Luis De Carolis

Sífilis maligna en un paciente con infección por VIH: Presentación de un caso y revisión de la literatura

La sifilis maligna es una forma rara de presentacion de lues secundaria asociada a la infeccion por el virus de la inmunodeficiencia humana (VIH). Se caracteriza por lesiones cutaneas atipicas, ulceradas, costrosas y diseminadas, asociadas con sintomas generales inespecificos que pueden retrasar el diagnostico correcto. Existen solo escasas publicaciones en la literatura medica acerca de sifilis maligna en pacientes con infeccion por VIH. La lues maligna debe incluirse en el diagnostico diferencial de los pacientes con VIH que consultan por fiebre y lesiones ulcero-costrosas diseminadas. Se describe el caso de un paciente con infeccion por VIH que desarrollo una sifilis maligna con confirmacion diagnostica a partir de los hallazgos histopatologicos y se realiza una revision de la literatura cientifica sobre el tema.

Compromiso ocular en el sarcoma de Kaposi asociado con el sida

BACKGROUND The study evaluates the incidence of ocular compromise in the Kaposis sarcoma associated with AIDS. METHODS We revised the clinical histories of HIV seropositives patients seen in the ophthalmology department from January, 1994 to December, 1998. All patients were examined by direct visually and dilated fundus examination with the use of either a direct or an indirect ophthalmoscope. RESULTS In 6,552 patients, ocular Kaposis sarcoma was diagnosed in 17 (0.25%), predominantly in male sex (88.23%). The lesions predominated in eyelids, and the inferior has been the most affected. In only one female, the ocular compromise was the first neoplastic manifestation. CONCLUSIONS The ocular compromise in the Kaposis sarcoma is an alternative to be considered in AIDS patients with previous or simultaneous cutaneous or visceral involvement. Due to the few clinical signs of these lesions, a thorough ocular study is recommended in these patients.Fundamento Evaluar la incidencia del compromiso ocular en el sarcoma de Kaposi asociado con el sida. M etodos Se revisaron las consultas efectuadas en el servicio de Oftalmologia entre enero de 1994 y diciembre de 1998 por personas infectadas por el virus de la inmunodeficiencia humana (VIH). Todos ellos fueron sometidos a examen oftalmologico directo, fondo de ojo, biomicroscopia y examen con lampara de hendidura. Resultados En 6.552 consultas, se diagnostico compromiso ocular por el sarcoma de Kaposi en 17 pacientes, lo que significa una incidencia del 0,25%. La media del recuento de linfocitos T CD4 fue de 172 celulas /mm3. Las lesiones predominaron en el sexo masculino (88,23%). La estructura ocular afectada con mayor frecuencia fueron los parpados, siendo el inferior el mas comprometido. En una de las mujeres afectadas, la localizacion ocular constituyo la primera y unica manifestacion de la neoplasia. Conclusion El compromiso ocular en el sarcoma de Kaposi es una alternativa que debe considerarse en sujetos con infeccion por VIH, con compromiso previo de piel y otras mucosas. Dada la escasa repercusion clinica de las lesiones, recomendamos efectuar un minucioso examen ocular en estos pacientes.

Oral cavity lymphoma as secondary AIDS-defining neoplasm in a patient on HAART with immune reconstitution

Lymphomas of the oral cavity are a rare complication of advanced HIV/AIDS disease. The clinical appearance of these neoplasms includes masses or ulcerative lesions that involve the oral soft tissue and the jaw as the predominant manifestation. We report the case of a patient with AIDS who developed diffuse large B-cell non-Hodgkins lymphoma of the oral cavity during highly active antiretroviral therapy, with undetectable plasma viral load and immune reconstitution.

Candida parapsilosis meningitis in a patient with AIDS. Report of a case and review of the literature

BACKGROUND Candida parapsilosis is an important species in the genus Candida that plays a significant role in hospitalized patients with nosocomial infections. In patients with HIV infection or AIDS, central nervous system involvement by Candida species is exceptional. CASE REPORT Here we report a case of an acute meningoencephalitis due to C. parapsilosis in an adult patient with AIDS. We describe the clinical manifestations, the diagnosis methods, antifungal therapy and outcome. CONCLUSIONS C. parapsilosis is uncommonly reported as a cause of meningitis in AIDS patients. A higher index of suspicion and culture is necessary to confirm the diagnosis of candidal meningoencephalitis.

Disseminated nocardiosis with psoas abscess in a patient with AIDS: first reported case

Psoas muscle abscess is an uncommon infection that have been diagnosed increasingly in the last years. We present a case of a patient with advanced human immunodeficiency virus infection who developed a disseminated infection due to Nocardia asteroides sensu stricto type VI with psoas abscess. To our knowledge no other cases of Nocardia psoas abscess in the setting of HIV infection have been reported in the literature.

Infección por Rhodococcus equi en pacientes con SIDA: Análisis retrospectivo de 13 pacientes en Argentina

INTRODUCTION Rhodococcus equi is a gram positive coccoid rod that causes pulmonary infections in immunosuppressed patients. METHODS We retrospectively analyzed epidemiological, clinical, microbiological, radiological, and immunological features as well as the outcomes of 13 AIDS patients with R. equi infection. RESULTS Between January 1994 and December 2012, 13 patients attending the AIDS department of the Infectious Diseases reference hospital in Buenos Aires were diagnosed with R. equi infection. All were men, the median age was 27 years. At the time of diagnosis, the median of CD4+ T cell counts was 11 cells/μl Twelve patients presented pulmonary disease with isolation of the microorganism from sputum or bronchoalveolar lavage; in the other patient the diagnosis was postmortem with positive culture of cerebrospinal fluid. The most frequent clinical manifestations were fever, haemoptysis, and weight loss. The predominant radiological finding was lobe consolidation with cavitation. Nine patients died after a median survival of 5.5 months. In all of them, cultures persisted positive until the last admission. The other 4 patients did continue clinical follow-ups. CONCLUSION The insidious course of R. equi disease and the difficulties in the isolation of the microorganism contribute to the delay in the diagnosis and to the high mortality rate of this opportunistic infection.

Erupción maculopapulosa diseminada en un paciente con sida

Se realizo biopsia cutanea cuyo informe histopatologico revelo la existencia de acantosis irregular con elongacion de crestas papilares, paraqueratosis con acumulacion de neutrofilos y denso infiltrado inflamatorio dermico intersticial y perivascular, en contacto con la epidermis, constituido por linfocitos, histiocitos, plasmocitos y polimorfonucleares. Las tinciones de Giemsa, acido peryodico de Caso clinico

Perianal ulcers in a human immunodeficiency virus-seropositive man

A 44-year-old man infected with human immunodefi ciency virus presented with 1-month history of fever, night sweats, weight loss, and two perianal ulcerations. He had a history of primary syphilis and pulmonary tuberculosis and underwent complete treatment for both diseases. He had never been administered highly active antiretroviral therapy. Physical examination showed a large submaxillary lymphadenitis, two perianal ulcers with indurated erythematous margins and exophytic verrucous lesions compatible with condyloma acuminata or anogenital warts due to human papillomavirus (Figure A). Initial laboratory fi ndings included anemia and high erythrocyte sedimentation (60mm/h). CD4 T-cell count was 107 cells/μL. The colonoscopy was normal and chest computed tomography showed an infiltrate compatible with miliary tuberculosis. Scarifi cation of the perianal lesions was performed; Ziehl-Neelsen stain was positive for acid-fast bacilli (AFB) (Figure B) and Grocott’s methenamine silver stain identifi ed numerous fungal intracellular organisms compatible with Histoplasma (Figure C). A skin biopsy revealed granulomatous infi ltration with multinuclear giant cells, lymphocytes and histiocytes without necrosis. The culture of skin biopsy smears was positive for Mycobacterium tuberculosis. Direct examination and cultures of sputum, bronchoalveolar lavage and aspiration of the cervical lymph node were positive for AFB and M. tuberculosis. Treatment with the antituberculous fi rst-line drug regimen and amphotericin B resulted in rapid clinical improvement. Two months later, the perianal lesions were completely healed. Perianal lesions represent a rare form of periorificial cutaneous tuberculosis and an unusual skin manifestation of disseminated histoplasmosis and tend to occur predominantly in patients with AIDS(1) (2) (3).