Ciro Fulgaro

Associated thyreoiditis, myasthenia gravis, thymectomy, Chron’s disease, and erythema nodosum: pathogenetic and clinical correlations, immune system involvement, and systemic infectious complications

The case of a young woman suffering from multiple autoimmune-dysreactive disorders (including thyreoiditis, myasthenia gravis, thymectomy, Crohn’s disease, and erythema nodosum), while undergoing steroideal therapy, was complicated by a severe infectious disorder (severe upper urinary tract infection). While the pathogenetic and clinical relationship between the different autoimmune-dysreactive complications is still unclear, and the supporting role of the frequent immunosuppressive treatment may add significantly to these risk factors, clinicians who are engaged in the management of these patients should be aware that multiple, concurrent or subsequent disorders might occur in these subjects, and also that severe infections might be of relevant concern.

Cervicofacial and Pulmonary Actinomycosis Associated with Non-Hodgkin's Lymphoma

A case of cervicofacial and pulmonary actinomycosis associated with non-Hodgkins lymphoma (NHL) is reported. The patient underwent antimicrobial treatment and surgical debridement of a palatine lesion. Complete clinical recovery was achieved. The presence of actinomycosis may obscure and delay the diagnosis of NHL.

A very particular case of long-term non-progressor: nineteen consecutive years of follow-up in the absence of any detectable HIV-1 viraemia

A case of extremely prolonged non-progression of HIV-1 infection, characterized by 19 consecutive years of persistently undetectable viraemia (or no laboratory markers of HIV replication) is presented and discussed based on recent literature issues regarding virological and immunological outcome of the natural history of HIV-1 infection.

More than ten years without any detectable HIV viremia: exceptionally long-term non-progressive HIV infection

Background It is still unclear whether the virological-immunological steady-state observed among the small number of HIVinfected patients defined “long-term non-progressors” may have a prolonged-undefined duration, or it simply represents the extremity of a gaussian curve, and the progression of HIV disease is therefore an unavoidable event. These subjects are actively investigated, to understand this prolonged infection latency, so that many studies focused on the viremia levels predictive of disease progression.

Long-term stabilized immunological–virological parameters of HIV infection in an AIDS presenter followed for 20 years, with irregular or no antiretroviral therapy

We report the case of an HIV-infected patient who has been followed for 20 years, and despite presenting with AIDS (due to three episodes of cryptococcosis plus one of Pneumocystis jirovecii pneumonia) who during subsequent years missed, refused or took with limited compliance all recommended medications, including combination antiretroviral therapy, and primary and secondary antimicrobial chemoprophylaxis against opportunistic infections. The unexpected clinical and laboratory stabilization of our patient paralleled a progressive increase in his peripheral CD4+ T-lymphocyte count (range 410–825 cells/mL) and a relatively controlled HIV viraemia (5970–44,000 HIV-RNA copies/mL). Such a recovery of sufficient immune competency after experiencing four episodes of severe AIDS-associated opportunistic infections, without reliable antiretroviral and antimicrobial support raises several questions.

An HIV-infected patient with associated, lethal rhinopharyngeal actinomycosis and a rapidly progressing local adenocarcinoma

Methods An extremely infrequent episode of associated nasopharyngeal squamous adenocarcinoma plus an underlying actinomycosis occurred in a HIV-infected male patient (p) with a previous diagnosis of AIDS, treated with cART taken with insufficient adherence, so that a satisfactory immune system recovery (as expressed by a CD4+ count persistingly >400 cells/μL), was in contrast with a lowlevel persistance of detectable HIV viremia, and extensive genotypic drug resistance mutations.