La Revue du praticien
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Sarcoidosis treatment suppresses the granulomatous process and its clinical, functional and radiographic consequences but it is not etiological. Only a minority of patients necessitate systemic therapy. This is definitely required in severe extra-respiratory sarcoidosis including cardiac, neurological, renal, ocular involvement not responding to topical therapy and malignant hypercalcemia. ⋯ One of the following sparing agents can be associated with steroids when the threshold level to control the disease is high: hydroxychloroquine, methotrexate or azathioprine. An alternative option to corticosteroids is proposed in case of contra-indication or cortico-resistant sarcoidosis; methotrexate is then the treatment of choice. Although other drugs are only occasionnally needed, the available therapeutical range is wide (thalidomide, infliximab, cyclophosphamide, leflunomide...).
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Cushing's syndrome results from inappropriate exposure to excessive endogenous glucocorticoids. Untreated, it has an important morbidity and a significant mortality. The syndrome remains a challenge to diagnose and manage. Here, we propose algorithms for the diagnosis of Cushing's syndrome and its cause, and review pathogenesis, clinical features, and treatment.
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Aspergillosis, due to moulds belonging to the genus Aspergillus, occurs in patients with residual lung cavities. The clinical manifestations are determined by the host immune response, ranging from a local inflammatory response to the systemic dissemination. ⋯ The chest X-ray reveals a round mass with a radio-lucent crescent of air. The antifungal treatments are successful.
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Carbon monoxide (CO) poisoning is still complicated by a high mortality and morbidity rate. Diagnosis can be obvious but is most of time difficult and sometimes remained unknown. It is usually based on clinical signs and must be confirmed by assessment of CO level in room air or in patient's expired breathing or blood and detection of a source. ⋯ All CO poisoning has to be declared to sanitary authority, which will in turn conduct a technical inspection to remove the source. The patient must be informed that he is at risk of new poisoning and of neurological complications. Progress in prevention and research in therapeutics are needed in order to reduce CO related morbidity.