1/6. autopsy case of alcoholic hepatitis and cirrhosis treated with corticosteroids and affected by pneumocystis carinii and cytomegalovirus pneumonia.A case of the very early phase of pneumocystis carinii pneumonia in a human immunodeficiency virus (hiv)-negative man with alcoholic hepatitis and cirrhosis treated with steroids is presented. A 40-year-old man with a 10-year history of alcohol abuse was admitted to hospital with jaundice, fever and macrohematuria. Laboratory examinations revealed neutrophilic leukocytosis and a serum bilirubin level of 13.9 mg/dL. The serum bilirubin level rose to 28.5 mg/dL over 1 month. prednisolone administered orally for 10 days produced a slight improvement in the jaundice and fever. After an interval of a week, it was resumed and maintained for 22 days (total dose, 1555 mg) until the patient died of a massive hemorrhage from ruptured vessels of a gastric ulcer. An autopsy disclosed P. carinii pneumonia in the lower lobe of the left lung, cytomegalovirus infection in both lungs and the esophagus, and esophageal candidiasis. To our knowledge, this is the first report of P. carinii pneumonia together with cytomegalovirus infection in an hiv-negative alcoholic patient. The present case suggests that a rare opportunistic infection such as P. carinii pneumonia might be caused by treating cirrhosis and alcoholic hepatitis with corticosteroids, even if only for a relatively short period.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/6. pneumocystis carinii infection in bilateral aural polyps in a human immunodeficiency virus-positive patient.pneumocystis carinii is an opportunistic infection found in patients with impaired immunity. Under favourable conditions the parasite can spread via the blood stream or lymphatic vessels and cause extrapulmonary dissemination. We report a case of P carinii infection presenting as bilateral aural polyps, otitis media and mastoiditis in human immunodeficiency (hiv)-positive patient with no history of prior or concomitant P carinii infection.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/6. Clue to fine-needle aspiration diagnosis of pleural pneumocystoma: neovascularization and Langhans' giant cell reaction.Pneumocystis pneumonia is a common component of the acquired immunodeficiency syndrome (AIDS) in the united states. Extrapulmonary pneumocystosis, however, is much less common. Rare cases have been reported in lymph nodes, bone marrow, spleen, pleura, gastrointestinal tract, liver, common bile duct, pancreas, skin, thyroid, and eye. A 39-yr-old man with history of chest wall injuries from gunshot and stabbing presented with multiple pleural masses clinically suspicious of metastatic deposits from an unknown primary. Fine-needle aspiration biopsy of the largest pleural mass revealed extrapulmonary pneumocystis, which led to the diagnosis of AIDS. Similar to the previous reports of pneumocystis mass lesions in extrapulmonary sites, the current case is associated with exuberant vascular proliferation and Langhans' giant cell reaction. Neovascularization and histiocytic influx from the newly formed blood vessels and Langhans' giant cell reaction seem to be a common tissue reaction to the massive deposition of pneumocystis organisms in extrapulmonary sites in patients with AIDS.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/6. Acute hepatic and renal failure caused by pneumocystis carinii in patients with AIDS.Clinical and pathological findings are described in two AIDS patients with pneumocystis carinii infection who received prophylactic treatment with nebulised pentamidine and developed unusual hepatic and renal failure. Histological examination showed clumps of P carinii massively obstructing hepatic sinuses and portal vessels in the first patient, and merular and intertubular capillaries in the second. These findings could explain the unusual clinical features, characterised by acute hepatic and renal failure.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/6. pneumocystis carinii thyroiditis diagnosis by fine needle aspiration cytology: a case report.BACKGROUND: Extrapulmonary infection or dissemination of pneumocystis carinii (PC) is rare, but under certain conditions the parasite can spread via the bloodstream or lymphatic vessels. Systemic pneumocystosis most often involves the lymph nodes, stomach, spleen, liver, skin, pancreas, choroid and eye. Isolated lesions containing PC have also been identified in the thyroid. CASE: A 41-year-old homosexual male infected with the human immunodeficiency virus (hiv) developed a PC infection in the thyroid gland. The patient had had thrush and anal herpes since being diagnosed as hiv positive in 1984. In 1992 the patient developed a mass in the area of the right lobe of the thyroid gland. Smears from fine needle aspiration cytology of the thyroid mass revealed epithelioid cells. However, a cell block revealed numerous PC organisms on Gomori methenamine-silver stain; that finding was confirmed by an excisional biopsy. The patient had not previously been diagnosed with PC pneumonia. CONCLUSION: Our case of thyroid involvement with PC expands the clinical spectrum of extrapulmonary pneumocystosis in patients with the acquired immunodeficiency syndrome. We believe that in these patients the incidence of Pneumocystis thyroiditis will continue to rise and be reported.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/6. central nervous system pneumocystosis in a patient with AIDS.Extrapulmonary involvement with pneumocystis carinii has been described in 0.5%-2.5% of persons with AIDS. One hundred nine patients with AIDS and confirmed extrapulmonary pneumocystosis were identified, and seven of these patients (including our patients) had central nervous system (CNS) pneumocystosis. Of these seven patients, six had prior AIDS-related complications, and three had previous P. carinii pneumonia. Six patients had CNS symptoms, one of whom underwent a focal neurological examination. No cases were diagnosed before death. The involved sites were the cerebral cortex (2 patients), meninges (2), pituitary gland (1), putamen (1), and nonspecified locations (3). In two patients, organisms were seen around blood vessels, and in five patients there was concurrent neuropathology. In summary, CNS involvement with P. carinii usually occurs as a late complication of AIDS and probably represents hematogenous dissemination.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |