Acute miliary blastomycosis in an AIDS patient

The incidence of blastomycosis in immunocompromised patients with HIV infection is very low when compared to other mycoses. Of the 19 cases of blastomycosis described in HIV-infected patients, only four had a miliary pattern on chest x-ray. A case of acute miliary blastomycosis in an HIV infected patient from Louisville is described.     

Salmonella lung abscess and bacteraemia in an AIDS patient

This report describes a 28-year-old, HIV-infected man presenting with subacute onset of pyrexia, cough, dyspnoea and pleuritic pain. Chest radiograph showed bilateral multiple cavitary lesions. The diagnosis of salmonellosis was secured by isolation of salmonella typhimurium in blood, as well as in sputum. Therapy with sequential ceftriaxone/ciprofloxacin led to satisfactory improvement symptomatically and radiologically. The present report serves to heighten the awareness of AIDS-associated salmonella bacteremia and lung abscesses.     

Primary non-Hodgkin''s lymphoma of the larynx in an AIDS patient

BACKGROUND AND OBJECTIVES: Interscalene brachial plexus block is a useful technique to provide anesthesia and analgesia for the shoulder and proximal upper extremity. The initial needle direction at the interscalene groove has been described as being "perpendicular to the skin in every plane" (1). A cross-sectional (axial) approach may offer a more easily conceptualized directed needle placement. The purpose of this study is to define the cross-sectional anatomy and idealized needle angles important to interscalene brachial plexus block. METHODS: Following IRB approval, 50 patients were studied. Cross-sectional volume coil T1-weighted magnetic resonance images (MRI) were obtained from 50 patients undergoing cervical region imaging for other reasons. At the interscalene groove, a simulated needle path to contact the ventral rami or trunks of the brachial plexus was approximated at the level of C6 or C6-C7 interspace. The angle of this needle path intersecting the sagittal plane was recorded for each patient. RESULTS: The mean angle of the simulated needle path relative to sagittal plane was determined to be 61.1 +/- 6.1 degrees (range, 50-78 degrees). In 13 of 50 (26%) MRI scans, the cervical nerve roots were not visualized at the level of C6 and were measured at the C6-C7 level. CONCLUSIONS: These findings suggest initial needle placement at the interscalene groove should be angled less perpendicularly relative to the sagittal plane than is often observed. A cross-sectional approach enables more practical visualization of initial needle placement. A more accurate initial needle placement may minimize the number of needle passes necessary to contact the nerve roots, thereby more efficiently obtaining a successful block.     

Unilateral adrenal mass due to Mycobacterium kansasii in an AIDS patient

Infection with Mycobacterium kansasii in patients with acquired immunodeficiency syndrome usually involves the lung or disseminated infection. We report a case of infection with M kansasii confined to the adrenal gland and possibly to an adjacent vertebral body that presented as a fever of undetermined origin.     

Incomitance patterns in different ocular motility disorders

Patients with severe trauma and illness were treated at our critical care medical center. Many of these patients have diabetes, anemia and other underlying conditions which sometimes lead to serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa. A clinical study imipenem/cilastatin sodium (IPM/CS) was performed at our Medical Center. IPM/CS was administered to 30 patients with serious infections. Clinical results were excellent in 11, good in 5, fair in 9 and poor in 5 patients, thus an overall efficacy rate of 53.3% was obtained. Bacteriological efficacy rate was 50% with eradications in 11 cases and decreases in 3 cases out of 28 cases examined. No side effects were observed in any patients.     

Leishmania infection occurring in herpes zoster lesions in an HIV-positive patient

We report the first case of co-infection with herpes zoster and leishmania in the same lesion, on the face of a 29-year-old female, who was an intravenous drug user and who was HIV positive. The infection was initially resistant to acyclovir and itraconazole, and the patient died due to severe internal complications, not attributed to visceral leishmaniasis. The prevalence of leishmania infection in the Mediterranean countries is increasing among the HIV-positive population because of the existence of human carriers. Paradoxically, most of these patients show mild forms of visceral leishmaniasis.     

Incidental finding of a microsporidian parasite from an AIDS patient

Light microscopic examination of feces from a human immunodeficiency virus-positive patient with chronic diarrhea, anorexia, and lethargy revealed the presence of numerous refractile bodies resembling microsporidian spores. They were subsequently identified as belonging to the genus Nosema on the basis of their ultrastructural characteristics. However, the microsporidia were enclosed within striated muscle cells, suggesting that they were probably ingested in food; thus, this represented an incidental finding rather than a true infection.     

Cladophialophora bantiana isolated from an AIDS patient with pulmonary infiltrates

Cladophialophora bantiana causes a rare phaeohyphomycosis, usually manifested by brain abscesses but rarely by skin or pulmonary lesions. It has not been reported as a common colonizer or as a cause of pulmonary symptoms in patients with AIDS. We present a case in which C. bantiana was repeatedly isolated from the sputum of a patient with AIDS having pulmonary infiltrates.     

Lymphoproliferative disorders of the ocular adnexa

Immunodysregulation appears to play a prominent role in the evolution of some lymphomas, as evidenced by the strong associations between congenital and acquired immunodeficiencies and lymphoid neoplasia, and abnormal ratios of helper T cells in lymphoid proliferations. Lympho-proliferative diseases of the ocular adnexa encompass a spectrum of lesions that may present with similar clinical and radiological features. Most primary lymphoid proliferations of the ocular adnexa consist of small lymphocytes of B-cell origin. Employing morphological, immunohistochemical, and molecular genetic criteria, proliferations may be separated into polyclonal and monoclonal categories. Increased insight into the biology and behavior of these tumors tells us that seemingly benign, as well as frankly malignant proliferations, might disseminate to nodal or extranodal sites. The diagnosis of lymphoproliferative disease of any type necessitates a complete workup for systemic lymphoma. Major prognostic criteria for lymphomas are anatomical site, stage, and histological features. Radiotherapy is employed for localized lymphoid proliferations, with chemotherapy recommended for disseminated disease. Long-term follow-up with semiannual examination is recommended. A significant percentage of primary ocular adnexal lymphoid lesions are MALT-type lymphomas, extranodal low-grade B-cell lymphomas usually associated with mucosal tissues or glandular epithelia. The pathogenesis of this lymphoma in orbital soft tissue, which normally is devoid of lymphoid tissue, lymphatic vessels, and epithelium, is unclear. MALT-type lymphomas of the ocular adnexa follow an indolent course, with long periods between relapses, and are responsive to therapy. Dissemination, when it occurs, preferentially affects other extranodal sites.     

Meningocerebral lesions in children with iatrogenic AIDS

This study is focused on structural modifications of leptomeninges and cerebral matter in children deceased because of iatrogenic AIDS. Although we do not evidence the specific lesions of AIDS, we have noticed edema, hyperemia, hematic extravasation, microlesions of the small vessel walls, perivascular infiltrations with lymphocytes, macrophages and even plasmocytes, moderate tigrolysis, mild demyelination, gliosis and sidero-calcic deposits. We do not consider these lesions as specific to HIV-infected patients.