1/8. PCP presenting as cavitary pneumonia: a case report.As pneumocystis carinii pneumonia cases increase, physicians must consider the various atypical radiographic presentations of the disease. The following case report illustrates one atypical presentation and the dramatic response to treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Cryptococcal anal ulceration in a patient with AIDS.We report the case of an African patient with acquired immune deficiency syndrome (AIDS) who had a chronic cryptococcal rectal abscess with anal fistula and a disseminated neurologic and bony fungal disease, associated with pulmonary infiltration due to pneumocystis carinii. The anal lesion was surgically excised because of failure of the medical treatment. Although clinical intestinal cryptococcal involvement is quite rare, the experience here recorded should draw physicians' attention to the possibility of an insidious disseminated disease in AIDS patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. pneumocystis carinii pneumonia complicating methotrexate treatment of primary sclerosing cholangitis.The etiology of primary sclerosing cholangitis, a chronic progressive cholestatic liver disease, is poorly understood. Treatment with oral methotrexate may improve patient symptoms, liver biochemistry, and hepatic histology. This report describes a severe life-threatening complication of methotrexate therapy in primary sclerosing cholangitis--the development of pneumocystis carinii pneumonia. The reported cases of methotrexate-associated P. carinii pneumonia in the literature are reviewed. With the increasing use of methotrexate in chronic inflammatory disorders, physicians should be aware of this potentially lethal complication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Severe co-trimoxazole reaction in a man with AIDS.Although other drugs can be used in the prophylaxis and treatment of hiv-infected persons, family physicians will prescribe co-trimoxazole frequently. These providers need to recognize the overall increased frequency of adverse reactions to this drug in this population and the potential for severe hypersensitivity effects requiring intensive hospital care. While the exact importance re-exposure has in causing this reaction remains unclear, certainly providers must pay particular attention to patients who have had any earlier sensitivity to the drug before treatment is resumed. Desensitization therapy has been used successfully in some hiv-positive individuals, even after severe reactions; however, this case again teaches the need for prudence in the use of all pharmacological agents.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. legionella and Pneumocystis pneumonias in asthmatic children on high doses of systemic steroids.asthma is increasingly treated as an inflammatory disease with inhaled and/or systemic corticosteroids. We report 3 cases of unusual pneumonias associated with high doses of oral steroids. Two patients contracted legionella pneumonia and one patient contracted pneumocystis carinii pneumonia. With increasing usage, it is important for physicians to be aware of the possible infectious complications of high dose steroids. This report highlights the risk of corticosteroid treatment in asthma in predisposing to opportunistic infections that have not heretofore been readily associated with asthma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Fulminant reexpansion pulmonary edema in a patient with AIDS.A 23-year-old man with AIDS presented to the emergency department with recurrent spontaneous pneumothoraces secondary to recent pneumocystis carinii pneumonia. Shortly after placement of bilateral pigtail catheters for chest reexpansion, he developed fatal unilateral reexpansion pulmonary edema. The association between P carinii pneumonia and pneumothorax, and the risk factors and pathophysiology of reexpansion pulmonary edema are reviewed. Emergency physicians should recognize that reexpansion pulmonary edema is an important complication in the treatment of prolonged spontaneous pneumothorax that can lead rapidly to severe hypoxia, hypotension, and death.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. talc pleurodesis during videothoracoscopy for pneumocystis carinii pneumonia-related pneumothorax. A new technique.pneumocystis carinii pneumonia in AIDS patients represents a growing problem for chest physicians. For thoracic surgeons, spontaneous pneumothorax and recurrent or persistent pneumothoraces can complicate this disease, requiring surgical intervention. Minimally invasive videothoracoscopy has now become a standard form of surgery for these patients, and we present a technique of talc insufflation that we believe is safe, simple, cost-effective, and reliable.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. pneumocystis carinii pneumonia presenting as asthma: increased bronchial hyperresponsiveness in pneumocystis carinii pneumonia.Two male patients presented with clinical and laboratory findings consistent with typical bronchial asthma and subsequently developed pneumocystis carinii pneumonia (PCP). Only on subsequent questioning did both admit to homosexuality and behavior associated with a high risk of hiv-infection. In order to determine how frequently reversible airway obstruction is seen in patients with PCP, we measured peak expiratory flow rates (PEFR) before and after bronchodilator administration in 37 of these patients. Initial PEFR measurements revealed a significant decrease in PEFR (< 80% predicted) in 84%, with 54% of these exhibiting a significant bronchodilator response (> or = 15% increase). For comparison, peak flow measurements were made in a control group of 31 hiv-infected patients without acute PCP, divided between those with asymptomatic hiv-infection, aids-related complex (ARC), and AIDS, (including patients with previous PCP). Only 23% of these individuals had low PEFR, and only 3% exhibited bronchodilator responses. In order to confirm the existence of bronchial hyperreactivity in patients with PCP, another 16 patients with PCP were tested by methacholine bronchial challenge and 50% were found to have positive responses. These findings suggest that both reversible airway obstruction and airway hyperreactivity are found in association with acute PCP and that as a result some patients with PCP may present with symptoms of asthma. It is important for physicians to have a high degree of suspicion to avoid missing a diagnosis of PCP in a patient presenting with apparent asthma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |