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Resume Introduction La pneumopathie interstitielle aigue liee au methotrexate represente un effet secondaire rare mais qui peut etre fatal. Il s’agit d’un diagnostic d’exclusion. Il existe des formes precoces et tardives et differents patterns cellulaires dans la formule du lavage broncho-alveolaire (LBA). Observation Nous presentons ici un cas de pneumopathie interstitielle aigue chez une patiente de 54 ans qui prenait du methotrexate depuis un an et demi pour une polyarthrite rhumatoide. Apres avoir exclu les autres causes et en se basant sur certains criteres diagnostiques, nous pouvions raisonnablement identifier le methotrexate comme etant la cause de cette pneumopathie. Il s’agissait d’une atteinte tardive et la formule du LBA montrait une neutrophilie et une eosinophilie. Conclusion La pneumopathie interstitielle aigue liee au methotrexate est un diagnostic d’exclusion. Les atteintes tardives combinees a la predominance de neutrophiles et d’eosinophiles dans le LBA sont rares dans la litterature, ce qui demontre la grande heterogeneite des atteintes pulmonaires interstitielles liees au methotrexate.

Methotrexate-induced pneumonitis is a rare but potentially fatal side effect. It is a diagnosis of exclusion. There are early and late forms and different cell patterns in the bronchoalveolar lavage (BAL).We present a case of acute interstitial lung disease in a 54-year-old patient who had been taking methotrexate for a year and a half for rheumatoid arthritis. After excluding other causes and based on the diagnostic criteria of Searles and McKendry, we could reasonably identify methotrexate as the cause of the lung disease. It was of late onset and the BAL showed neutrophilia and eosinophilia.Methotrexate-induced pneumonitis is a diagnosis of exclusion. A late onset combined with the predominance of neutrophils and eosinophils in BAL is rare in the literature, demonstrating the wide heterogeneity of methotrexate-related interstitial lung disease.

International audience; BACKGROUND:Kodamaea ohmeri is a yeast is frequently mistaken for Candida, which belongs to the same family. This micro-organism has been reported to cause life-threatening infections in humans.CASE PRESENTATION:A 81-year-old woman developed a severe fungemic pulmonary infection due to Kodamaea ohmeri that was identified from bronchoalveolar fluid and blood cultures, which is unusual in immunocompetent patients. Because K. ohmeri was first wrongly identified as Candida albicans, the patient inadequately received caspofungin, which was clinically ineffective, especially as the strain was resistant to echinocandins. Clinical cure was obtained after treatment was switched to voriconazole.CONCLUSIONS:An increasing number of serious infections due to K. ohmeri has been reported in the literature, but the correct identification of this micro-organism remains difficult.

Acute pulmonary histoplasmosis (APH) is rare in an immunocompetent patient. We report a case of APH diagnosed by culture of broncho-alveolar lavage (BAL) in a patient presenting a pseudo-tumoral form with nodules progressing to cavitation.A 41 year-old male smoker was hospitalized with a persistent fever, dry cough and dyspnoea on exertion. The first CT scan showed a reticulo-nodular interstitial infiltrate with lymphadenopathy that progressed rapidly to multiple pulmonary nodules with central cavitation. Bronchial endoscopy, with BAL culture, provided the diagnosis of Histoplasma capsulatum, variety capsulatum. The infection may have occurred during work in a hangar in Guadeloupe that was scattered with bats' guano. After two months of treatment by itraconazole, the patient's condition improved clinically and radiologically with reduction of the nodules and their cavitation.This case presents an immunocompetent patient with pulmonary histoplasmosis and multiple, radiologically atypical, nodules. The diagnosis was established by BAL culture.

We describe a case of small-cell lung cancer limited to the thorax but with malignant pleural effusion in a 47-year-old man that was revealed by a nephrotic syndrome due to membranous glomerulonephritis (MGN). Chemotherapy led to a partial tumor response with total resolution of the nephrotic syndrome. Tumor relapse did not provoke proteinuria. Primary lung cancer is the cause of about 3% of all cases of MGN and 40% of tumor-related MGN. There are 49 cases of tumor-related MGN in the literature, including 9 cases of small-cell lung cancer.