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The beneficial role of corticosteroid therapy for the treatment of methotrexate-induced pneumonia remains controversial. We report two cases of acute severe interstitial pneumonia induced by methotrexate in patients with non-Hodgkin lymphoma given a polychemotherapy protocol (M'BACOD). The first signs appeared on the eleventh day of the first cycle in patient one and on the tenth day of the third cycle in patient two. The causal implication of methotrexate was based on the history, the clinical and radiological presentation, and the negative tests in both patients: lymphocyte alveolitis with granulomatous lesions on the transbronchial biopsy in patient one and positive leukocyte migration test in the presence of methotrexate in patient two. Early acute respiratory failure required high flow rate oxygen therapy with positive expiratory pressure ventilatory assistance. The course was rapidly favorable both for blood gases and radiographic presentation without corticosteroids. These two cases illustrate that pulmonary disease can be cured without corticosteroids despite severe respiratory failure at onset. This provides a further argument on reservations about using corticosteroids for suspected methotrexate-induced pneumonia.

We report a case of multisystemic sarcoidosis with adenopathy, skin and respiratory involvements, which have a prolonged evolution. After 3 years with corticosteroid and synthetic antimalarial drugs treatment, the patient have a new skin and pseudo-tumoral pulmonary development, which have a spontaneous regression. Few month later, he developed a malignant lymphoma.

Idiopathic restrictive myocardiopathy is an uncommon condition. The differential diagnosis with constrictive pericarditis may require endomyocardial biopsy or surgical exploration. The prognosis of idiopathic restrictive myocardiopathy reported in the literature is to the order of several years. In this case the association with pulmonary Raynaud syndrome appears to be fortuitous and has not been previously reported.

We report a case of a patient of forty two years who was admitted with a chronic cough and had a left hilar "tumour". Scanning showed a hilar opacity with an air bronchogram. Fibreoptic bronchoscopy did not succeed in achieving a precise diagnosis, the biopsies showed no sign of malignancy. An open lung biopsy was necessary to establish the diagnosis of pulmonary mediastinal sarcoidosis with a pseudo-tumoral presentation and localised unilateral disease involving a segmental bronchus and the left upper lobe. There was a rapidly favourable outcome after treatment with steroids.

Abstract: Introduction: Percutaneous transthoracic needle biopsy is a useful and common procedure in the investigation of a lung nodule. The occurrence of air embolism after percutaneous transthoracic needle biopsy is extremely rare. Case report: We report a 62-year-old woman who presented with neurological signs including restlessness, meningeal signs and focal neurologic deficits 4hours after percutaneous transthoracic lung biopsy, related to air embolism. The outcome was favorable with hyperbaric oxygen therapy. Conclusion: Percutaneous transthoracic needle biopsy complicated by air embolism has been rarely reported. It usually occurs within minutes after the biopsy. The late onset of this adverse event in our patient is exceptional. Air embolism occurs more frequently after biopsy of lung infiltrates compared to nodules. Occurrence of a pneumothorax or an intraalveolar haemorrhage following a percutaneous transthoracic needle biopsy may be warning manifestations and justify a close monitoring. [Copyright &y& Elsevier]