Reversible central respiratory events induced by valproic acid treatment: A case report.

Valproic acid holds a prominent position as the primary therapeutic option for epilepsy cases. The utilization of antiepileptic agents like valproic acid has been linked to disturbances in sleep architecture. Although scant, there exists a subset of studies that allude to the potential manifestation of sleep apnea as an adverse effect of valproic acid administration. In this context, we present a case report of a 76-year-old man with a past medical history of arterial hypertension, atrial fibrillation, and obstructive sleep apnea syndrome treated with continuous positive airway pressure since 2020. Following the commencement of valproic acid treatment for vascular epilepsy, obstructive sleep apnea evolved toward to central sleep apnea. This case exemplifies the need for a heightened awareness of the multifaceted implications of valproic acid therapy on sleep patterns.

Pulmonary actinomycosis mimicking lung malignancy: About two cases.

Pulmonary actinomycosis is a rare anaerobic infection with non specific clinical and radiographic presentations that delay diagnosis. Throughout literature, a significant number of misdiagnosed cases have been reported. The diagnosis is substantially based on histopathological pattern. We describe the cases of two patients evaluated and treated in pulmonary department 1 of Abderrahmane Mami hospital of Tunisia with a diagnosis of pulmonary actinomycosis. There are two men. The first patient had hypertension and chronic obstructive pulmonary disease and the second one underwent surgery for bronchiectasis. Clinical presentation was consistent with productive cough, hemoptysis, and deterioration of general status. The medical examination was non-specific. The chest X-ray revealed an apical opacity, excavated in the first case and retractable in the second one. Biology showed an inflammatory syndrome. Bronchoscopy was performed in the two cases and showed lesions mimicking lung malignancy. Diagnosis is confirmed by histopathological examinations of surgical specimens in the two cases. Both patients were received antibiotic therapy. The results were excellent with a favorable clinical course and no deaths. This study highlights the misleading patterns of actinomycosis to prompt accurate diagnosis and earlier treatment, thus improving the outcome. Given either its low culture yield or the limited use of new molecular diagnostic tools in routine clinical practice, histological examination of lung tissue specimens is crucial to get the correct diagnosis.

Rifampicin-induced acute tubulointerstitial nephritis during pulmonary tuberculosis treatment: A case report.

Drug-induced tubulointerstitial nephritis is an uncommon complication in patients on anti-tuberculosis therapy that can lead to permanent kidney damage. Rifampicin is the most offending drug. We report a case of a 41-years old man being treated for pulmonary tuberculosis and presenting with tubulointerstitial nephritis associated with rifampicin. We focus on diagnosis features and therapeutic challenges.

A life-threatening pericardial tamponade revealing disseminated tuberculosis: A challenging medical care.

Tuberculous pericarditis (TBP) is one of the most important causes of pericarditis in developing countries in which tuberculosis remains a public health problem. We report the case of a 20-year-old immunocompetent woman who presented with hypotension and tachycardia echocardiography showed a massive pericardial effusion and signs of tamponade. The patient underwent an urgent pericardiocentesis; 700 ccs of serosanguinous pericardial fluid was drained. She had a surgical biopsy of the pleuropericardial window. The pathological examination confirmed TBP. Oral anti-tuberculosis therapy was initiated. Two months after therapy started, she was admitted for dyspnea and edema of the lower limbs. Echocardiography showed paradoxical inter-ventricular septum and non-compliant dilated inferior vena cava. She has been set on diuretics associated with Akurit for another two months. Thoracic CT scan done at 4 months of tuberculosis treatment showed: thickening of the pericardial layers, with an encysted collection facing the trunk of the pulmonary artery, bilateral pleural effusion, and thickening of the peribronchovascular and interlobular septa of the right lung, due to lymphatic stasis. We then switched to dual therapy for a total of eight months. An ultrasound check at the end of treatment was performed showing the absence of pericardial effusion with diminished systolic ejection fraction (54%). This case is the witness that TBP can be life-threatening even for immunocompetent patients. The risk is the evolution towards sequelae and constrictive pericarditis. The high mortality and morbidity from TBP despite the use of anti-tuberculous drugs call for research targeting host-directed immunological determinants of treatment outcome.