Ghassan N. Awar

Profile of opportunistic infections in HIV-infected patients at a tertiary care center in Lebanon

OBJECTIVES According to statistics published in December 2007 by the National AIDS Program, Lebanon is home to 1056 individuals infected with HIV. Little is known about the clinical profile of opportunistic infections (OIs) and AIDS defining illnesses (ADIs) and their relative contribution to the morbidity and mortality of HIV-infected patients in Lebanon. The aim of this study is to describe the spectrum of OIs and ADIs in HIV-infected patients diagnosed and/or treated at the American University of Beirut Medical Center (AUBMC) in Lebanon. METHODS Data on various OIs and ADIs were collected from the medical records of patients with HIV infection who were diagnosed or received their medical care at AUBMC from 1984 to January 2008. RESULTS Eighty-nine HIV-infected patients were included in the analysis. The incidence of ADIs was 72% (64/89). The most commonly diagnosed OIs were cerebral toxoplasmosis (21%), followed by fungal infections (17%). The majority of ADIs (75%) occurred when the CD4 count was below 200 cells/mm(3). CONCLUSION Clinical guidelines for the prevention of OIs in HIV-infected individuals have been developed on the basis of natural history data collected in industrialized countries. Our results can be used to define local priorities for opportunistic infection prophylaxis.

Buttock abscess brucellosis.

Human brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations, and its complications can affect almost all organs and systems with varying incidence. Soft-tissue infection due to Brucella species is a rare complication of brucellosis. This report presents a case of a 30-y-old previously healthy woman whose right buttock abscess culture grew Brucella spp. The patient was treated successfully with abscess drainage and antibiotic therapy.

Toxocara canis myelitis: clinical features, magnetic resonance imaging (MRI) findings, and treatment outcome in 17 patients.

Toxocara myelitis is a rare disease. Few cases have been reported in the literature. Patients present with myelopathy, occasional eosinophilia in blood and cerebrospinal fluid (CSF), with abnormal signals on magnetic resonance imaging (MRI). In the current study we report 17 cases of isolated Toxocara myelitis from a single tertiary referral center in Lebanon, with description of the clinical presentation, laboratory data, MRI findings, and response to antihelminthic treatment. Clinical and laboratory data were collected for 17 patients who presented with evidence of spinal cord disease. The clinical presentation included sensory, motor, and autonomic dysfunction, predominantly in the lower extremities. Patients exhibited a subacute or chronic course; this was either slowly progressive or remitting-relapsing with mild to moderate disability. The patients underwent extensive blood and CSF workup as well as MRI of the spinal cord and brain. Only 2 patients had a high eosinophil count in the CSF, although blood eosinophilia was seen in 6 patients. All patients tested positive for Toxocara canis antibodies in the blood and CSF. MRI of the spinal cord revealed a single characteristic lesion in the spinal cord with fusiform enlargement that was isointense on T1-weighted images and hyperintense on T2-weighted images. Nodular enhancement was seen after gadolinium injection. Treatment with albendazole, with or without steroids, resulted in marked neurologic improvement and normalization of the MRI in all patients.The finding of a single inflammatory MRI lesion in the spinal cord with positive Toxocara canis serology in the blood and CSF in cases of subacute or chronic myelitis suggests the diagnosis of Toxocara myelitis, irrespective of the presence of eosinophilia. Antihelminthic treatment is associated with a good outcome.Abbreviations: AI = Hauser Ambulation Index, ANA = antinuclear antibodies, CSF = cerebrospinal fluid, CNS = central nervous system, HIV = human immunodeficiency virus, MRI = magnetic resonance imaging.

Emergence of fluoroquinolone-resistant Streptococcus pneumoniae in Lebanon: a report of three cases.

The global emergence of Streptococcus pneumoniae resistance to fluoroquinolones is alarming and has grown to be a cause for significant concern worldwide. We report the first three cases of levofloxacin resistant S. pneumoniae isolates in a tertiary medical center in Beirut, Lebanon. Judicious use of antimicrobial agents is imperative to limit the spread of such resistant strains.

Generalized Telangiectasia: A Manifestation of Intravascular B-Cell Lymphoma

Introduction Intravascular lymphoma (IVL) is a type ofnon-Hodgkin lymphoma that has peculiar tropism to the central nervous system and skin vasculatures. Its most common cutaneous manifestation is subcutaneous nodules and plaques. Generalized telangiectasia as a presentation of IVL has been rarely described in the literature. In this report, we present a case of IVL whose initial and only cutaneous involvement consisted of this unusual presentation.

Odontogenic abscess mimicking acute dacryocystitis

A middle-aged poorly controlled diabetic man developed left-sided orbital and facial swelling several days after extraction of a left upper wisdom tooth. The clinical impression was that of acute dacryocystitis. Opening the skin above the lacrimal sac failed to reveal an inflamed sac establishing the diagnosis of deep facial cellulitis. Complete resolution occurred few weeks after systemic antibiotics and repeated dental drainage of the tooth abscess.

Gastrointestinal Cancer Educatinal Case Series: A 65 year-old Female with Locally Advanced Gastric Cancer and a Supraclavicular Lymph Node

A 65-year-old female presented to her primary care physician with a 6-week history of early satiety and weight loss of 15 lbs. Past medical history was not significant for any previous illnesses or surgeries. Family history was significant for gastric cancer in her mother aged 71 years. The patient was a lifelong non-drinker and non-smoker, and had immigrated to the USA from Ireland almost 50 years prior to her presentation. Physical examination revealed a well-appearing female with pale conjunctiva. There was no palpable lymphadenopathy in the neck. Abdominal exam demonstrated mild tenderness in the epigastrium with no organomegaly or ascites. Laboratory tests demonstrated a microcytic, hypochromic anemia with hemoglobin of 8.6 g/dL. The patient underwent endoscopy which revealed a malignant appearing, partially obstructing mass in the gastric antrum extending into the pylorus and measuring approximately 7 cm. Histology was consistent with a moderately differentiated adenocarcinoma of gastric origin. As part of the patients initial staging, computerized tomography of the chest abdomen and pelvis was performed. This demonstrated thickening in the region of the gastric antrum, gastrohepatic and perigastric lymphadenopathy, and a 1.5-cm left supraclavicular lymph node. The liver and lung parenchyma demonstrated no evidence of metastatic disease. A small exophytic renal mass was seen, measuring less than 2 cm at the lower pole of the left kidney.

Imaging of Parasitic Diseases of the Hepatobiliary Tract, Pancreas, and Spleen

The objective of this chapter is to increase the awareness and knowledge of tropical and especially nontropical radiologists and physicians with regard to the imaging findings of parasitic diseases that can affect the hepatobiliary system, spleen, and pancreas.