1/233. Disseminated Mycobacterium genavense infection in a patient with acquired immunodeficiency syndrome: first case report in taiwan.Mycobacterium genavense is a recently described fastidious mycobacterium identified as a pathogen causing disseminated infection in patients with advanced human immunodeficiency virus (hiv) disease. In this report, we describe the first reported case of disseminated M. genavense infection in a patient with acquired immunodeficiency syndrome (AIDS) in taiwan. A 22-year-old Chinese man was found to be seropositive for hiv at age 18, in 1993. In 1997, he presented with abdominal pain, weight loss, low cd4 lymphocyte count, hepatomegaly, and generalized lymphadenopathy. Microscopic examination of a biopsy specimen from an inguinal lymph node showed both ill- and well-formed noncaseating granulomas. Numerous acid-fast bacilli were present in the histiocyte cytoplasm. Although the organism did not grow on conventional solid media used in our laboratory, two molecular biology techniques, including polymerase chain reaction (PCR) followed by sequencing of 16S rRNA, and PCR together with restriction enzyme fragment polymorphism analysis, confirmed the M. genavense infection. The patient's abdominal symptoms responded well to a chemotherapy regimen that included ethambutol, ciprofloxacin, and clarithromycin, and he survived more than 6 months after diagnosis. However, the lymphadenopathy was still present at his final follow-up. Our report indicates that disseminated infection with M. genavense should be added to the list of differential diagnoses of secondary infections in advanced AIDS patients in taiwan.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/233. granuloma inguinale (donovanosis) presenting as a neck mass in an infant.A case of granuloma inguinale (GI) presenting as a lateral neck mass in a 4-month-old, hiv-positive infant is described. The histological features of the mass were typical of GI, with numerous macrophages containing intracellular organisms with a "closed-safety-pin" appearance. This is a rare occurrence, and the mode of transmission of infection is discussed. An awareness of GI in infants by both clinicians and pathologists is important to prevent morbidity and allow for prompt institution of appropriate treatment.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
3/233. corynebacterium pseudodiphtheriticum: an easily missed respiratory pathogen in hiv-infected patients.Despite being a well-known respiratory pathogen for immunocompromised patients, corynebacterium pseudodiphtheriticum has uncommonly been reported to occur in persons with infection attributable to hiv virus. We report three cases of respiratory tract infection attributable to C. pseudodiphtheriticum in hiv-infected patients and review the four previous cases from the medical literature. All of them were male with a median cd4 lymphocyte count of 110 cells/mm3 (range, 18-198/mm3); five of the seven cases occurred in persons for whom AIDS was diagnosed previously. The onset of symptomatology was usually acute and the most common radiographic appearance was alveolar infiltrate (six patients) with cavitation (two patients) and pleural effusion (two patients). In five of the seven cases, C. pseudodiphtheriticum was isolated from bronchoscopic samples and in the remaining two cases was recovered from lung biopsy (one patient) and sputum (one patient). In the three patients reported herein and in one previous case from the medical literature, quantitative culturing of bronchoscopic samples obtained through either bronchoalveolar lavage or protected brush catheter procedures yielded more than 10(3) CFU/mL. All the strains tested were susceptible to penicillin and vancomycin. Resistance to macrolides was common. Recovery was observed in six of the seven patients. C. pseudodiphtheriticum should be regarded as a potential respiratory pathogen in hiv-infected patients. This infection presents late in the course of hiv disease and it seems to respond well to appropriate antibiotic treatment in most of the cases. This easily overlooked pathogen should be added to the list of organisms implicated in respiratory tract infections in this population.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
4/233. Infection by rhodococcus equi in a patient with AIDS: histological appearance mimicking Whipple's disease and mycobacterium avium-intracellulare infection.rhodococcus equi pneumonia with systemic dissemination is being reported increasingly in immunocompromised patients. This is the first case report of disseminated R equi infection with biopsy documented involvement of the large intestine. The patient was a 46 year old male with AIDS who was diagnosed with cavitating pneumonia involving the left lower lobe. R equi was isolated in culture from the blood and lung biopsies. Subsequently, the patient developed anaemia, diarrhoea, and occult blood in the stool. colonoscopy revealed several colonic polyps. Histological examination of the colon biopsies showed extensive submucosal histiocytic infiltration with numerous Gram positive coccobacilli and PAS positive material in the histiocytes. Electron microscopy showed variably shaped intrahistiocytic organisms which were morphologically consistent with R equi in the specimen. Disseminated R equi infection may involve the lower gastrointestinal tract and produce inflammatory polyps with foamy macrophages which histologically resemble those seen in Whipple's disease and mycobacterium avium-intracellulare infection.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
5/233. Multiple renal aspergillus abscesses in an AIDS patient: contrast-enhanced helical CT and MRI findings.renal insufficiency or allergic reactions for X-ray contrast agents are frequent limitations in immunocompromised hosts such as neutropenic or AIDS patients. Due to a better tolerance of contrast agents in MRI, this technique is well suited for investigation of parenchymal organs. We demonstrate an allergic AIDS patient who presented with fever and flank pain. At sonography, anechoic renal lesions were supposed to be non-complicated cysts; however, on T2-weighted MRI, the center was of high signal. Dynamic contrast-enhanced MRI of the kidneys demonstrated an enhancing rim with ill-defined margins. The lesions were supposed to be multiple bilateral abscesses. Due to the multiple dynamic contrast series, a delayed enhancement of renal parenchyma was detectable adjacent to the lesion. This was suggested as accompanying local pyelonephritis and an infectious etiology became more reliable. aspergillus fumigatus was identified by CT-guided biopsy as the underlying microorganism. The MR appearance of this manifestation has not been described previously.- - - - - - - - - - ranking = 2keywords = organ (Clic here for more details about this article) |
6/233. Bilateral trochlear nerve palsy associated with cryptococcal meningitis in human immunodeficiency virus infection.This is the report of a case of bilateral trochlear nerve palsy secondary to cryptococcal meningitis in a 34-year-old woman with acquired immune deficiency syndrome. Based on clinical and neuroradiologic findings, it is concluded that in the present case, a postinflammatory shrinking of the arachnoid has stretched the fourth cranial nerves at their point of emergence from the dorsal surface of the brainstem.- - - - - - - - - - ranking = 2.9749823397708keywords = nerve (Clic here for more details about this article) |
7/233. Progression of cytomegalovirus retinitis in acquired immunodeficiency syndrome: a case report.We report an AIDS patient with cytomegalovirus (CMV) retinitis that developed from an early minor lesion and progressed to extended involvement of the retina and severe deterioration of vision due to poor compliance with ganciclovir treatment. A 33-year-old man was known to have acquired immunodeficiency syndrome (AIDS) for eight months. The patient had no complaint of visual symptoms. A routine eye examination revealed his visual acuity to be 6/6 in both eyes. The dilated eye fundus examination using indirect ophthalmoscopy disclosed a localized white yellowish granular lesion in the peripheral retina of the right eye and a completely normal left eye. CMV retinitis with initial manifestation in the right eye was diagnosed. Due to incomplete treatment with ganciclovir, the retinal lesion rapidly enlarged and extended to the posterior pole, with eventual destruction of the nerve fiber layer and optic disc. The visual acuity of right eye dropped from 6/6 to 1/60 within six months. This case report indicates the importance of early, dilated eye fundus examination and recognition of early CMV retinitis in order to salvage visual function in AIDS patients. Completion of the anti-CMV treatment course in halting the progression of CMV retinitis is also emphasized.- - - - - - - - - - ranking = 0.49583038996181keywords = nerve (Clic here for more details about this article) |
8/233. Acute varicella zoster with postherpetic hyperhidrosis as the initial presentation of hiv infection.A 31-year-old man presented with acute pain in his left arm and hemorrhagic vesicles that followed his left 8th cervical nerve. A diagnosis of herpes zoster was made, and the patient was treated with valacyclovir. He refused testing for antibodies to hiv because he denied being at risk. Two months later he returned with postherpetic neuralgia and postherpetic hyperhidrosis in the distribution of the vesicles, which had since resolved. serology for hiv at this visit was positive, and the patient admitted to having sexual relations with prostitutes. Six months later the patient was being treated with triple antiretroviral therapy, and all signs and symptoms of postherpetic zoster had resolved. This case report documents the need for hiv testing in patients with unusual presentations of herpes zoster even if they initially deny being at risk.- - - - - - - - - - ranking = 0.49583038996181keywords = nerve (Clic here for more details about this article) |
9/233. coinfection of visceral leishmaniasis and Mycobacterium in a patient with acquired immunodeficiency syndrome.We report a case of coinfection of visceral leishmaniasis and Mycobacterium avium-intracellulare in the same lesions in the small bowel and bone marrow of a 33-year-old man with acquired immunodeficiency syndrome who complained of abdominal pain and chronic diarrhea. The duodenal mucosa and bone marrow biopsy specimens showed numerous foamy macrophages packed with two forms of microorganisms that were identified histologically and ultrastructurally as Leishmania and Mycobacterium species. Visceral leishmaniasis is rarely suspected in patients residing in nonendemic countries including the united states. It should be included in the differential diagnosis for opportunistic infection in patients with acquired immunodeficiency syndrome. An appropriate travel history is important. To our knowledge, this is the first reported case showing coinfection of visceral leishmaniasis and Mycobacterium avium-intracelluulare in the same lesion in a patient with acquired immunodeficiency syndrome.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
10/233. Rapid respiratory deterioration and sudden death due to disseminated cryptococcosis in a patient with the acquired immunodeficiency syndrome.We report the case of a patient with the acquired immunodeficiency syndrome (AIDS) whose death occurred within 30 hours of hospitalization due to disseminated cryptococcosis, manifested by dizziness, cough, and shortness of breath. The clinical picture was consistent with pneumocystis pneumonia, and antibiotic therapy with corticosteroids was initiated. Despite initial improvement, the patient's condition quickly worsened, resulting in cardiorespiratory arrest and death. autopsy revealed cryptococci in several organs. Sudden, rapid deterioration and death are rare consequences of disseminated cryptococcosis, and steroids may worsen the course of the disease. On the basis of this case and review of similar cases in the literature, we recommend early consideration of disseminated cryptococcosis in AIDS patients with pneumonia. early diagnosis and appropriate therapy are essential to reduce morbidity and mortality.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
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