La Revue du praticien
-
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...).
-
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.
-
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.