Claudio Yampolsky

Prolonged survival and immune reconstitution after chagasic meningoencephalitis in a patient with acquired immunodeficiency syndrome

We report a case of cerebral meningoencephalitis due to Trypanosoma cruzi in a patient with acquired immunodeficiency syndrome. The patient presented with seizures and focal neurological signs. Definitive diagnosis of chagasic meningoencephalitis was made by demonstration of free trypomastigote forms in the cerebrospinal fluid. Benznidazol was prescribed with clinical and neurological improvement. Antiretroviral drugs improved cellular immunity and three years later the patient presents a good clinical condition with immune reconstitution and undetectable viral load. Chagasic meningoencephalitis has a poor prognosis when specific treatment is not initiated or is delayed. A high index of diagnosis is necessary for early diagnosis and treatment, especially in endemic areas for Trypanosoma cruzi infection.

Linfomas primarios del sistema nervioso central en pacientes con sida

Introduccion El linfoma primario es la neoplasia mas frecuente del sistema nervioso central (SNC) en pacientes con sida. Metodos Se analizaron de manera retrospectiva las manifestaciones clinicas, los hallazgos en las neuroimagenes, los metodos de diagnostico, las caracteristicas histologicas, la deteccion del ADN del virus de Epstein-Barr (VEB) por reaccion en cadena de la polimerasa (PCR) en liquido cefalorraquideo (LCR) y tejido cerebral y la evolucion de 18 pacientes con sida y linfomas primarios del sistema nervioso central (LPSNC). Resultados La incidencia global de LPSNC fue de 2,6%; 15 eran varones, con una edad media de 33,6 anos. Las manifestaciones clinicas mas comunes fueron los deficit neurologicos focales y las convulsiones. La media de linfocitos T CD4†fue de 44 cel./μl. Los LPSNC se presentaron como lesiones grandes y unicas en 14 pacientes (77,8%). Todas presentaron efecto de masa y edema perilesional. La deteccion del ADN del VEB en biopsias de tejido cerebral fue positiva en 9 pacientes. En siete de estos 9 casos, ademas, se detecto el ADN del VEB por PCR en muestras de LCR. La mediana de supervivencia luego del diagnostico fue de 75 dias. Conclusiones Este estudio confirma la asociacion entre el VEB y estos tumores. Los LPSNC se asociaron con mal pronostico y corta supervivencia en este grupo de pacientes.

Sudden blindness due to bilateral optic neuropathy associated with cryptococcal meningitis in an AIDS patient

BACKGROUND Cryptococcosis is one of the most frequent and severe AIDS defining illnesses. AIMS We present a patient with advanced HIV/AIDS disease and a diffuse meningoencephalitis due to Cryptococcus neoformans. The patient developed an acute and bilateral blindness associated with high cerebrospinal fluid pressure and optic neuropathy. METHODS Post-mortem anatomopathologic study revealed a high number of Cryptococcus in the central nervous system, including the optic nerves and the optic chiasm. CONCLUSION The patients sudden visual loss appeared to be related to the perineuritic arachnoiditis and the massive invasion of the optic nerves by the fungus.

Spinal epidural abscess due to Mycobacterium tuberculosis in a patient with AIDS: case report and review of the literature

Spinal epidural abscess (SEA) is a rare infectious disorder that often has delayed diagnosis and is associated with significant morbidity and mortality rates. We present a case of an AIDS patient with a SEA due to Mycobacterium tuberculosis. This type of SEA in AIDS patients is characterized by localized spinal pain and prolonged fever. Magnetic resonance imaging is the method of choice in the diagnostic process. Early diagnosis, followed by specific therapy (surgical decompression combined with antituberculous drugs), is necessary to improve the prognosis of these kinds of patients.

Fungal cerebral abscess in a diabetic patient successfully treated with surgery followed by prolonged antifungal therapy

BACKGROUND Intracranial fungal masses are uncommon diseases, but their incidence is increasing, most often due to the prolonged survival of patients with different immunodeficiencies. The management of patients with intracranial fungal masses included stereotactic biopsy for diagnosis, partial or radical surgery excision and prolonged antifungal therapy. AIMS We report the case of a 51-year-old diabetic man with a history of psoas abscess due to Candida albicans 1 year before the onset of neurological symptoms, including headache and generalized tonoclonic seizures. METHODS Magnetic resonance imaging showed a single lesion located in the right parietal lobe with mass effect, surrounding edema and enhancement after injection of gadolinium. The material was purulent. RESULTS Direct microscopic examination showed hyaline, branched and septate hyphae compatible with fungal elements. CONCLUSIONS Fungal infections, especially due to Candida species, should be considered in diabetic patients with parenchymal brain abscesses. Radical excision followed by prolonged antifungal therapy based on fluconazole or amphotericin B is necessary to improve the prognosis of this type of patients.

Acute meningoencephalomyelitis due to varicella-zoster virus in an AIDS patient: report of a case and review of the literature

Varicella-zoster virus (VZV) meningoencephalomyelitis is a rare but severe neurological complication of VZV reactivation in immunocompromised patients. We report the case of an HIV-infected individual who developed an acute and severe meningoencephalomyelitis accompanied by a disseminated cutaneous eruption due to VZV. The presence of VZV DNA in cerebrospinal fluid was confirmed by polymerase chain reaction (PCR) technique. The patient started undergoing an intravenous acyclovir therapy with a mild recovery of neurological manifestations. Varicella-zoster virus should be included as a cause of acute meningoencephalomyelitis in patients with AIDS. Early diagnosis followed by specific therapy should modify the rapid and fulminant course for this kind of patients.

Oligodendroglioma in a patient with AIDS: case report and review of the literature

In the last years, new techniques of neuroimages and histopathological methods have been added to the management of cerebral mass lesions in patients with AIDS. Stereotactic biopsy is necessary when after 14 days of empirical treatment for Toxoplasma gondii encephalitis there is no clinical or neuroradiologic improvement. We report a woman with AIDS who developed a single focal brain lesion on the right frontal lobe. She presented a long history of headache and seizures. After two weeks of empirical treatment for toxoplasma encephalitis without response, a magnetic resonance image with spectroscopy was performed and showed a tumoral pattern with a choline peak, diminished of N-acetyl-aspartate and presence of lactate. A stereotactic biopsy was performed. Histopathological diagnosis was a diffuse oligodendroglioma type A. A microsurgical resection of the tumor was carried out and antiretroviral treatment was started. To date she is in good clinical condition, with undetectable plasma viral load and CD4 T cell count > 200 cell/uL.

Spondilodiscitis due to Mycobacterium tuberculosis in HIV and non-HIV-infected patients: Eleven years experience in a referent Hospital of infectious diseases in Argentina

Background: Tuberculosis (TB) is an emerging health problem despite the advances in the methods of diagnosis and treatment. The resurgence of tuberculous spondilodiscitis (TBSD) or Potts disease can be expected to be associated with a concomitant increase in the incidence of extra-pulmonary TB. Aim: To describe the clinical features, imaging findings, and laboratory diagnosis in a group of patients with TBSD. Materials and Methods: From January 1 st 2000 to December 31 st 2010, we retrospectively reviewed 22 cases of spinal TB. Only those with positive culture results and/or characteristic clinical and pathological findings were enrolled. Demographic data, comorbilities, clinical manifestations, time up to the definitive diagnosis, outcome and sequelae were considered. Results : During the study period, 22 patients were diagnosed with TBSD; 14 were men and 8 women with a median of age of 34 years at the time of diagnosis. The median duration of symptoms before the TBSD diagnosis was 120 days (range 30 to 360 days). At the time of diagnosis, fever and back pain were the most common clinical symptoms; 7 patients (32%) had fever and 21 (95%) had spinal pain; eleven patients (50%) had constitutional symptoms; 6 (27%) had respiratory symptoms and 3 (13.6%) had neurological manifestations. Magnetic resonance imaging (MRI) was performed in 9 (40%) cases, computed tomography (CT) in 7 patients (32%), and abdominal ultrasound in 6 cases (27%). The lumbar spine was the most commonly involved site (14 patients, 64%); thoracic spine was involved in 2 patients (9%); dorsolumbar spine was compromised in 4 cases (18%). Cervical spine was only involved in one patient (4.5%) and the last patient (4.5%) presents a global spinal involvement (cervical-thoracic and lumbar spine). Conclusion: Insidious clinical course and ambiguous manifestations of TBSD often delay the accuracy of diagnosis. Spinal TB should be included in the differential diagnosis of patients with prolonged back pain and fever.