Georges M. Akoun

Minocycline-induced Cell-mediated Hypersensitivity Pneumonitis

OBJECTIVE To identify the cause of a hypersensitivity pneumonitis and to determine its pathogenesis. DESIGN Case study. SETTING Intensive care unit of a referral hospital. PATIENT A 51-year-old man with chronic bronchitis who developed a hypersensitivity pneumonitis within 1 month after exposure to minocycline, amoxicillin, and erythromycin. INTERVENTION Sequential bronchoalveolar lavages after reexposure to minocycline and amoxicillin. MEASUREMENTS Immunologic analysis of the phenotype and function of alveolar lymphocytes. RESULTS Reexposure to minocycline but not to amoxicillin was followed by an interstitial pneumonitis. Sequential bronchoalveolar lavages showed a transient rise of eosinophils and neutrophils and a persistent alveolar lymphocytosis. Alveolar lymphocytes consisted predominantly of CD8+ but also CD4+ cells. Two CD8+ lymphocyte subsets were identified: CD8+ D44+ cytotoxic T cells that increased rapidly after the drug was resumed and CD8+ CD57+ suppressor T cells that predominated 11 days after the drugs withdrawal. In-vitro assays showed the presence of a lymphocyte-mediated specific cytotoxicity against minocycline-bearing alveolar macrophages. CONCLUSION These results support the hypothesis of a central role of T lymphocytes in the pathogenesis of drug-related hypersensitivity pneumonitis.

A prospective study of detorubicin in malignant mesothelioma

Between January 1981 and December 1983, a prospective therapeutic trial of detorubicin (14‐diethoxyacetoxy‐daunorubicin [DTR]) was conducted in 40 patients with histologically proven malignant mesothelioma (MM). DTR was given intravenously at 40 mg/m2 on days 1, 2, and 3 for five 21‐day cycles, then 40 mg/m2 once every 21 days. Thirty‐five patients (32 with pleural MM, 3 with peritoneal MM) were eligible. The overall median survival from onset of chemotherapy was 17 months. Complete relief from chest pain was observed in 8 of 15 cases (53%). Of 21 patients with measurable disease, there were 2 complete responses (10%) and 7 partial responses (33%). Median duration of response was 30 weeks. Congestive cardiac failure developed in two patients after 1100 and 1600 mg/m2 of DTR, respectively. Hematologic toxicity was moderate. This study demonstrates that DTR is effective against MM.

Les pneumopathies infiltrantes diffuses d’origine médicamenteuse : un problème avant tout diagnostique

Resume Les medicaments sont frequemment incrimines a l’origine de pneumopathies infiltrantes diffuses (PID). Ils sont a l’origine de PID par deux grands mecanismes qui peuvent s’associer avec le meme medicament : toxicite directe et mecanisme immunoallergique. Toute la difficulte pour le clinicien qui suspecte l’origine medicamenteuse d’une PID est d’en apporter la preuve. La suspicion repose sur des criteres chronologiques, semiologiques, et sur la confrontation du cas avec les donnees de la litterature. La preuve ne peut etre apportee que par l’evolution. C’est souligner que les decisions therapeutiques doivent etre prises sur les seuls elements de suspicion.

Thyroid tuberculosis associated with mediastinal lymphadeniitis

A 25-year-old man developed thyroid tuberculosis associated with mediastinal lymph node enlargement. He was treated by antituberculosis chemotherapy and hemithyroidectomy.

Pulmonary Lesions of Kaposi's Sarcoma, Intra-alveolar Hemorrhage, and Pleural Effusion

Excerpt To the editor: We wish to comment on the interesting article by Dr. Ognibene and associates (1) on pulmonary impairment induced by Kaposis sarcoma in patients with the acquired immunodefic...