Jijo John

Metrorrhagia in a Human Immunodeficiency Virus Positive Woman Caused by Cervical Histoplasmosis

In patients with AIDS, infection with Histoplasma capsulatum frequently results in disseminated disease. We discuss a 42-year-old HIV-infected woman presenting with fever, weight loss, pulmonary infiltrates, diarrhea, and metrorrhagia. Biopsy of bone marrow and skin demonstrated H capsulatum. Necrotic lesions of the uterine cervix, initially thought to represent cervical carcinoma, proved to be because of disseminated histoplasmosis. Involvement of the female genital tract by histoplasmosis is exceedingly rare, with cervical disease not having been described previously.

ACTIVATED PROTEIN C IMPROVES SURVIVAL IN SEVERE SEPSIS PATIENTS WITH ELEVATED TROPONIN.: 257

Purpose Multiple studies in sepsis have demonstrated that elevated troponin is associated with poor outcome. The elevated troponin in this situation is thought to be secondary to microthrombi. We hypothesized that recombinant human activated protein C (APC) treatment would improve outcomes in patients with severe sepsis who have elevated troponin. Methods Patients with severe sepsis by consensus criteria in a university ICU were divided into a troponin-elevated group (T +ve) and a normal troponin (T −ve) group. Outcome was compared using the Fisher9s exact test. APACHE II and MODS were calculated by standard methodology. Data are mean (± SD). Results We identified 105 patients with severe sepsis and troponin measured of which 48 (46%) patients were in the T +ve group. The two groups were similar in terms of their age (54.4 ± 14.9 vs 54.9 ± 15) and other comorbid conditions. APACHE-II (28 ± 8 vs 25 ± 8) was slightly higher and MODS (11 ± 4 vs 9 ± 3) was significantly higher in the T +ve group. Mortality was 52% (25/48) in the T +ve group and 30% (17/57) in the T −ve group (p = .03). APC treatment of T +ve patients reduced mortality from 72% to 30% (p = .008). Conclusion Patients with severe sepsis who have an elevated troponin have increased mortality. In patients with severe sepsis who have elevated troponin, treatment with APC improves outcome. Troponin may be a simple, readily available marker to identify which patients with severe sepsis will benefit from APC.