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Background SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection is associated with various complications. PMA (primary meningococcal arthritis) is a rare meningococcus-associated disease causing arthritis of the knee usually, without any signs of invasive meningococcal disease. No case of PMA in a COVID-19 (coronavirus disease, 2019) patient has yet been described. PMA mainly strikes young adults. PMA is not associated with any immunocompromising condition. It has a better outcome than usual septic arthritis Case presentation Herein, we report an 18-year-old man diagnosed with COVID-19, later admitted with persistent fever, right knee arthralgia and maculopapular rash. Due to family history, psoriasis and Henoch-Schönlein purpura were hypothesized and ruled out. Finally, synovial fluid culture confirmed Neisseria meningitidis serogroup B arthritis without any other symptoms of invasive meningococcal disease. Healing was achieved quickly with surgery and antibiotics. We concluded in a PMA. Conclusion We describe here the first primary meningococcal arthritis in a COVID-19 patient and we hope to shine a light on this rare but serious complication.

Resume Introduction La recherche de mutations de l’ epidermal growth factor receptor (EGFR) a modifie l’approche therapeutique et le pronostic des carcinomes bronchiques non a petites cellules (CBNPC). L’efficacite des inhibiteurs des tyrosines kinases (TKI) par voie orale a ete demontree chez les patients mutes. Nous rapportons le cas d’une patiente pour laquelle le traitement par TKI a ete initie avec efficacite en reanimation. Observation Une patiente de 59 ans est suivie pour un adenocarcinome pulmonaire stade IV au niveau hepatique, cerebral, surrenalien, pulmonaire et pleural. Apres une 1 re cure de chimiotherapie (cisplatine/gemcitabine), la patiente presente au decours une detresse respiratoire aigue d’origine multifactorielle. Une mutation de l’EGFR etant presente, le transfert en reanimation est decide puis une intubation orotracheale avec ventilation mecanique. Il est alors decide d’instaurer un traitement par erlotinib via la sonde nasogastrique. L’evolution sera marquee par une reponse tumorale permettant une evolution favorable. Conclusions Ce cas clinique met en evidence l’interet d’initier les TKI malgre une hospitalisation en reanimation et pose la question du passage en reanimation des patients porteurs d’une mutation EGFR.

Resume Introduction Le carcinome a petites cellules (CPC) est un cancer rapidement evolutif de tres mauvais pronostic. Sa chimio-sensibilite implique un traitement rapide. L’hyponatremie du CPC rapportee au syndrome de secretion inappropriee d’hormone antidiuretique est classique. Nous rapportons un cas d’hyponatremie severe induite par la chimiotherapie ayant entraine une prise en charge de soins intensifs. Observation Un patient âge de 68 ans est pris en charge pour un cancer bronchique a petites cellules envahissant le poumon droit. A la premiere cure, le patient presente un coma necessitant une prise en charge en soins intensifs le deuxieme jour (j2) de chimiotherapie (cisplatine-vepeside) qui est rapporte a une hyponatremie severe (107 mmol/L) et d’evolution favorable sous therapeutiques specifiques. Le patient presentera ces memes episodes aux j2 des cures suivantes mais avec des manifestations cliniques de moins en moins intenses. Conclusions La notion d’hyponatremie induite par la chimiotherapie du CPC est peu connue. Ce cas clinique met en evidence le risque d’hyponatremie severe sous chimiotherapie du carcinome a petites cellules. Celle-ci pourrait etre correlee a la fonte tumorale. Une surveillance biologique lors du j2 de chimiotherapie est preconisee.

Recent studies have demonstrated that elevated BMI is associated with improved survival in patients with lung cancer. According to the authors, this "obesity paradox" could be a true benefit or a spurious relationship. In this context, data from the French KBP-2010-CPHG cohort (7,051 patients followed up for primary lung cancer diagnosed in 2010 in the respiratory medicine departments of 104 nonacademic hospitals) were analyzed.Patients were stratified according to BMI at diagnosis using the definition of the French-Speaking Society of Clinical Nutrition and Metabolism (Société Francophone de Nutrition Clinique et Métabolisme). Survival was analyzed using log-rank and a univariate Cox model. Prognostic factors were identified using a multivariate Cox model with backward elimination procedure, and with or without inclusion of prediagnosis weight loss in the model.Patients were followed for a median 20.2 months. At diagnosis, respectively 12%, 28%, 45%, and 15% of the 6,595 patients with BMI data were obese, overweight, normal-weight, and underweight; 35%, 43%, 57%, and 75% reported prediagnosis weight loss (i.e., weight loss within the 3 months prior to diagnosis). One-year survival (% [95% CI]) was 53% [50%-57%], 50%, [48%-52%], 43%, [42%-45%], and 32% [29%-35%] in obese, overweight, normal-weight, and underweight patients, respectively (p 0.001). It was particularly low in underweight patients with prediagnosis weight loss: 27% [24-30%]. BMI did not remain an independent prognostic factor associated with survival when prediagnosis weight loss was introduced in the Cox model. Risk of death was increased by 17%, 23%, and 46% in patients with5 kg, 5-10 kg, or ≥10 kg prediagnosis weight loss, respectively (p 0.001).BMI is an easy but crude assessment tool. Other variables should be used to improve management of patients, and understanding of how prediagnosis body size and nutritional status are associated with cancer survival.

Introduction: Parapneumonic pleuritis are frequently associated with high morbidity and severe sequelae. Management of this complication include early pleural evacuation. Guidelines do not currently recommend the use of lung ultrasound (LUS) as an alternative to chest X-ray (CXR) or chest computerized tomography (CT) scan for the diagnosis of pleural effusion. Chest x-ray (CXR) is the simplest diagnostic tool of Community Acquired Pneumonia (CAP), but it has some limitation. Therefore, the aim of this study is evaluate pleural sequelae with early use of LUS in detection Methods: In this multicentric prospective study, a consecutive sample of suspected patients with CAP was underwent daily LUS. Each patient received a chest x-ray and ultrasound on admission every day. The analysis of the pleural fluid was left to the discretion of the physician . The patients were monitored only 4 days if they had no para pneumonic pleurisy and benefited from an appropriate management if not. Complete respiratory explorations were carried out at 3 and 6 months. Results: In this preliminary reports , 65 patients with CAP were enroled : 48,3% females , mean age 64,4 years Sensitivity of LUS and CXR in detection of parapneumonic effusion were 91% and 40% respectively. Specificity of CXR was 40% while the LUS specificity was 92%. The evolution of pleurisy was unpredictable over the observation period with a significant diagnostic delay of the CXR. No pleurisy occurred after the 4-day period, the failure was 4.6% Compared with nearly 20% of the literature. Conclusion: Findings of the present study demonstrated high incidence of parapneumonic effusion and the higher diagnostic accuracy of LUS versus CXR. A daily echography is necessary and sufficient to detect the effusion and take care of it.

Rationale: EBUS-TBNA is now an usual technique in the diagnosis of mediastinal adenopathy. Some authors describe the use of a pathologist on site. To improve the diagnosis and reduce the number of procedures, we try to optimize the efficiency of EBUS-TBNA by a non-pathologist. Objectives: To determine efficiency of a non-pathologist to evaluate sample quality Methods: On each procedure of puncture, we have asked our nurses to evaluate the sample quality (presence of lymph nodes or not) based on the aspect of the aspiration. The responses (ROS) of the nurses were compared prospectively with responses of cytologist (ROC). Results: Between 2010 and 2016, 415 men and 188 women (mean age 63,1 ± 12) underwent a EBUS-TBNA. 1325 procedures were performed. The mean size of lymph nodes was 15,6 mm in CT and 17,4 mm in EBUS. With a mean punctures number of 3,2 the mean duration procedure was 30 min 40 sec. 72 % of our patients underwent this procedure for a diagnosis or a staging of cancer. With EBUS-TBNA, we obtained a final diagnosis for 73,2 % of them. The area 7 was the most often punctured (64,8 %) followed by the 11R area (23,2%). There were 88,2 % of correlation between ROS and the final diagnosis by the cytologist. There were more correlations ROS-ROC (p = 0,01) when the final diagnosis was obtained (vs only lymph nodes), if the number of punctures increased (p = 0,008) and if experience of the nurse increased (first 3 months of the study vs. last 3 months: p = 0,01). The correlation ROS-ROC was not associated with the size of lymph nodes or length of the exam. Conclusion: Evaluation by a non pathologist may optimize efficiency of EBUS-TBNA

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an increasingly used mediastinal sampling technique. The purpose of the study is the evaluation of the tolerance during EBUS-TBNA according to the choice of anesthesia. Methods: this is a prospective two-center observational study extended form january 2012 to April 2014. We conducted a systematic review of patients undergoing EBUS-TBNA in the hospitals of Amiens and Saint Quentin where we practiced respectively under conscious sedation or under general anesthesia with propofol and laryngeal mask. The main objectives were the hemodynamic tolerance and the subjective tolerance collected by a questionnaire. Results: Eighty eight patients were included in our study, forty one in the general anesthesia group and forty seven in the conscious sedation group. Arterial blood pressure and heart rate increased in midazolam group, and decreased in propofol group. No incident occured in the general anesthesia group.The subjective tolerance seemed better in the general anesthesia group with an visual analogue scale estimated at 3/100 versus 32,6/100 in the conscious sedation group (p Conclusion: the tolerance is better under general anesthesia but the choice of anesthesia does not affect the profitability of the examination,.

Resume Introduction L’echoendoscopie est une technique en cours de developpement en France dans le staging et le diagnostic des cancers bronchopulmonaires. Cet examen, par la taille de l’endoscope et par la duree de cet examen, pose le probleme du type d’anesthesie propose aux patients. Nous avons developpe au sein de notre centre hospitalier une technique interessante pour la realisation de cet examen. Celle-ci utilise le masque larynge. Patients et methodes Nous avons realise une etude retrospective monocentrique afin de comparer les resultats de l’echoendoscopie bronchique realisee sous masque larynge par rapport a l’anesthesie locale pure. Resultats Soixante-trois patients ont ete inclus. Quarante et un (65 %) examens ont ete effectues sous masque larynge et 22 (35 %) examens sous anesthesie locale. Cinquante examens sur cinquante-sept (87 %) ont ete informatifs, c’est-a-dire avec cellules ganglionnaires (34/38 [89 %] pour les examens sous masque larynge avec 3,8 ponctions en moyenne et 17/19 [86 %] pour les examens sous anesthesie locale avec en moyenne 2,9 ponctions en moyenne). Quarante-cinq (78 %) resultats ont permis d’eviter la mediastinoscopie. Conclusion La realisation des echoendoscopies bronchiques sous anesthesie generale avec ventilation par masque larynge semble ne pas perturber les resultats de l’examen avec une bonne tolerance et peu de complications.

Introduction L’infection des loges de pneumonectomie est une complication classique. Son traitement consiste le plus souvent en une thoracostomie. Celle-ci necessite une prise en charge par des soins locaux. Nous rapportons ici une complication inhabituelle de cette situation. Observations Un homme de 62 ans subit une pneumonectomie pour carcinome bronchique non a petites cellules. Il beneficie par la suite d’une thoracoplastie a la suite d’une surinfection de sa loge de pneumonectomie. Il beneficie alors de soins locaux. Lors d’un bilan d’alteration de l’etat general, il est diagnostique une hyperthyroidie due aux mechages effectues avec des produits desinfectants iodes. Conclusion Il s’agit d’un cas original de thyreotoxicose chez un patient porteur d’une thoracoplastie. Nous preconisons la surveillance reguliere du bilan thyroidien dans de tels cas.

Infectious complications are common in patient with multiple myeloma. However, Paecilomyces variotii, a common saprophytic fungus, rarely causes human infection. We report the first case of P. variotii fungemia in this illness with good response with adapted anti-mycotic treatment.

Background The chemotherapy used to treat lung cancer causes febrile neutropenia in 10 to 40% of patients. Although most episodes are of undetermined origin, an infectious etiology can be suspected in 30% of cases. In view of the scarcity of data on lung cancer patients with febrile neutropenia, we performed a retrospective study of the microbiological characteristics of cases recorded in three medical centers in the Picardy region of northern France. Methods We analyzed the medical records of lung cancer patients with neutropenia (neutrophil count < 500/mm3) and fever (temperature > 38.3°C). Results The study included 87 lung cancer patients with febrile neutropenia (mean age: 64.2). Two thirds of the patients had metastases and half had poor performance status. Thirty-three of the 87 cases were microbiologically documented. Gram-negative bacteria (mainly enterobacteriaceae from the urinary and digestive tracts) were identified in 59% of these cases. Staphylococcus species (mainly S. aureus) accounted for a high proportion of the identified Gram-positive bacteria. Bacteremia accounted for 60% of the microbiologically documented cases of fever. 23% of the blood cultures were positive. 14% of the infections were probably hospital-acquired and 14% were caused by multidrug-resistant strains. The overall mortality rate at day 30 was 33% and the infection-related mortality rate was 16.1%. Treatment with antibiotics was successful in 82.8% of cases. In a multivariate analysis, predictive factors for treatment failure were age >60 and thrombocytopenia < 20000/mm3. Conclusion Gram-negative species were the most frequently identified bacteria in lung cancer patients with febrile neutropenia. Despite the success of antibiotic treatment and a low-risk neutropenic patient group, mortality is high in this particular population.

Objective: To report a case of bronchial fistula associated with sunitinib in a patient previously treated with radiation therapy. Case Summary: A 40-year-old man with renal cell cancer diagnosed in 2005 and initially treated by radical nephrectomy presented in March 2007 with a recurrence with cerebral, mediastinal, and lung metastases. A thoracic computed tomography (CT) scan showed a subcarinal tumor obstructing the bronchus intermedius. The patient was initially treated with cerebral and thoracic radiotherapy and then with sunitinib 50 mg/day (4 weeks on, 2 weeks off). Two months after the beginning of treatment, a CT scan revealed a dramatic reduction in the size of the tumor, associated with a bronchial fistula. This was confirmed by flexible bronchoscopy, which showed complete necrosis of the tumor and a large perforation of the bronchus intermedius. Sunitinib was immediately withdrawn and antibiotic prophylaxis was instituted. It was not possible to place an endobronchial stent. Two weeks later, flexible bronchoscopy revealed the reappearance of a yellowish mass protruding into the bronchus intermedius (40% obstruction). A few months later, the obstruction of the bronchus intermedius progressed to 90% and was associated with a contralateral obstruction of the left mainstem bronchus (20%). A rigid bronchoscopy was then performed to clear the obstruction and an endobronchial stent was placed, with satisfactory initial results. In February 2008, the patient presented with new bronchial obstruction under the endobronchial stent but refused a rigid bronchoscopy and died in March 2008. Discussion: Sunitinib, a multitarget tyrosine kinase inhibitor with antiangiogenic and antitumoral activities, has been approved for the treatment of advanced renal cell carcinoma. This treatment is generally well tolerated. Serious complications may occur, however. According to the Naranjo probability scale, the bronchial fistula was possibly related to sunitinib treatment. Conclusions: This is a rare case of a bronchial perforation leading to a fistula associated with sunitinib treatment after mediastinal radiation therapy. Clinicians may consider strict follow-up of patients with proximal lung metastases treated with sunitinib (CT scan and, if appropriate, placement of an endobronchial stent).

Co-infection with Schistosoma mansonii and Mycobacterium tuberculosis have been rarely reported in spite of the high African incidence of these two infections. We report the case of a 32 years old Mauritanian male living in France since 2001 who consulted with isolated abdominal pain. Rectal biopsies showed granuloma around Schistosoma mansonii eggs. He had persistent abdominal pain despite a treatment with Praziquantel , the biology stayed abnormal: elevated aspartate-(AST) and alanine transaminase (ALT), inflammatory syndrome and hypereosinophilia. Patient was explored for another diagnosis, 4 epigastric nodules were found and a punction is performed. Anatomopathology observed granulomatous lymphadenitis with necrosis, and positive acid-fast bacilli on excisional lymph node biopsy was found (culture showed Mycobacterium tuberculosis ). Tuberculous lymphadenitis diagnosis is then performed and standard anti-tuberculosis drugs are prescribed. Reviewing the literature on Schistosoma mansonii and Mycobacterium tuberculosis co-infections, one interrogate on the potential link between those two infections, specially on an immunophysiopathological basis. Described as an ulcerating mycobacteria, Schistosoma induce a specific cellular Th2-predominant immune response, on the opposite Mycobacteria's immunity which is rather Th1 cell-mediated related. The lymphocyte population imbalanced with Th2 could enhance susceptibility to mycobacterial diseases. This communication rounds up Schistosoma and Mycobacterium co-infection and studies the different physiopathological hypothesis for co-development.

e19078 Background: In recent years, many major advances have been made in non-small-cell lung cancer (NSCLC), and in particular in adenocarcinoma, but not in SCLC. In 2010, the French College of General Hospital Respiratory Physicians (CPHG) performed a prospective multicentre epidemiological study (KBP-2010-CPHG) to describe the baseline characteristics and management of all new cases of primary lung cancer and to evaluate survival. The present abstract reports results in SCLC patients. Methods: 7,051 patients ≥18 years presenting with a new case of primary lung cancer, histologically or cytologically diagnosed between 1 January and 31 December 2010 and managed in the respiratory department of one of the 104 general hospitals participating in the study, were included. A standardised form was completed for each patient. A steering committee checked data collection exhaustiveness. SCLC data were analysed separately. Results: There were 968 SCLC patients: mean age, 65.6 years (+/-10.6); 23.2% female; 4.4% non-smokers (11 % in women), 35.8% ex-smokers, 59.8% current smokers; 63.4% with performance status 0 or 1; 59.9% having lost weight within the previous 3 months (19.8% of whom had lost >10 kg). Main tumour characteristics at diagnosis were: 71.2% stage IV, 24.7% stage IIIA or IIIB, 4.1% of stage 70 (59.1%) than