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Pneumonia caused by varicella infection is a serious and severe complication of the disease when it occurs in adults. The authors report two cases of a varicella pneumonia in a 36 and a 41 year-old non-immunocompromised man. They were admitted to hospital for acute respiratory failure, not requiring intensive care, associated with exanthema. High resolution CT revealed well-defined diffuse nodules throughout both lungs, nodules with a surrounding halo of ground-glass opacity. Thrombocytopenia, hepatic cytolysis and an increase in lacticodeshydrogenase were noted. The patients made a full recovery with anti-viral therapy and oxygen therapy. Varicella pneumonia is the most common complication of varicella in adults. Anti-viral treatment is usually successful.

Resume Le pneumothorax tuberculeux est une forme rare mais grave de la tuberculose, qui persiste en Tunisie. Pour analyser notre experience dans le service de Pneumologie-Allergologie de l’Hopital de Sousse (Tunisie), nous avons realise une etude retrospective a partir des observations de pneumothorax tuberculeux, pris en charge entre 1985 et 2003. Les donnees cliniques, radiologiques, diagnostiques et evolutives ont ete renseignees. En 18 ans, nous avons collige 23 cas de pneumothorax tuberculeux (dont 16 hommes ; âge moyen : 36 ans). La symptomatologie evocatrice de pneumothorax est toujours survenue dans un contexte d’alteration febrile de l’etat general. La radiographie thoracique a montre soit un pneumothorax (n = 8), soit un hydropneumothorax (n = 15) et des lesions parenchymateuses associees dans 82,5 % des cas. Le diagnostic bacteriologique a ete obtenu dans 21 cas ; chez les deux patients restants, l’origine tuberculeuse a ete suggeree par l’examen histologique d’une piece operatoire. Le traitement a associe une chimiotherapie antituberculeuse conforme aux recommandations du plan National de Lutte contre la Tuberculose (n = 23), un drainage thoracique (n = 21) et une kinesitherapie respiratoire (n = 18). Cinq patients ont ete operes : decortication pleurale (n = 3), exerese pulmonaire (n = 2). Deux patients ont ete perdus de vue. L’evolution a ete favorable dans 78 % des cas et defavorable chez 3 patients : pyopneumothorax cloisonne (n = 2) et deces post-operatoire (n = 1). Dans notre experience, le pneumothorax tuberculeux est, dans la majorite, des cas en rapport avec une tuberculose pulmonaire cavitaire. L’evolution est le plus souvent favorable, sous traitement antituberculeux et drainage thoracique.

Resume Les auteurs rapportent le cas d’un pneumothorax spontane recidivant chez une jeune fille de 15 ans, qui a presente un osteosarcome du femur gauche, diagnostique 2 ans auparavant et traite par chimiotherapie et chirurgie. Le bilan d’extension initial etait normal ; en particulier, il n’y avait pas de metastases pulmonaires. La tomodensitometrie thoracique realisee a la fin du traitement, soit 8 mois apres la chirurgie, a revele l’apparition de deux petites lesions nodulaires pulmonaires peripheriques, l’une au niveau du lobe inferieur droit et l’autre au niveau du culmen. Une chimiotherapie palliative a ete indiquee. Le controle radiologique apres 4 cures de chimiotherapie (ifosfamide et cisplatine) a montre la progression des lesions nodulaires pulmonaires dont certaines se sont excavees, et a revele un pneumothorax bilateral plus abondant du cote droit. Ce dernier a recidive deux mois apres le drainage. Un talcage pleural a ete alors realise. La thoracoscopie n’a pas mis en evidence de lesions pleurales pathologiques.

Pneumonia caused by varicella infection is a serious and severe complication of the disease when it occurs in adults. The authors report two cases of a varicella pneumonia in a 36 and a 41 year-old non-immunocompromised man. They were admitted to hospital for acute respiratory failure, not requiring intensive care, associated with exanthema. High resolution CT revealed well-defined diffuse nodules throughout both lungs, nodules with a surrounding halo of ground-glass opacity. Thrombocytopenia, hepatic cytolysis and an increase in lacticodeshydrogenase were noted. The patients made a full recovery with anti-viral therapy and oxygen therapy. Varicella pneumonia is the most common complication of varicella in adults. Anti-viral treatment is usually successful.

The tubercular pneumothorax is a rare and severe form of tuberculosis which persists in Tunisia. We reviewed retrospectively our experience at the Pneumology-Allergology Department of the Sousse Hospital with 23 cases of tubercular pneumothorax observed between 1985 and 2003. The suggestive symptom, pneumothorax, always occurred within a context poor general health and fever. The chest roentgengraph showed pneumothorax (n=8) or hydropneumothorax (n=15), and pulmonary lesions associated in 82.5% of patients. Bacteriological proof was obtained in 21 cases; in the two other patients, histological examination of the surgical specimen was highly suggestive of tuberculosis. Treatment associated antitubercular chemotherapy in compliance with the National Plan of against Tuberculosis (n=23), chest drainage (n=21) and respiratory physiotherapy (n=18). Five patients underwent surgery: pleural decortications (n=3), pulmonary resections (n=2). Two were lost to follow-up. The course was favourable in 78% of patients; there were two cases of partitioned pyopneumothorax and one post-operative death. In our experience, tubercular pneumothorax was always associated with active cavitated tuberculosis. The course was almost favorable with antitubercular chemotherapy and chest drainage.

We report the case of a 15-year-old girl with osteosarcoma in the left distal femur who developed a recurrent spontaneous pneumothorax. The patient was treated by neoadjuvant chemotherapy followed by surgery (limb-sparing surgical procedure with insertion of a knee prosthesis) and then adjuvant chemotherapy. The initial extension assessment was normal. No pulmonary metastasis was found. The chest tomography performed at the end of treatment (8 months after surgery) revealed two peripheral pulmonary nodules not seen on the chest X-ray. Palliative chemotherapy was given, the thoracic tomography after four chemotherapy courses showed a progress of the pulmonary metastasis and on the right more abundant bilateral pneumothorax which had recurred two months after thoracic draining. Thoracoscopy showed no pleural lesions.