1/45. Localised upper airway obstruction in a patient with acquired immunodeficiency syndrome.We describe a case of rapidly progressive upper airway obstruction due to tracheal Pseudomonas abscesses in a patient with acquired immunodeficiency syndrome. The case highlights the aggressive nature of pseudomonas infections and the difficulty of eradicating this organism in patients infected with the human immunodeficiency virus.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/45. Visceral leishmaniasis masquerading as tuberculosis in a patient with AIDS.We report a case of visceral leishmaniasis presenting as significant lymphadenopathy in a patient with acquired immune deficiency syndrome. The lymphadenopathy was initially suspected to be tubercular in nature on pathological examination. This report highlights the increasing incidence of acquired immune deficiency syndrome and Leishmania co-infection in india, and the importance of demonstrating tubercle bacilli on culture before suggesting a diagnosis of tuberculosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/45. multiple myeloma as the first manifestation of acquired immunodeficiency syndrome: a case report and review of the literature.Various hematologic malignancies and solid tumors are increasingly diagnosed in patients with human immunodeficiency virus (HIV) infection and may be the presenting manifestation of acquired immunodeficiency syndrome (AIDS). multiple myeloma, however, has never been reported as the presenting manifestation of AIDS. We report on a 34-year-old man who presented with back pain, paresthesias, paraparesis, vertebral bony disease, and an associated soft tissue mass. biopsy of the mass revealed immature plasmacytes with very faint cytoplasmic expression of kappa light chains. bone marrow biopsy revealed 25% infiltration with poorly characterized malignant cells and 15% polyclonal plasma cells. Immunofixation of serum and urine was positive for IgG kappa and kappa light chains, respectively. A bone survey revealed lesions in the skull, left femur bone, and the pelvis. The diagnosis of an anaplastic myeloma was made. Because of the poorly characterized nature of the malignant cells and the difficulties in immunophenotyping, serologic evaluation for HIV was undertaken and was positive. The concept of myeloma as an opportunistic neoplasm defining AIDS was considered. We discuss this view and recommend that patients with multiple myeloma with poorly characterized myeloma cells as well as difficulties in immunophenotyping should undergo testing for HIV infection.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/45. Progressive myoclonic ataxia and jc virus encephalitis in an AIDS patient.A case of progressive myoclonic ataxia in an AIDS patient is described, which evolved over a 13 month period. The ataxia persisted as the only clinical finding for several months before the appearance of a severe tetraparesis and cachexia. Throughout the clinical progression, magnetic resonance imaging (MRI) revealed the presence of bilateral, progressive, isolated, and symmetrical lesions involving the red nuclei, subthalami, thalami, lenticular nuclei, and primary motor cortices. Neuropathological examination, supplemented by in situ hybridisation for jc virus dna, confirmed that the lesions were those of progressive multifocal leucoencephalopathy (PML). The exceptional clinical presentation of PML in this case is the first report of progressive myoclonic ataxia caused by PML. The selective nature of the lesions confirms the role of the dentato-rubral-thalamo-cortical tract in the pathogenesis of progressive myoclonic ataxia. The atypical MRI findings further emphasise the need for expanded diagnostic criteria for PML in AIDS patients and support the use of more aggressive diagnostic methods as new treatments become available.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/45. Overcoming the false dichotomy of curative vs palliative care for late-stage HIV/AIDS: "let me live the way I want to live, until I can't".Recent advances in human immunodeficiency virus (HIV) therapy have significantly reduced HIV-related mortality in the developed world, but mortality rates have plateaued, and AIDS remains a leading cause of serious illness and death for young adults. The chronic nature of the HIV disease course and the increasing burden of cumulative HIV-related morbidity and treatment-related toxic effects pose new challenges to the care of patients over time. Uncertainties about prognosis and the promise and limitations of rapidly evolving therapies have made decision making about advance care planning and end-of-life issues more complex and elusive than when the disease course was more uniform, rapid, and predictable. The emerging biomedical paradigm of highly active antiretroviral therapy (HAART) as the cornerstone of treatment has helped to transform HIV into a manageable chronic disease, yet at the same time has resulted in a more narrow focus and a de facto separation between disease-specific "curative" and symptom-specific "palliative" care for patients with HIV/AIDS. As patients survive longer in the latter stages of progressive HIV disease, they may in fact have increasing need for comprehensive symptom management as well as wide-ranging need for psychosocial, family, and care planning support. In the HAART era, the false dichotomy of curative vs palliative care for patients with HIV/AIDS must be supplanted by a more integrated model to provide comprehensive care for patients with advanced HIV disease and their families.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/45. acquired immunodeficiency syndrome-associated T-cell lymphoma: evidence for human immunodeficiency virus type 1-associated T-cell transformation.The majority of lymphomas in the setting of acquired, iatrogenic, or congenital immunodeficiencies are B-cell lymphoproliferations. We describe a rare T-cell lymphoma in a fulminantly ill patient infected with human immunodeficiency virus type 1 (hiv-1). The T-cell nature of the process was defined genotypically (monoclonal T-cell receptor beta-chain [CT beta] rearrangement) and phenotypically (CD45RO , CD4 , CD5 , CD25 , CD8-, CD3- and negative for a variety of B-cell and monocyte markers). The CD4 , CD25 (interleukin-2 receptor [IL-2R]) phenotype with production of IL-2 and IL-2R rna is analogous to human T-lymphotropic virus type I (HTLV-I)-associated adult T-cell leukemia/lymphoma (ATLL); however, no HTLV-1 could be detected. Southern blot analysis did demonstrate monoclonally integrated hiv-1 within the tumor genome. Furthermore, the tumor cells were producing HIV p24 antigen as shown by immunohistochemistry. This is the first case of acquired immunodeficiency syndrome (AIDS)-associated non-Hodgkin's lymphoma in which hiv-1 infection may have played a central role in the lymphocyte transformation process.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/45. Clinical vignette in antiretroviral therapy: jaundice.HIV caregivers face many challenges following initiation of art. The development of jaundice is uncommon but worrisome. In this case, two distinct and contrasting episodes of jaundice were observed. In the first instance, isolated elevation of the indirect bilirubin without elevation of the alkaline phosphatase was noted. The normal PT and serum aminotransferase levels indicate the absence of intrinsic liver dysfunction. Elevations in the indirect bilirubin may result from either impaired uptake/conjugation or excess production. The latter, usually from acquired hemolysis, may be a complication of an occult NHL. A work-up for this AIDS-related malignancy was not initiated since the caregivers recognized jaundice as a complication of IDV, which inhibits UDP-glucuronyl transferase and produces a Gilbert's-like syndrome. physicians can expect to encounter this syndrome even more frequently with ATV. Experienced patients given RTV-boosted ATV have experienced elevations of unconjugated hyper-bilirubinemia in up to 45 percent of cases in clinical trials. However, such elevations do not reflect liver dysfunction and symptomatic jaundice requiring dosage reduction that occurred infrequently (7 to 8 percent of study patients). counseling patients about this syndrome may promote adherence and prevent self-directed interruptions of ATV that compromise efficacy. The second case of jaundice provides a more formidable diagnostic challenge. The triad of LFT abnormalities (mild elevation of aminotransferases, normal PT, and marked cholestatic jaundice) implies an acute process that is mildly toxic to hepatocytes without affecting their synthetic function. The subacute nature of the patient's cholestatic jaundice suggests either intrahepatic infiltrative disease of the liver or extrahepatic obstruction of the biliary tree, most likely due to the patient's relatively modest level of pain and lack of fever. Despite LFT abnormalities occurring 17 months after a switch in his art, cumulative drug-related toxicities must still be considered. ritonavir can produce significant elevations in the AST/ALT, especially with pre-existing chronic liver disease as with hepatitis c virus coinfection. The NRTIs can produce hepatic steatosis, a result of mitochondrial toxicity and impaired fatty acid oxidation. However, jaundice and cholestasis are not typical of the latter syndrome. With a negative contrast CT that excludes parenchymal liver disease, investigation of the biliary tree to assess the presence of AIDS-related cholangitis was the next step. Performing a sphincterotomy or stent placement, and obtaining brushings or biopsy specimens to determine the extent of extrahepatic obstruction may help define a pathogen and be life-saving. The negative results of the ERCP justify the final diagnostic step, a liver biopsy to evaluate microscopic infiltrative disease that might not have been detected on contrast abdominal CT. Examples might include granulomatous disease (MAC), fungal etiologies (histoplasmosis), carcinomatosis (lymphoma, hepatoma, cholangiocarcinoma), and microvascular disease (bacillary angiomatosis). The failure to observe granulomatous inflammation in the liver does not exclude MAC infection, as MAC may involve other peri-aortic or mesenteric lymph nodes. This form of iris is unlikely given the abdominal CT findings, lack of systemic complaints, and extended persistence of liver aminotransferases. The nonspecific results of the liver biopsy are a common outcome in advanced AIDS patients with elevated alkaline phosphatase levels. Despite not having identified a pathogen, the biopsy establishes chronic liver disease and prompts re-evaluation and change of treatment to NFV. The subsequent normalization of the patient's aminotransferase levels suggests a prior adverse effect of LPV/r in the setting of unexplained, chronic liver disease. Most importantly, this case highlights the importance of HIV caregivers to review art for safety when noting chronic liver dysfunction. patients need to be counseled to minimize acetaminophen use, to consume alcohol in moderation, and to avoid behavior with risk for hepatitis c. Finally, all HIV patients should receive appropriate vaccination against hepatitis a and B if serology shows lack of protective immunity.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/45. False-positive D-dimer result in a patient with Castleman disease.In suspected cases of disseminated intravascular coagulation, concurrent elevation of both fibrin(ogen) degradation products (FDPs) and D-dimer levels aids in confirming the diagnosis. This pattern of results reflects the action of plasmin proteolysis of cross-linked fibrin polymers as well as fibrinogen. We report the case of a patient with human immunodeficiency virus (HIV) and Castleman disease who presented with a high-positive D-dimer level and a negative FDP level in the course of a workup for disseminated intravascular coagulation. This finding suggested the possibility of either a false-positive D-dimer or a false-negative FDP level. To investigate the former, a Western blot was performed on the patient's serum to determine the presence of the D-dimer. No D-dimer band was visualized on the Western blot, confirming the false-positive nature of the D-dimer result. Insufficient quantity of patient serum, however, prevented further investigation into the etiology of this result. The false-positive D-dimer result is likely attributable to interference caused by the patient's Castleman disease-associated monoclonal gammopathy, a phenomenon that has been reported in other immunoassays. As the development of lymphoproliferative disorders is especially common within the HIV population, and hypergammaglobulinemia in Castleman disease is particularly common, clinicians should be aware of this phenomenon when the laboratory findings do not fit the clinical picture. Although it is rare, recognition of potential paraprotein interference in immunoassays will help avoid undertreatment or overtreatment of patients based on erroneous laboratory results.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/45. "Star" suture opacities of the crystalline lens: an illustrative report in AIDS patients.BACKGROUND: acquired immunodeficiency syndrome (AIDS) is disease of epidemic proportion associated with significant visual morbidity. Visual complications of AIDS have been described as a result of cytomegaloviral retinitis as well as fungal and protozoan opportunistic eye disease. Although cataracts have been established as a direct consequence of human immunodeficiency virus (HIV) or AIDS, studies suggest that HIV disease may indeed be a risk factor for the development of cortical cataract. This report further characterizes potential lens abnormalities associated with HIV and AIDS by clearly demonstrating opacities associated with lens sutures in two AIDS patients with long-term use of nucleoside analogue reverse transcriptase inhibitors (NRTIs). MATERIAL/ methods: Case series demonstrating digitized slit lamp biomicroscopic anterior segment photos using indirect lens illumination. RESULTS: Prominent "star" lens sutures of assumed abnormality typified by unusual branching and irregular caliber are photo-documented. CONCLUSIONS: Normally inconspicuous star suture branches are clearly demonstrated in two patients with AIDS and diabetes mellitus. Uncharacteristic star lens sutures have not Been previously reported in AIDS patients however the occurrence of lens opacities due to HIV disease and AIDS is not without precedent. Despite the prominence and atypical nature of the illustrated lens sutures, assessment of morphologic abnormality is limited by lack of appropriate normative data describing star sutures clinically as a function of age and lens development.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/45. Understanding the experience of HIV/AIDS for women: implications for occupational therapists.BACKGROUND: Within the past few years, HIV/AIDS has shifted from being an acute, palliative disease to one that is more chronic and episodic in nature. This shift has major implications for the role of occupational therapy in women's lives. Very few studies, however, have examined the perspective of women living with HIV/AIDS from an occupational therapy perspective. PURPOSE: This qualitative study was designed to examine the experiences of five women living with HIV/AIDS in Southern ontario and to begin to explore the implications of these findings for occupational therapy. METHOD: Through the implementation of five in-depth interviews, a phenomenological approach was used to explore the lived experience of women with HIV/AIDS. RESULTS: Four main themes emerged: fearing disclosure, experiencing challenges (physical and psychological), having supportive networks, and coping positively with being HIV positive (spirituality and opportunity for living and learning). PRACTICE IMPLICATIONS: There are several potential roles for occupational therapy in working with women who are living with HIV/AIDS More studies need to be pursued in this area of rehabilitation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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