmonary involvement (nonspecific alveolitis, opportunistic infections, Kaposi's sarcoma), and is also found in ARC, and lymphocytosis, open lung biopsy shows a lymphoid interstitial infiltration with respect of the alveolar septa, thus differing from the classical lymphoid interstitial pneumonia described by Carrington. The prognosis of lymphocytosis in ARC remains unknown.