Central nervous system sarcoidosis: follow-up at MR imaging during steroid therapy.

PURPOSE: To document the changes observed at sequential magnetic resonance (MR) imaging of sarcoidosis lesions of the central nervous system (CNS) during treatment with corticosteroids. MATERIALS AND METHODS: The abnormalities detected in 24 patients (mean follow-up, 36 months) were compared before and after therapeutic periods (n = 75) that were divided into attack (high-dose), upkeep (decreased-dose), and minimal (low-dose) periods. Parenchymal lesions were classified as type 1 (enhanced with gadolinium), type 2 (demyelinating), or type 3 (lacunar) and were assessed as regressing, stable, or progressing. RESULTS: Seven of the 24 patients had several types of lesions. Isolated type 3 lesions (six patients) were the only lesions not associated with neurologic deficit. Type 1 lesions (13 patients) regressed in 22 of 22 attack periods and progressed in nine of 27 upkeep and minimal periods. MR imaging depicted relapses in patients with multifocal CNS involvement or long-standing CNS impairment or in those who had previously received steroid therapy. Type 2 (seven patients) and type 3 (13 patients) lesions remained stable in 68 of 68 therapeutic periods. Type 1 lesions appeared in three patients with type 2 and type 3 lesions during two upkeep and three minimal periods. Findings at follow-up MR imaging contributed to the reintroduction of high-dose corticosteroid therapy in eight patients. CONCLUSION: MR imaging can be used to differentiate between reversible and irreversible lesions in CNS sarcoidosis. MR imaging can be a useful tool for adjusting treatment to prevent irreversible CNS damage.

[Hypoxic eosinophilic pneumonia in two patients treated with ACE inhibitors]. / Pneumopathie à éosinophiles hypoxémiante sous traitement par IEC.

Diffuse hypoxic pneumonia was found to be caused by angiotensin converting enzyme (ACE) inhibitors in two patients given enalapril and fosinopril for hypertension. Both patients developed sub-acute respiratory failure and lost weight. Imaging explorations showed multiple areas of alveolar consolidation, moderate pleural effusion and in one case linear opacities. In both cases, peripheral eosinophila was found and the bronchoalveolar lavage fluid contained lymphocytes. Progressive improvement was achieved after withdrawal of the ACE and corticosteroid therapy for three months. Subsequent x-rays and respiratory function tests returned to normal apart from persistently low CO diffusion in one patient. In view of other cases reported in the literature, ACE inhibitors should probably be included in the list of drugs capable of inducing pneumonia, notably eosinophilic pneumonia.

[Visceral larva migrans in adults with severe pulmonary manifestations]. / Larva migrans viscérale de l'adulte avec manifestations pulmonaires sévères.

BACKGROUND: Toxocariosis, the most frequent cause of visceral larva migrans, is usually a disease of children due to ingestion of eggs from the roundworm of dogs (Toxocara canis). Clinical expression varies from an symptomatic state to fuminant disorders; hepatomegaly with fever is frequent. Severe symptoms (rarely in adults) may occur. CASE REPORT: A 42-year-old male with no past medical history complained of sudden onset pulmonary disorders. Laboratory findings included eosinophilia on blood tests, a severe respiratory obstructive syndrome and positive serum tests for Toxocara canis. All clinical and biological abnormalities regressed in a few weeks. DISCUSSION: Diagnosis of visceral larva migrans is exceptional in adults and can only be proven by positive serological tests. Correct treatment remains under debate.

[Environmental interstitial pneumonia caused by asbestos. Study of a Turkish family exposed to tremolite]. / Pneumopathie interstitielle environnementale à l'amiante. Etude d'une famille turque exposée à la trémolite.

Environmental exposure to asbestos, as observed in Anatolia (Turkey), usually results in pleural pathology (plaques and mesothelioma). We report the case of a 50-year old woman who, until the age of 50, had lived in Eregli, central Anatolia, a region where inhalation of environmental asbestos is responsible for a high prevalence of pleural diseases. Radiology showed diffuse interstitial pneumonia without pleural involvement. Bronchoalveolar lavage brought back asbestos bodies (AB) in concentrations of 4,250 per millilitre. All were made of tremolite, a non-commercial variety of asbestos. The patient's family was investigated by chest radiography and search for AB in sputum. The husband, who came from the same town as his wife and had been exposed until the age of 45, had the classical response with bilateral pleural thickening but no parenchymal abnormalities; 2 AB were found in his sputum. The 3 sons, exposed for 10, 13 and 20 years respectively, had normal radiograms and no AB in their sputum, except for the older (3 AB) who had been exposed for 20 years. These cases illustrate the importance of environmental exposure to asbestos which may produce lesions similar to those observed in industrial exposure. Only mineralogical examinations can determine whether the asbestos is environmental or industrial.