Bechir Louzir

Rosai and Dorfman Disease with Pleural Involvement: Case Report

Sinus histiocytosis with massive lymphadenopathy (SHLM) disease is considered to be an indolent and self-limiting pathology. However, severe morbidity and mortality have been attributed to complications of SHLM. Lower respiratory tract involvement is rarely reported and is often unfavorable, and carries a particularly grave prognosis. A case of SHLM is reported, in which the patient had lower respiratory and pleural involvement.

Tuberculosis is the main pulmonary complication of AIDS in Tunisia

While Pneumocystis carinii is the main pulmonary complication of acquired immunodeficiency syndrome (AIDS) in Europe and North America it has been rarely reported in sub-Saharan Africa possibly because many African AIDS patients die relatively early after infection with human immunodeficiency virus (HIV). AIDS is infrequent in Tunisia; fewer than 500 people infected with (HIV) were recorded from 1985 (the beginning of the epidemic) to 1994 and less than 150 AIDS cases were diagnosed. The results reported here of a study conducted on 30 Tunisian AIDS patients (14 men and 6 women age range = 30-43 years mean age = 33.6 years) with clinical pulmonary manifestations and/or radiographic abnormalities include the following: 1) 48% had fever 60% had cough and 35% had breathlessness (chest pain was another clinical symptom used); 2) although 6 patients had normal chest films the radiographs of 10 patients showed bilateral pulmonary interstitial infiltrates and those of 4 patients demonstrated unilateral or focal infiltrates; and 3) while examination using bronchofibroscopy of bronchoalveolar lavage (BAL) fluid for parasitic or bacterial agents demonstrated no opportunistic agent in 10 cases 20 cases were positive for such agents (Mycobacterium tuberculosis in 12 cases or 60% of the positives P. carinii in 3 cases or 15% of the positives an atypical mycobacterium in 1 case an aspergillus in another case and candida in 3 cases). The high prevalence of tuberculosis in Tunisia (120/100000 inhabitants) causes increased exposure to the organism. The feasibility of prophylaxis therapy against tuberculosis for patients with HIV in North Africa should be explored.

Respiratory Tract Vasculitis

The respiratory airway and pulmonary parenchyma are frequently involved in vasculitis particularly in small-vessel vasculitis associated with antineutrophil cytoplasmic antibodies. The diagnosis is based on anamnesis and physical examination but remains largely dependent on high-resolution CT and angiography. The confirmation of diagnosis depends on tissue biopsy. Conventional chest radiography is usually not very contributive. High-resolution CT is more sensitive in showing the spectrum of thoracic manifestations but it is nonspecific. MRI and MR angiography can provide information on vessel wall thickening in the early stage and on luminal changes. PET/CT is a good indicator of inflammation and helpful for follow-up.