Biomedical subjects
Publications and source records attributed to J Collazos.
Bronchiolitis obliterans, with or without organizing pneumonia, represents an uncommon response of the lung to several injuries, that results in characteristic histopathologic changes in the small airways. The present case report describes a patient with HIV infection who developed bronchiolitis obliterans, and reviews the previously reported cases of this condition in HIV-infected patients.
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We describe an immunocompetent patient with a solitary brainstem abscess that responded to antituberculous therapy. Although prompt surgical therapy has been advocated, the possibility of medical resolution of brainstem tuberculous abscesses should be considered.
Chlamydia psittaci may rarely involve the heart as the only manifestation of the infection. We report a case of myopericarditis caused by this agent, whose pathogenesis seemed to be autoimmune damage triggered by the infection.
Many conditions may present as fever of unknown origin in the HIV-infected patient, and their relative frequency is influenced by multiple factors. The history and physical examination may provide some useful clues for the diagnosis. Haematological, biochemical, and conventional radiological tests are rarely diagnostic; even serological and/or microbiological tests have some limitations in these patients. The geographical setting and the local prevalence of diseases are of the utmost importance. Infections that have a world-wide distribution, such as tuberculosis, should be intensively searched for, particularly in areas of high prevalence. The measurement of the CD4+ cell count is essential, as there is a strong association between this count and certain opportunistic diseases that may manifest as fever of unknown origin. Imaging procedures, such as CT and radionuclide scans, are useful for the location of inflammatory and neoplastic lesions. Liver and bone marrow biopsies are helpful in certain subsets of patients and the efficacy of empirical treatments has been clearly documented in certain infections. Some HIV-infected patients with fever of unknown origin remain undiagnosed after a thorough investigation; these individuals should be managed conservatively. Finally, symptomatic treatment is the best option for terminally ill patients in whom benefit from a detailed investigation of the cause of fever is not expected.
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Pyomyositis is caused by staphylococci in 70% to 90% of patients. We report a case of pneumococcal pyomyositis (PP), review the 11 cases previously published, and compare the features of pneumococcal pyomyositis with those of classic (nonpneumococcal) pyomyositis. Several clinical characteristics have been identified that are notably different in both groups. Psoas muscle involvement was observed in two thirds of the patients with PP, and a source for the infection was identified in half of the patients. Patients with PP were older than those with classic pyomyositis. Men were affected less often than women with PP, but the opposite was the rule in classic pyomyositis. The systemic response to the infection was more prominent in patients infected with pneumococci than from other causes. Most patients with PP were successfully treated with antibiotics and drainage. Secondary meningitis was observed in 3 patients with psoas muscle abscess caused by pneumococci. Mortality is low in pyomyositis regardless of the causative pathogen.
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Sclerosing cholangitis may be a cause of refractory pain in patients infected with the human immunodeficiency virus. We performed celiac plexus block in three such patients with sever pain from sclerosing cholangitis and a poor response to conventional analgesia. The pain had been centered in the epigastrium and/or upper-right quadrant of the abdomen for 2, 10, and 15 weeks, respectively. Computed tomography-guided celiac plexus block with absolute alcohol and bupivacaine was performed. All three patients reported complete disappearance of the pain immediately after the procedure in two cases and 3 days later in the remaining patient. All patients were discharged free of pain and without analgesics and were followed up for 2, 8, and 11 months, respectively, without recurrence of pain. Celiac plexus block deserves further trial for the treatment of severe pain associated with sclerosing cholangitis in patients with acquired immunodeficiency syndrome. The quality of life of our three patients was considerably improved with this relatively simple procedure.
OBJECTIVE: To report a patient with sulfadiazine-induced urolithiasis and acute renal failure. CASE SUMMARY: A patient with AIDS who was being treated with pyrimethamine and sulfadiazine for Toxoplasma encephalitis developed lumbar pain, dysuria, urinary frequency, and hematuria. Acute renal failure was found and numerous crystals of sulfadiazine were seen in the urine. Multiple calculi of up to 2 cm in diameter in both kidneys were noted on ultrasound. The patient was treated with intravenous fluids and alkalinization of the urine with rapid improvement. An intravenous urographic study performed 2 days later showed no evidence of calculi and renal function was normal. DISCUSSION: Patients with AIDS and Toxoplasma encephalitis may have several predisposing conditions that can lead to the development of sulfadiazine-induced crystalluria, including poor fluid intake, fever, diarrhea, and hypoalbuminemia, in addition to the high doses of the drug required and the prolonged period of treatment. CONCLUSIONS: This potentially serious complication can be managed easily with conservative treatment. Clinicians should be aware of this complication as it is expected to occur more frequently as more patients are treated with sulfonamides and patients with AIDS experience longer survival rates.
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A 24-year-old man infected with the human immunodeficiency virus (HIV) developed cough and progressive dyspnea over a period of 4 weeks. Absolute blood eosinophil count was 3360/mm3. Chest X-ray revealed alveolointerstitial infiltrates in both lower lobes. Eosinophilia was also found in bronchoalveolar lavage fluid. The clinical picture improved dramatically with steroids. Other causes of acute eosinophilic pneumonia were excluded.
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