Primary lung low-grade fibromyxoid sarcoma: A rare case with A diagnostic dilemma

Low-grade fibromyxoid sarcoma (LGFMS) is a rare, low-grade malignant soft tissue tumor that is often mistaken for benign or more rarely malignant tumor types. Commonly, this tumor affects young adults and typically arises in the deep proximal extremities or trunk with frequent recurrences and can metastasize to the lungs many years late. Visceral LGFMS is extremely rare. Only a few cases of primary LGFMS of the lung have been reported. Here, we present the clinical, gross, microscopic, and immunohistochemical characteristics of Evans tumor occurring in the lung with a review of the literature and discuss the differential diagnosis in this exceptional localization.

Pneumocystis jirovecii pneumonia in a healthy immunocompetent patient: A case report and literature review

Pneumocystis jirovecii pneumonia, typically an opportunistic infection, is commonly associated with risk factors such as low CD4+ lymphocyte count, underlying malignancies, organ transplantation, or immunosuppressive medications. However, occurrences in healthy individuals without known risk factors are exceptionally rare and sparsely documented. In our retrospective analysis of a 42-year-old male without past medical history at Abderrahmane Mami Hospital, Tunisia, Pneumocystis jirovecii pneumonia was diagnosed. The patient presented with fever, productive cough, hemoptysis, and a decline in general health. Clinical examination revealed fever and hypoxemia, and imaging studies demonstrated bilateral necrotic alveolar opacities. Despite empirical antibiotics, nonresponse necessitated bronchoscopy, confirming Pneumocystis jirovecii. Treatment with oral Sulfamethoxazole-Trimethoprim yielded excellent outcomes. This case highlights the potential occurrence of Pneumocystis jirovecii pneumonia in immunocompetent individuals, underscoring the importance of direct microbiological methods in assessing suggestive clinical and radiological features.

PDL1 and molecular biomarkers expression in non-small cell lung cancer in Tunisian patients

In cancer treatment, programmed death-1 (PD-1) and programmed death ligand-1 (PD-L1) inhibitors are thriving. Activated T lymphocytes expressed PD-1, it works with its ligand PD-L1 to limit T lymphocyte activation and prevent autoimmune disease. The expression of molecular biomarkers and PD-L1 in lung cancer determines the appropriate treatment strategy for patients with lung cancer. The purpose of this study was to look at the prevalence of molecular biomarkers and PD-L1 expression in a large group of Tunisian patients with advanced non-small cell lung cancer. We conducted an observational retrospective study in which medical/treatment history data were extracted retrospectively from medical records and archived tissue samples between January 1st 2019 and December 31st 2021. We gathered 157 patients who had recently been diagnosed with non-small cell lung carcinoma. In 36.9%of the cases, there was no molecular genotyping. EGFR (28.6%), KRAS (5.73%), and ALK gene rearrangement were the most common genotyping mutations (3.8%). ROS1 rearrangement was not present. There was a link between EGFR and gender, HER and age, and KRAS and biopsy tissue origin. Six of the tested cases with PD-L1 met the cut-off (³50%). PD-L1 positivity was more common in solid type adenocarcinoma (1.9%) than in acinar or papillary adenocarcinoma. There were no significant differences in PD-L1 expression across clinical and demographic parameters. High PD-L1 expression and molecular abnormalities were found in 1 case of EGFR, 1 case of BRAF, and 1 case of KRAS (3 cases). All of the other specimens with abnormalities had a PD-L1 <50%. ALK, ROS1, BRAF, KRAS, and MET were found to be significantly associated with PD-L1 expression. Our study is one of the country's largest, describing a large panel of biomarkers and their clinicopathologic/histopathologic associations in Tunisian lung cancer patients. We have the same molecular profile as European patients with an EGFR mutation, which is not the most common genotype abnormality in Tunisian patients. There is only one mutation at any given time. The expression of PD-L1 is determined by the histologic type and the origin of the biopsy tissue.

Pulmonary actinomycosis mimicking lung malignancy: About two cases

Pulmonary actinomycosis is a rare anaerobic infection with non specific clinical and radiographic presentations that delay diagnosis. Throughout literature, a significant number of misdiagnosed cases have been reported. The diagnosis is substantially based on histopathological pattern. We describe the cases of two patients evaluated and treated in pulmonary department 1 of Abderrahmane Mami hospital of Tunisia with a diagnosis of pulmonary actinomycosis. There are two men. The first patient had hypertension and chronic obstructive pulmonary disease and the second one underwent surgery for bronchiectasis. Clinical presentation was consistent with productive cough, hemoptysis, and deterioration of general status. The medical examination was non-specific. The chest X-ray revealed an apical opacity, excavated in the first case and retractable in the second one. Biology showed an inflammatory syndrome. Bronchoscopy was performed in the two cases and showed lesions mimicking lung malignancy. Diagnosis is confirmed by histopathological examinations of surgical specimens in the two cases. Both patients were received antibiotic therapy. The results were excellent with a favorable clinical course and no deaths. This study highlights the misleading patterns of actinomycosis to prompt accurate diagnosis and earlier treatment, thus improving the outcome. Given either its low culture yield or the limited use of new molecular diagnostic tools in routine clinical practice, histological examination of lung tissue specimens is crucial to get the correct diagnosis.

Rifampicin-induced acute tubulointerstitial nephritis during pulmonary tuberculosis treatment: A case report

Drug-induced tubulointerstitial nephritis is an uncommon complication in patients on anti-tuberculosis therapy that can lead to permanent kidney damage. Rifampicin is the most offending drug. We report a case of a 41-years old man being treated for pulmonary tuberculosis and presenting with tubulointerstitial nephritis associated with rifampicin. We focus on diagnosis features and therapeutic challenges.

Granular cell tumor of the lung and tracheobronchial tree: Two case-presentation with a review of the literature

Pulmonary granular cells tumors (CGT) are rare tumors, that derive from Schwann cells. In the tracheobronchial and pulmonary tree, they remain a diagnostic challenge. There are no well-established criteria to differentiate between benign, atypical, and malignant GCT. Moreover, its real frequency in the respiratory tract is still unknown. Here, we represent 2 cases of bronchial and lung GCTs. We aim to highlight the frequency of all clinicopathological characteristics of this rare tumor in the tracheobronchial and pulmonary tree location based on our cases and the available literature in a large systematic review.

A life-threatening pericardial tamponade revealing disseminated tuberculosis: A challenging medical care

Tuberculous pericarditis (TBP) is one of the most important causes of pericarditis in developing countries in which tuberculosis remains a public health problem. We report the case of a 20-year-old immunocompetent woman who presented with hypotension and tachycardia echocardiography showed a massive pericardial effusion and signs of tamponade. The patient underwent an urgent pericardiocentesis; 700 ccs of serosanguinous pericardial fluid was drained. She had a surgical biopsy of the pleuropericardial window. The pathological examination confirmed TBP. Oral anti-tuberculosis therapy was initiated. Two months after therapy started, she was admitted for dyspnea and edema of the lower limbs. Echocardiography showed paradoxical inter-ventricular septum and non-compliant dilated inferior vena cava. She has been set on diuretics associated with Akurit for another two months. Thoracic CT scan done at 4 months of tuberculosis treatment showed: thickening of the pericardial layers, with an encysted collection facing the trunk of the pulmonary artery, bilateral pleural effusion, and thickening of the peribronchovascular and interlobular septa of the right lung, due to lymphatic stasis. We then switched to dual therapy for a total of eight months. An ultrasound check at the end of treatment was performed showing the absence of pericardial effusion with diminished systolic ejection fraction (54%). This case is the witness that TBP can be life-threatening even for immunocompetent patients. The risk is the evolution towards sequelae and constrictive pericarditis. The high mortality and morbidity from TBP despite the use of anti-tuberculous drugs call for research targeting host-directed immunological determinants of treatment outcome.

Drug reintroduction testing and beta-lactam hypersensitivity in children: Protocols and results, a 12-year experience

Introduction: Oral provocation test (OPT) to beta-lactam antibiotics (BL) is a gold standard in allergology investigation. We aimed to demonstrate the contribution of OPT in BL hypersensitivity (HS) indicated as a first step in diagnosis. Methods: We conducted a retrospective study from 2007 to 2019, in a single Tunisian tertiary care academic center. It concerned children with presumed non-severe allergic manifestations to BL, with a reaction that has occurred at least 6 months before the OPT. Results: We identified 35 children for inclusion. After the first OPT, a second OPT with a different BL was performed in case of a positive result of the first one. In 12 cases (34.2%), the OPT elicited a reaction. In eight cases the allergy was to penicillin and in two cases to cephalosporins (cefixim). Cross-reactivity was noted in two cases. Conclusion: An OPT to BL indicated in the first instance in non-severe reaction in children will allow a rapid diagnosis in case of suspicion of HS to BL.

Seroprevalence and risk factors for peste des petits ruminants in sheep and goats in Djibouti

Despite the occurrence of peste des petits ruminants (PPR) in all other countries in the Horn of Africa, which engage in free animal movement, to date, PPR has not been reported in Djibouti. The objective of this study was to estimate the seroprevalence of PPR and its associated risk factors in sheep and goats in that country. A cross-sectional method was used with proportional sampling to allocate the number of small ruminants to be sampled from each of the country's regions (Ali Sabieh, Arta, Dikhil, Djibouti, Obock and Tadjourah). From a total of 1,516 serum samples tested, using a competitive enzyme-linked immunosorbent assay (cELISA), 91 were positive, with an overall 6% (95% confidence interval [CI] = 4.8-7.2) prevalence of antibodies to the PPR virus (PPRV). Antibodies to PPRV were detected in small ruminants from all the regions, excluding Obock. Seroprevalence was highest in the Tadjourah region (8.92%), whereas the lowest prevalence was observed in the Djibouti region (1.28%). The species, age and sex of the animals and the herd size were identified as risk factors for PPR seropositivity. The risk of goats testing positive for PPRV antibodies was2.95 (CI = 1.39-6.35) times that of sheep. Moreover, the risk of animals younger than two years testing positive for PPRV antibodies was 2.29 (CI = 1.47-3.56) times that of animals older than two years. Similarly, it was shown that female animals were more frequently infected (odds ratio [OR] = 3.82; CI = 1.51 to 9.67) than their male counterparts. In addition, small ruminants from small herds/flocks were more likely to be seropositive (OR = 2.06; CI = 1.10-3.83) than those from medium-sized herds/flocks. The present study revealed, for the first time, the widespread occurrence of PPRV antibodies in small ruminants in Djibouti with low prevalence.

Microbial models of mammalian metabolism. Fungal metabolism of phenolic and nonphenolic p-cymene-related drugs and prodrugs. I. Metabolites of thymoxamine

This study was undertaken to validate the use of microbial biotransformation systems for drug metabolism studies. Thymoxamine 1 was rapidly hydrolyzed to desacetylthymoxamine (DAT) 2 by numerous fungi. Other known animal metabolites, such as N-desmethyl-desacetylthymoxamine 3 and desacetylthymoxamine-O-sulfate 6, were produced from DAT by Mucor rouxii and Mortierella isabellina. DAT-N-oxide 5, a putative animal microsomal metabolite, was also produced by M. isabellina, in addition, a few strains (such as Actinomucor elegans, Mucor hiemalis, and Mucor janssenii) produced a glycosylated metabolite that was identified by high-resolution 1H- and 13C-NMR, MS, and enzymatic hydrolysis as the corresponding [4-(2-dimethylaminoethoxy)-5-isopropyl-2-methyl-phenyl]-1-beta-D- glucopyranoside 7. A similar glucosylation reaction was observed when thymohydroquinone 10 was incubated with A. elegans. Several strains were able to produce transiently thymohydroquinone from DAT-N-oxide 5, possibly through a beta-elimination mechanism.

Microbial models of mammalian metabolism. Fungal metabolism of phenolic and nonphenolic p-cymene-related drugs and prodrugs. II. Metabolites of nonphenolic derivatives

A cymene-derived drug, 3-[4'-(o-ethoxyphenyl)piperazin-1'-yl]-ethyloxy-p-cymene+ ++ (B1178), is not significantly metabolized by fungal microorganisms. On the contrary, one of its metabolites in rat, 3-(piperazin-1'-yl)ethoxy-p-cymene (B1071), is quantitatively converted by Cunninghamella echinulata NRRL 3655 into two hydroxylated products: the corresponding phenol derivative and a benzylic alcohol derivative. Other strains, such as Beauveria bassiana ATCC 7159 and Mortierella isabellina MMP 108, produce exclusively an N-acetyl derivative in high yield. Results obtained are discussed on the grounds of relative hydrophobicity of substrates vs. fungi metabolism and detoxification capabilities.

Congenital prepubic sinus

We report the fifth case of congenital prepubic sinus that goes from the anterior wall of the bladder through the public symphysis to the skin. The various embryological theories that could be responsible for this pathology are discussed, and according to us, it seems to be a variant of dorsal urethral duplication.