Disseminated strongyloidiasis in a patient with acquired immunodeficiency syndrome

We report a case of Strongyloides stercoralis hyperinfection in a Spanish patient who had never traveled to an endemic area and in whom HIV infection and long-term immunosuppressive treatment most likely contributed to the dissemination of strongyloidiasis.     

Toxoplasma peritonitis in a patient with acquired immunodeficiency syndrome

Toxoplasma gondii was identified in a stained slide preparation of, and isolated from, peritoneal fluid specimens obtained from a patient with the acquired immunodeficiency syndrome (AIDS). At the time of admission to the hospital, the patient's serologic tests were positive for Toxoplasma. Toxoplasma was isolated from samples of the patient's blood by mouse inoculation. Findings of newly developed methods for diagnosis of the presence of T gondii in body fluids by assay for Toxoplasma-specific antigen and by use of a DNA probe were positive.     

Disseminated intravascular coagulation associated with disseminated cryptococcosis in a patient with acquired immunodeficiency syndrome

Summary Disseminated intravascular coagulation (DIC) is uncommon in acquired immunodeficiency syndrome (AIDS), despite the high incidence of infectious diseases. We describe an HIV-infected patient presenting with disseminated cryptococcosis, who had clear-cut laboratory evidence of progressively worsening DIC (thrombocytopenia, prolonged prothrombin time and partial thromboplastin time, hypofibrinogenemia, increased fibrin(ogen) degradation products and D-Dimer, reduced antithrombin III), although the clinical signs of the disease were rather scarce. The patient died despite intense treatment, which included heparin and fresh frozen plasma, and DIC was confirmed histologically. It is suggested that, in a patient with AIDS presenting with an opportunistic infection, laboratory signs of DIC should be carefully checked to early recognize this complication and promptly initiate the required therapy.

---

Diffuse intravasale Gerinnung bei disseminierter Kryptokokkose bei einem AIDS-Kranken

Zusammenfassung Trotz der hohen Inzidenz von Infektionen wird bei AIDS-Kranken nur selten eine diffuse intravasale Gerinnung beobachtet. Wir berichten über einen HIV-infizierten Patienten, der mit einer disseminierten Kryptokokkose aufgenommen wurde. Die Laborwerte zeigten eindeutig die Zeichen einer progredienten diffusen intravasalen Gerinnung mit Thrombozytopenie, verlängerter Prothrombinzeit und partieller Thromboplastinzeit, Hypofibrinogenämie, vermehrt Fibrin(ogen)-Abbauprodukten und D-Dimeren sowie vermindertem Antithrombin III, während die klinische Symptomatik schwach ausgeprägt war. Der Patient verstarb trotz intensiver Therapie mit Heparin und gefrorenem Frischplasma. Die diffuse Gerinnung wurde histologisch bestätigt. Bei AIDS-Kranken, die mit einer opportunistischen Infektion zur Aufnahme kommen, sollte anhand der Laborwerte sorgfältig nach einer diffusen Gerinnung gesucht werden, um diese Komplikation frühzeitig zu erkennen und die erforderlichen therapeutischen Maßnahmen sofort einleiten zu können.

     

Cytomegalovirus peritonitis in a patient with the acquired immunodeficiency syndrome

Summary Peritonitis has been reported infrequently in patients with the acquired immunodeficiency syndrome (AIDS). Intestinal or colonic perforation resulting from cytomegalovirus (CMV) enteritis is the most common cause of peritonitis in these patients. We report a patient with CMV peritonitis occurring in the absence of perforation (primary peritonitis) to alert physicians to this potentially treatable disorder.     

Disseminated Sporothrix schenckii infection with arthritis in a patient with acquired immunodeficiency syndrome

Patients with the acquired immune deficiency syndrome are susceptible to a wide spectrum of opportunistic infections. We report a 34-year-old man who developed systemic sporotrichosis involving the skin and joints, and whose illness terminated in subacute encephalopathy and Pneumocystis carinii pneumonia. Fungal arthritis is another infection to which patients with this syndrome are subject.     

Hyperviscosity syndrome in a patient with acquired immunodeficiency syndrome

The hyperviscosity syndrome is most commonly seen in association with monoclonal gammopathies and has only rarely been described in association with polyclonal hypergammaglobulinemia. We have recently seen a patient with known acquired immunodeficiency syndrome who presented with the hyperviscosity syndrome in the setting of polyclonal hypergammaglobulinemia. To our knowledge, this is the first reported case of a patient with the acquired immunodeficiency syndrome and the hyperviscosity syndrome. The case is presented and the pathogenesis and implications of this diagnosis are discussed.     

Generalised tuberculosis in a patient with acquired immunodeficiency syndrome

We describe a heroin addict who presented with cellular immunodeficiency, generalised tuberculosis, and pneumonia caused by Pneumocystis carinii, and discuss the risk of these associations.     

Rectal leishmaniasis in a patient with acquired immunodeficiency syndrome

A severe rectal lesion due to Leishmania infection is described in an American-born homosexual man with the acquired immunodeficiency syndrome. The infection, which may have been venereally transmitted, responded to treatment with amphotericin B. There was no evidence of visceral leishmaniasis. The contribution of the patient's immunodeficiency to the development of the atypical cutaneous leishmanial lesion is unclear. The case may foretell increasing problems with protozoan infections in AIDS as the epidemic spreads to areas with endemic protozoan diseases.     

Pyomyositis in a patient with the acquired immunodeficiency syndrome

Pyomyositis is an acute bacterial infection of skeletal muscle. It is a common disease in the tropics; fewer than 50 cases of pyomyositis have been reported in the continental United States. Most patients are healthy males, although the disease has been reported in diabetics and in the immunocompromised. This article presents the first detailed known reported case of pyomyositis in a patient with the acquired immunodeficiency syndrome; Staphylococcus aureus was the etiologic agent.     

Disseminated coccidioidomycosis. Unusual manifestations in a cardiac transplantation patient

Because of the immunosuppressive therapy received by patients undergoing cardiac transplantation, disseminated infections, including disseminated fungal infections, often develop. Disseminated coccidioidomycosis developed in a 23-year-old man soon after undergoing orthotopic cardiac transplantation. Clinical manifestations included an unusual rash, severe myositis and arthropathy, a rapid downhill course, and pathologic evidence of widespread fungal invasion, including invasion of the cardiac graft. Detailed travel and geographic histories, and perhaps skin testing and antibody determinations for geographic-specific pathogens, should be part of the preoperative evaluation of all transplant candidates.     

Isolated primary hepatic lymphoma in a patient with acquired immunodeficiency syndrome.

Non-Hodgkin lymphoma (NHL) of the B-cell type is the second most common neoplasm in patients with human immunodeficiency virus (HIV) infection after Kaposi sarcoma (KS). The majority of cases of NHL in patients with acquired immunodeficiency syndrome (AIDS) involve extranodal sites; most frequently the gastrointestinal tract (GIT) and the central nervous system (CNS). Hepatic NHL in patients with AIDS was first described by Reichert et al in 1983 in an autopsy series. It usually presents with multiple large hepatic masses and involvement of other abdominal organs or lymph nodes. The authors present a case of primary hepatic NHL in a patient with AIDS, presenting with innumerable small intrahepatic masses without the involvement of any other organs.