Hydroxychloroquine in a G6PD-Deficient Patient with COVID-19 Complicated by Haemolytic Anaemia: Culprit or Innocent Bystander?

Hydroxychloroquine has been used worldwide as a first-line treatment for patients hospitalized with COVID-19. Little is known about COVID-19 and its effects on patients with congenital red blood cell disorders. We report a case of haemolytic anaemia in a 32-year-old patient and a fortuitous highlighting of G6PD deficiency. We reviewed the literature to assess the risk of hydroxychloroquine use in this context

Toux chronique après gastroplastie par anneau modulable

National audienceIntroduction Patients are frequently referred for chronic cough. The causes are various. Case report We report two cases of chronic cough that occured after laparoscopic adjustable gastric banding for treatment of morbid obesity. In both cases, the computed tomography scan showed an important oesophageal dilatation. The cough disappeared after the band deflation. Conclusion Oesophageal dilatation after laparoscopic adjustable gastric banding is a new cause to be included in the aetiology of chronic cough.Introduction La toux chronique est un motif fréquent de consultation. Les causes en sont multiples. Cas cliniques Nous rapportons deux cas de toux chronique invalidante après mise en place d'un anneau modulable de gastroplastie pour obésité morbide. La tomodensitométrie thoracique a montré une dilatation majeure de l'oesophage avec une stase alimentaire. Le desserrage de l'anneau a permis la disparition complète de la toux. Conclusion La dilatation majeure de l'oesophage après gastroplastie par anneau modulable est une nouvelle cause à ajouter à l'étiologie des toux chroniques

Toux chronique après gastroplastie par anneau modulable

National audienceIntroduction Patients are frequently referred for chronic cough. The causes are various. Case report We report two cases of chronic cough that occured after laparoscopic adjustable gastric banding for treatment of morbid obesity. In both cases, the computed tomography scan showed an important oesophageal dilatation. The cough disappeared after the band deflation. Conclusion Oesophageal dilatation after laparoscopic adjustable gastric banding is a new cause to be included in the aetiology of chronic cough.Introduction La toux chronique est un motif fréquent de consultation. Les causes en sont multiples. Cas cliniques Nous rapportons deux cas de toux chronique invalidante après mise en place d'un anneau modulable de gastroplastie pour obésité morbide. La tomodensitométrie thoracique a montré une dilatation majeure de l'oesophage avec une stase alimentaire. Le desserrage de l'anneau a permis la disparition complète de la toux. Conclusion La dilatation majeure de l'oesophage après gastroplastie par anneau modulable est une nouvelle cause à ajouter à l'étiologie des toux chroniques

Concordance between superficial swab and deep sampling in post-sternotomy mediastinitis: Single center experience.

OBJECTIVES: Deep sampling (DS) is the gold standard for microbiological diagnosis of post-sternotomy mediastinitis (PSM), however superficial swab (SS) are frequently performed in some centers and antibiotherapy initiated base on their results. We analysed the concordance between superficial swab and deep sampling in PSM. MATERIALS AND METHODS: We analysed retrospectively patients with a PSM between 2010 and 2014 at Saint-Luc University hospital (Belgium). We considered that there was a concordance between SS and DS when the same microorganism was found in the two sampling method in each patient. Patients were stratified in six groups according to microbiology results as Staphylococcus Aureus (SA) sensitive or resistant, coagulase negative Staphylococcus (CoNS), Gram negative bacilli (GNB), other Gram positive bacteria (GPB) and fungi. RESULTS: Thirty-six patients were included. Twenty-five men (69%) and a mean age of 66 years old. The overall concordance between SS and DS was 57%. SA and GNB showed high concordance (100% and 85.7% respectively). For the other groups the concordance was low. The sensitivity and specificity of SS was 97% and 33% respectively. The PPV and NPV of superficial swab was 96% and 50% respectively. CONCLUSION: Microbiological results from SS, even with flocked swabs, except for SA and GNB have low concordance with those obtained from deep sampling. Our data confirm that in PSM, deep sampling is the gold standard for microbiological assessment

Infections opportunistes et sarcoïdose

National audienceIntroduction In spite of CD4+ T-lymphocytopenia and corticosteroids-induced immune suppression, the risk of opportunistic infection is not usually considered to be increased in sarcoidosis. Methods We describe 5 cases of opportunistic infection in patients with sarcoidosis and CD4+ T- lymphocytopenia. A systematic review of the literature was done. Results We describe 2 cases of chronic necroziting aspergillosis, one case of Mycobacterium avium complex pneumonia, one case of pneumocystis pneumonia, and one case of cryptoccocal meningitidis in five patients with sarcoidosis. Four patients were receiving corticosteroids at time of diagnosis. Four patients had CD4+ T-lymphocytopenia. In the literature, we documented 65 cases reports of sarcoidosis complicated by opportunistic infection. At the time of infection diagnosis, 36 patients were receiving corticosteroids. CD4+ T-lymphocytopenia was present in 5 of 11 reported cases. Cryptococcosis was the most common reported infection. Conclusion Opportunistic infectious complications are rare in patients with sarcoidosis. Opportunistic infections mainly occur in patients receiving corticosteroids, and with CD4+ T-lymphocytopenia. Except for cryptococcosis, sarcoidosis by itself does not appear to be a risk factor of opportunistic infection.Introduction Chez les patients atteints de sarcoïdose, malgré la fréquence de la lymphocytopénie T-CD4, et l'immunodépression induite par la corticothérapie, les infections opportunistes semblent rares. Méthodes Nous décrivons cinq cas de sarcoïdose compliquée d'infection opportuniste. Une recherche bibliographique des cas rapportés d'infection opportuniste chez des patients atteints de sarcoïdose, a été effectuée. Résultats Parmi les 5 cas d'infection opportuniste que nous décrivons, quatre (une aspergillose nécrosante chronique, une infection pulmonaire à mycobactérie atypique, une cryptococcose neuro-méningée, et une pneumocystose pulmonaire) sont survenus sous corticothérapie, et un seul (aspergillose nécrosante chronique) chez une patiente non traitée. Dans 4 cas, il existait une lymphocytopénie T-CD4 au moment du diagnostic de l'infection. Dans la littérature, parmi les 65 cas documentés de sarcoïdose compliquée d'infection opportuniste, 36 sont survenus chez des patients traités par corticoïdes. Une lymphocytopénie T-CD4 a été notée dans 5 cas (sur 11 documentés). La cryptococcose a été l'infection la plus fréquemment rapportée. Conclusion Les infections opportunistes sont rares au cours de la sarcoïdose, et surviennent principalement au cours d'un traitement par corticoïdes, dans un contexte de lymphocytopénie TCD4. Sauf peut-être pour la cryptococcose, la sarcoïdose en elle-même ne représente pas un facteur de risque infectieux

Progressive diffuse pulmonary Langerhans cell histiocytosis improved by cladribine chemotherapy

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Severe pulmonary hypertension in histiocytosis X: long-term improvement with bosentan

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Infections opportunistes et sarcoïdose

National audienceIntroduction In spite of CD4+ T-lymphocytopenia and corticosteroids-induced immune suppression, the risk of opportunistic infection is not usually considered to be increased in sarcoidosis. Methods We describe 5 cases of opportunistic infection in patients with sarcoidosis and CD4+ T- lymphocytopenia. A systematic review of the literature was done. Results We describe 2 cases of chronic necroziting aspergillosis, one case of Mycobacterium avium complex pneumonia, one case of pneumocystis pneumonia, and one case of cryptoccocal meningitidis in five patients with sarcoidosis. Four patients were receiving corticosteroids at time of diagnosis. Four patients had CD4+ T-lymphocytopenia. In the literature, we documented 65 cases reports of sarcoidosis complicated by opportunistic infection. At the time of infection diagnosis, 36 patients were receiving corticosteroids. CD4+ T-lymphocytopenia was present in 5 of 11 reported cases. Cryptococcosis was the most common reported infection. Conclusion Opportunistic infectious complications are rare in patients with sarcoidosis. Opportunistic infections mainly occur in patients receiving corticosteroids, and with CD4+ T-lymphocytopenia. Except for cryptococcosis, sarcoidosis by itself does not appear to be a risk factor of opportunistic infection.Introduction Chez les patients atteints de sarcoïdose, malgré la fréquence de la lymphocytopénie T-CD4, et l'immunodépression induite par la corticothérapie, les infections opportunistes semblent rares. Méthodes Nous décrivons cinq cas de sarcoïdose compliquée d'infection opportuniste. Une recherche bibliographique des cas rapportés d'infection opportuniste chez des patients atteints de sarcoïdose, a été effectuée. Résultats Parmi les 5 cas d'infection opportuniste que nous décrivons, quatre (une aspergillose nécrosante chronique, une infection pulmonaire à mycobactérie atypique, une cryptococcose neuro-méningée, et une pneumocystose pulmonaire) sont survenus sous corticothérapie, et un seul (aspergillose nécrosante chronique) chez une patiente non traitée. Dans 4 cas, il existait une lymphocytopénie T-CD4 au moment du diagnostic de l'infection. Dans la littérature, parmi les 65 cas documentés de sarcoïdose compliquée d'infection opportuniste, 36 sont survenus chez des patients traités par corticoïdes. Une lymphocytopénie T-CD4 a été notée dans 5 cas (sur 11 documentés). La cryptococcose a été l'infection la plus fréquemment rapportée. Conclusion Les infections opportunistes sont rares au cours de la sarcoïdose, et surviennent principalement au cours d'un traitement par corticoïdes, dans un contexte de lymphocytopénie TCD4. Sauf peut-être pour la cryptococcose, la sarcoïdose en elle-même ne représente pas un facteur de risque infectieux

Thymic carcinoma: a clinicopathological and immunohistological study of 19 cases

International audienceAims: To study 19 cases of primary thymic carcinoma in order to define the clinicopathological features and the precise histochemical profile of this rare and heterogeneous group of tumours of the anterior mediastinum. Methods and results: The study group consisted of 13 males and six females, with a mean age of 58.5 years (range 29-75 years). Superior vena cava syndrome and chest pain were the main presenting symptoms. Three patients were asymptomatic. No patient had myasthenia gravis. Six different histological types were identified: neuroendocrine tumours (six patients), epidermoid carcinoma (five patients), sarcomatoid carcinoma (three patients), lymphoepithelioma-like carcinoma (two patients), mucoepidermoid carcinoma, clear cell carcinoma, and undifferentiated carcinoma (one patient each). The clear cell carcinoma was associated with a thymic cyst. No association with thymoma was observed. Surgical resection, performed in 10 cases, was complete in two. Sixteen patients received thoracic radiation, and 11 received systemic chemotherapy. Follow-up information was available in 16 cases; 12 patients presented with local or metastatic relapse, and 10 patients died of their tumour. The overall 5-year survival was 14.5%. Conclusion: Primary thymic carcinoma is a very heterogeneous group of tumours of the anterior mediastinum with an aggressive clinical behaviour, and a poor overall prognosis

Chemotherapy is the cornerstone of the combined surgical treatment of lung cancer with synchronous brain metastases

International audienceBackground: Lung cancer accounts for about 50% of brain metastases, of which nearly 25% are eligible for neurosurgery, providing a neurological control rate of up to 70% when followed by whole brain radiation therapy. How to manage the primary tung carcinoma remains elusive. Methods: We undertook a retrospective study of consecutive patients who underwent surgical resection for synchronous brain metastases from non-small cell lung cancer in a single institution, to determine overall. survival. and prognostic factors, with particular attention to the treatment of the primary tung tumor. Results: Fifty-one patients underwent surgical resection of synchronous brain metastases from non-small cell lung cancer. Median survival was 13.2 months. Prognosis mainly depended of the treatment of the tung tumor, with a marked survival advantage in the 29 patients receiving a focal treatment (thoracic surgery or radiotherapy), compared to the 22 other patients: median, 1-year, and 2-year survival were 22.5 months, 69%, and 42%, versus 7.1 months, 33%, and 5%, respectively (p < 0.001); response to pre-operative chemotherapy before focal treatment was the main favorable prognostic factor (p = 0.023), and further identified patients who had benefit from resection of the lung tumor, with a significantly better outcome. Conclusions: Chemotherapy, by its therapeutic and prognostic value, may be considered as the cornerstone of the combined medical and surgical therapeutic sequence whereby brain metastasectomy is followed by chemotherapy and further focal treatment of the primary lung tumor in responders to chemotherapy