1/109. Differentiating hiv-1 parotid cysts from papillary cystadenoma lymphomatosum. BACKGROUND: patients with parotid cystic lesions may first be seen in the dental office. These conditions most often represent either papillary cystadenoma lymphomatosum, or PCL, or lymphoepithelial cysts associated with human immunodeficiency virus, or HIV, disease. The authors present a case report to illustrate the differential diagnosis. CASE DESCRIPTION: PCL represents a benign, usually unilateral, circumscribed parotid tumor with cystic elements. HIV-associated lymphoepithelial cysts of the parotid gland usually are seen bilaterally, create cosmetic concerns and are hallmarked by an associated cervical lymphadenopathy. Therapy for PCL demands surgical excision, while patients with HIV-associated lymphoepithelial cysts may be treated with antiviral therapy and undergo periodic monitoring by a physician. CLINICAL IMPLICATIONS: As a member of the health care team, the dentist must be familiar with head and neck swellings. Early clinical recognition of parotid swellings leads to successful treatment. ( info) |
2/109. relapsing fever in an HIV-infected man. ( info) |
3/109. Central pontine myelinolysis complicating treatment of multicentric Castleman's disease and Kaposi's sarcoma in a patient with AIDS. An HIV positive black African woman presented with widespread lymphadenopathy and pancytopenia that had been ascribed to tuberculosis. Lymph node biopsy showed both Kaposi's sarcoma and multicentric Castleman's disease. Despite antiretroviral therapy and chemotherapy the patient deteriorated, developing confusion and dysphasia. A cranial magnetic resonance scan showed central pontine myelinolysis. Despite supportive therapy the patient died. ( info) |
4/109. Hormonal and immunological pattern in a patient with acquired immunodeficiency syndrome related complex and Cushing's syndrome. A case of Cushing's syndrome in a 24-yr-old homosexual with an aids-related complex is reported. In this patient certain symptoms common to both diseases, i.e. weakness, myalgia and muscle atrophy were accentuated, whereas other symptoms pathognomic of the human immunodeficiency virus (HIV) infection, i.e. lymphoadenopathies and weight loss, were less pronounced by the high levels of circulating adrenal steroids. ketoconazole was administered po in order to block adrenal steroidogenesis, the drug caused a remarkable fall of cortisol serum concentrations, but was unable to modify significantly the immunological pattern of the patient. Our data suggest that changes of serum adrenal steroid levels have little effect on the immune network of patients with AIDS. ( info) |
5/109. Unusual skin pigmentation in a patient with human immunodeficiency virus (HIV) infection. Diffuse addisonian hyperpigmentation in a male patient with acquired immunodeficiency syndrome related complex (ARC) is described. The etiology of pigmentation in this patient remains obscure but is most probably related to the H.I.V. infection. Other causes of addisonian hyperpigmentation are considered less likely. ( info) |
| A 26-year-old man with aids-related complex (ARC) was treated with high-dose busulphan and cyclophosphamide, followed by allogeneic bone marrow transplantation. For 3 months before transplantation he received a combination of four drugs considered active against human immunodeficiency virus (HIV) to reduce the viral burden: zidovudine, acyloguanosine, fusidic acid and phenylidantoin. Although in reduced doses in coincidence with marrow engraftment, zidovudine therapy was scheduled after transplantation in order to protect donor cells from infection with HIV. Engraftment rapidly occurred and was documented by cytogenetic analyses. The post-transplant course was characterized by severe acute GvHD with irreversible hepatorenal failure. The patient died on day 48 after transplantation. polymerase chain reaction analyses for detecting HIV dna showed the persistence of positivity at day 30 and 45 after transplantation. antibodies to specific HIV proteins evaluated with Western blot testing also persisted at days 21 and 35 after transplantation. Circulating immunocomplexes disappeared on day 31, and an increase in the CD4/CD8 ratio occurred. The short survival of the patient, affected by chronic hepatitis too, does not allow final conclusions about the role of BMT in HIV disease. ( info) |
7/109. Toxic epidermal necrolysis due to vancomycin. Toxic epidermal necrolysis due to vancomycin is reported in a patient with human immunodeficiency virus infection. The same patient had anaphylaxis to cloxacillin but tolerated other penicillin derivatives. These reactions were documented using in vivo and in vitro tests. The role of human immunodeficiency virus infection in the pathogenesis of these reactions is discussed. ( info) |
8/109. Pyrexia of unknown origin and HIV infection in a middle aged woman. A case study. Pyrexia of unknown origin (PUO) is defined as a prolonged fever of more than 3 weeks duration and which resists a diagnosis after a week in hospital. Here we present a case admitted in our hospital with fever of prolonged duration, esophageal candidiasis, multiple systemic symptoms and infections. She was diagnosed as being infected by HIV and presenting with AIDS related complex with no clear details of the source of infection. There is no significant history of exposure, sexual transmission or blood transfusions. The only mode suggestive of acquiring HIV in this case was probably due to her repeated hospital admissions and repeated intravenous infusions. She also had history of dental procedures which may be a considerable factor. ( info) |
9/109. One-year follow-up of vaccine therapy in HIV-infected immune-deficient individuals: a new strategy. immunization of AIDS/ARC patients with autologous cells expressing hiv antigens, although providing clinical and biological benefits, fails to restore cellular immunity. The latter result is due partly to the antiproliferative effect of hiv-1 on activated T-cells (immune suppression), which leads to blockade of specific immune reactions. To overcome immune suppression, a new vaccine strategy was designed consisting of an immunization against hiv-1 combined with components of the T-cell-suppressive (antiproliferative) network. This new vaccine treatment proved to be innocuous in mice, monkeys, and two non-HIV-infected humans. A Phase I clinical trial was performed in six patients previously under cellular immunotherapy and still presenting a cellular immune defect. Preliminary results confirmed, after a 1-year follow-up of the patients, the safety of the new vaccine, which also partially restored the cellular immune response, including anti-HIV HLA-restricted cell-mediated cytotoxicity, delayed hypersensitivity to recall antigens, and proliferation of T-cells specifically activated by recall antigens. ( info) |
10/109. Storage artifact increases helper T lymphocytes and helper-to-suppressor T lymphocyte ratio to normal levels in a patient with acquired immune deficiency related complex. An increase in both the helper/suppressor T lymphocyte ratio and the absolute number of helper T lymphocytes from subnormal to normal values was observed on overnight storage of a lymphocyte preparation from a patient with acquired immune deficiency related complex. Storage of lymphocyte preparations did not significantly alter the helper/suppressor ratio for four additional patients with acquired immune deficiency related complex but produced increases for one patient with Crohn's disease and two patients with sickle cell disease. Overnight storage of heparinized blood at room temperature did not alter the helper/suppressor ratio for one healthy volunteer and one patient with acquired immune deficiency related complex but produced increases for one patient with Crohn's disease and one patient with acute infectious mononucleosis, resulting in a change from a subnormal to a normal value in the latter patient. We suggest that physicians and laboratory directors consider storage artifacts when evaluating results of tests for absolute numbers of helper T lymphocytes or helper/suppressor T lymphocyte ratios performed on patients. ( info) |