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Intra-thoracic textiloma is an exceptional complication leading to misdiagnosis. It could present as hemoptysis, pulmonary abscess, pseudotumor or chronic cough. We report a rare case of a superinfected intra-bronchial textiloma, revealed by flexible bronchoscopy. A 21-year-old patient, operated for esophageal atresia at the age of 10 days, who had a right bilobectomy for bronchial dilatation at the age of 9 years, and who presented several episodes of bronchial superinfections over the 12 past years. In the light of this observation, we show that flexible bronchoscopy should be part of the systematic work-up to be considered in front of dragging abscessed pneumopathies.

Introduction: Miliary tuberculosis is an increasingly rare form (2% to 8%), defined by the hematogenous or lymphatic dissemination of the tubercle bacillus from a pulmonary or extra-pulmonary focus but which remains serious and can lead to acute respiratory failure due lesional pulmonary edema. Patients and Methods: This is a retrospective study of 101 cases of miliary tuberculosis hospitalized between January 1989 and July 2019 in the pneumology department of “20 Aout” in Casablanca. Results: The average age is 43 years with a predominance of men (64%), the history of tuberculosis is found in 8 cases and tuberculosis contagion in 10 cases. The common symptom in all cases (100%) is an alteration of the general condition, fever is present in 76% of cases, dry cough is found in 75.5% of cases and dyspnea is found in 38.3% of cases. Among the causes of immunosuppression, we noted: 3 cases of neoplasia, 5 cases of diabetes, 5 cases of pregnancy and 4 cases of system diseases. The chest X-ray (frontal view) found an aspect of pulmonary miliaria in all cases associated with pleurisy in 18 cases, an excavated opacity in 3 cases and pneumothorax in 1 case. Tuberculin intradermal reaction (tIDR) was positive in 35 cases. Antibacillary treatment was started urgently in all cases. The outcome was good in the majority of cases with 10 deaths. Further work-up allowed confirmation of the diagnosis either by direct isolation of the koch bacillus or by biopsy in 47.52% of cases.

Testicular metastases are rare, accounting for about 1% of testicular cancers. Among the metastatic localizations of lung malignant tumors, the testis are seldomly encountered. In this work, we report a case of testicular metastasis of a lung adenocarcinoma in a 45-year-old patient. Our observation underlines the interest of a meticulous and complete clinical examination of the patients, in order to diagnose even rare secondary localizations.

Le syndrome de detresse respiratoire aigue (SDRA) est l´une des complications les plus graves de la pneumopathie virale a Influenza A H1N1. Une evolution aussi severe peut etre favorisee par la toxicomanie, notamment a l´heroine, comme l´illustre parfaitement ce cas.

Granulomatosis with polyangiitis (GPA) is a rare vasculitis among adolescents. Its pulmonary manifestations may mimic tuberculosis. We report the case of a 16-years-old female patient with multiple excavated lung nodules revealed by a chronic cough, hemoptysis, epistaxis and weight loss. The diagnosis of GPA was achieved due to systemic pulmonary, ENT and renal involvement, the positivity of anti-neutrophil cytoplasmic antibody directed against proteinase 3 (C-ANCA) and bronchial and nasal biopsies showing granulomatous inflammation with a dense perivascular infiltrate destroying the vessel wall. Bolus of glucocorticoids and immunosuppressants reversed her symptoms. Although GPA is a rare disease in teenagers, it should be considered as one of the differential diagnosis in adolescents presenting with excavated pulmonary nodules.

Resume Introduction La iatrogenie induite par les antivitamines K (AVK) represente un probleme majeur de sante pouvant etre limite grâce a l’information medicale et l’education therapeutique des patients. L’objectif de notre etude est d’explorer les besoins en information des patients traites par AVK, dans la perspective d’elaborer des outils d’information et de construire un programme d’education therapeutique adapte aux differents profils des patients. Patients et methode Une etude qualitative par entretien semi-directif a ete menee aupres de trente patients traites par AVK. L’analyse thematique des reponses a permis d’explorer les discours des patients sur le plan qualitatif et semi-quantitatif. Resultats Les principaux besoins en information des patients ont porte sur les modalites du traitement (27,6 %), les effets indesirables (24,1 %) et les precautions/gestion au quotidien du traitement (24,1 %). Les informations sur l’etiologie de la maladie (p = 0,022) et le mode d’action des AVK (p = 0,012) ont ete particulierement demandes par les patients en initiation de traitement. Conclusion Les patients traites par AVK sont avides d’informations aussi bien sur leur pathologie que sur leur traitement. La demarche de l’education therapeutique permettra d’adapter les outils et les messages educatifs aux besoins et attentes des patients traites.