Lung cancers are diagnosed at a metastatic stage in 40% to 50% of cases. Skeletal muscle metastases are rare and usually discovered at autopsy. We report 3 cases of skeletal muscle metastasis. Muscular metastasis revealed the cancer in one patient. The metastases were asymptomatic in all patients. The diagnosis was confirmed histologically in one case and by radiography in the other 2. The evolution was characterized by tumor progression and death after 1-7 months.

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Several studies in the past few decades have shown that very intense and repeated exercise, particularly when performed over many years, could cause respiratory health problems. The prevalence of exercise-induced asthma has increased in the athletic population, particularly in elite athletes and has not been published in North African athletes. The aim of this study was to determine the prevalence of exercise-induced asthma and/or exercise-induced bronchoconstriction in Tunisian elite athletes. Each participant responded to a questionnaire about respiratory symptoms and medical history and underwent a resting spirometry testing before exercise. Exercise-induced bronchoconstriction was defined as a decrease of at least 15% in pre-exercise forced expiratory volume in one second at any time point after exercise. Post-exercise spirometry revealed the presence of exercise induced bronchoconstriction in 14 out of 107 (13%) elite athletes, while only 1.8% of the subjects reported having previously diagnosed asthma. The prevalence of exercise-induced bronchoconstriction was 19% (8/42) among those athletes training outdoors and 10% (6/65) among those training indoors. In conclusion, our findings indicate that a significant number of Tunisian athletes had exercise-induced bronchoconstriction while not diagnosed before.

Tuberculosis has a high prevalence in Tunisia, but pulmonary embolism is rarely reported in Mycobacterium tuberculosis infection. We describe 3 cases of pulmonary embolism associated with severe pulmonary tuberculosis. Pulmonary embolism occurred within 2 to 13 days of pulmonary tuberculosis diagnosis. Clinical, bacteriological, and radiological evolutions were noted within 6 months for pulmonary tuberculosis, but controlling the international normalized ratio was difficult in 2 cases, and low-molecular-weight heparin was prescribed for 6 months in one case. The association between tuberculosis and pulmonary embolism is rare, but it should be systematically investigated, particularly in those with severe pulmonary or disseminated tuberculosis.

This study made us wonder about the possibility of implementing molecular techniques in low-income countries and about the necessity of optimizing the financial resources.