Can Coronavirus Disease 2019 Induce Sarcoidosis: A Case Report.

Since the emergence of coronavirus disease 2019, a large spectrum of clinical manifestations following this acute viral infection has been reported especially autoimmune manifestations and inflammatory disorders. However, a causal link has not yet been established. Herein, we reported a case of pulmonary mediastinal sarcoidosis following coronavirus disease 2019 infection. A 41-year-old woman with no clinical or radiographic symptoms or signs of sarcoidosis prior to coronavirus disease 2019 infection developed dyspnea, cough, and fatigue, a few months after discharge. A chest thoracic scan performed 3 months after hospital discharge showed regression of groundglass opacities with the appearance of pulmonary micronodules. Clinical examination and spirometry were normal. The evolution was marked by progressive worsening of dyspnea and significant weight loss. A chest thoracic scan performed 6 months after discharge showed bilateral and symmetrical hilar and mediastinal and paratracheal lymphadenopathy. Bronchoalveolar lavage with cell count showed a lymphocytosis of 19.5% and a CD4/CD8 T cell ratio of 2.2. Endobronchial lung biopsy revealed noncaseating epithelioid granulomas. Sputum culture excluded tuberculosis. The diagnosis of pulmonary-mediastinal sarcoidosis was made. She was treated with an oral corticosteroid. The patient showed significant improvement during the 3-month follow-up period. Post-coronavirus disease sarcoidosis is very rare. Complementary studies are needed to discern the link between these diseases.

Idiopathic double tracheal stenosis mimicking asthma: a case report.

Idiopathic tracheal stenosis (Idio-SS) is an extremely rare disease. Its diagnosis is of exclusion and could be misdiagnosed as asthma. Herein, we report the case of a 39-year-old woman who had been treated for asthma for several months. She has no history of endotracheal intubation or granulomatous disease. Flexible fiberoptic bronchoscopy and thoracic computed tomography revealed double tracheal stenosis. The patient had rigid bronchoscopy; the upper tracheal stenosis was dilated with insertion of a silicone airway stent at the level of the distal stenosis. The diagnosis of idiopathic stenoses was made according to the clinico-radiological features. Symptoms were completely relieved and no recurrence was observed after one year of follow-up. This case highlights the importance of clinical suspicion and early diagnosis of Idio-SS in patients with unexplained wheezing and dyspnea. It also illustrates the role of endoscopic procedures in this situation.

Management peculiarities of costovertebral hydatidosis.

Background: Costovertebral hydatidosis is a rarely reported clinical and radiological entity, estimated at less than 1% of thoracic hydatid locations. Its management is still not codified. Objective: The aim of our study was to specify the management peculiarities of costovertebral hydatidosis. Methods: Between January 2000 and December 2018, 14 patients were managed for costovertebral hydatidosis in a thoracic surgery department. Results: The mean age of our patients was 48 years. The history of a prior hydatid disease was found in 7 patients. Imaging features were suggestive in 13 cases. They showed: involvement of the spinal canal (6 cases), of the soft tissues (5 cases) and spinal cord compression (3 cases). Costovertebral resection of the hydatid lesions was complete in 12 cases. Four patients presented postoperative complications. Conclusion: Costovertebral hydatid involvement, may threaten the functional and vital prognosis. Therefore, early diagnosis and management are mandatory, before the occurrence of irreversible neurological impairment. Surgical resection remains the treatment of choice and must be complete whenever possible. Relapse is frequent, hence the importance of a regular follow-up.

COPD prevalence in smokers with stable ischemic heart disease: A cross-sectional study in Tunisia.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) are common causes of mortality worldwide, with shared risk factors. COPD continues to be largely underdiagnosed and undertreated, especially in patients with IHD. OBJECTIVE: To investigate the prevalence of COPD in smokers with confirmed IHD and to compare IHD characteristics between COPD patients and those without COPD. METHODS: It was a cross-sectional study, conducted between August and December 2017, including patients over 40 years of age, current or former smokers, with stable and confirmed IHD. Spirometry was undertaken for all participants, and COPD was defined according to GOLD criteria. RESULTS: A total of 122 patients, with mean age of 59.3 years and mean pack-year of 52.3, were enrolled. Spirometry was normal in 63.2% of patients and airflow limitation was the most frequent ventilatory disorder (20.5%). COPD was diagnosed in 19.7% of patients. Of the 24 COPD patients, 17 (70.8%) were previously undiagnosed. Airflow limitation severity in COPD patients was classified mild, moderate, severe and very severe in 25%, 62.5%, 8.3% and 4.2% of patients. Comparison between COPD patients and non-COPD patients showed that comorbidities, respiratory symptoms, chest x-ray abnormalities, life-threatening lesions, three vessel disease, pulmonary hypertension and right ventricle dysfunction were significantly more frequent in COPD patients. CONCLUSIONS: There was a high prevalence of COPD among smoking patients with IHD, and most were undiagnosed despite being symptomatic. Smokers with IHD, especially if having respiratory symptoms, radiological or ultrasound abnormalities or life-threatening coronary lesions should be evaluated for airflow limitation.

Asthma in Menopausal Women: Clinical and Functional Particularities.

BACKGROUND: Hormonal changes in women, especially at menopausal transition, may have significant consequences on respiratory function. This issue in asthmatic patients is more frequent, more severe, and less controlled after menopause. Tunisian data regarding this issue are limited; therefore, we assessed the clinical and functional particularities of asthma at menopausal transition. MATERIALS AND METHODS: This descriptive-analytical study was performed for two years (2016-2017) on 82 asthmatic women followed up in the pulmonology department of Charles Nicolle hospital of Tunis. According to hormonal status, two groups were defined: G1 (menopausal patients) and G2 (non-menopausal patients). Asthma control and severity of asthma as well as other variables including gender, age, body mass index (BMI), comorbidities, allergenic status, spirometry results, health care use in the past 12 months, and prescribed medications were evaluated. RESULTS: The mean age of patients was 50 years and half of them (60%) were menopausal women. Allergy was the most common cause of asthma (82%). A mean of 2.3 exacerbations per patient was recorded. Asthma was well controlled in 58% of patients and was moderate to severe in 80% of them. Menopausal asthmatic women had more comorbidities (p=0.006), particularly arterial hypertension (p<0.0001). Atopy was more common in non-menopausal women and they were all allergic (p=0.01). Menopausal asthmatic patients had more airflow obstruction with lower forced expiratory volume 1 and forced vital capacity (p<0.0001). They also had more exacerbations (p<0.0001) with lower PaO2 (p=0.006). Univariate analysis showed that menopause was a predictive factor of severity (p=0.01) and bad control of asthma (p=0.03). Multivariate analysis confirmed that menopause was a predictor of severity (p=0.01; OR=5.02, IC [1.36-18.46]) but not control of asthma despite the tendency to significance (p=0.07). CONCLUSION: Our results confirm that menopause is a factor influencing the control and severity of asthma.