1/27. diagnosis of esophageal ulcers in acquired immunodeficiency syndrome.The esophagus is one of the most common sites of gastrointestinal involvement in human immunodeficiency virus (HIV)-infected patients, with at least 30% of the patients having esophageal symptoms at some point during the course of HIV infection. Esophageal ulcers are commonly caused by infections such as cytomegalovirus (CMV) or may be idiopathic. The clinical presentation of the various causes of esophageal ulcers are similar; therefore, a thorough endoscopic and histological workup is imperative to make a diagnosis and, consequently, to provide appropriate therapy. The widespread use of more effective antiretroviral therapy appears to have led to a decline in gastrointestinal opportunistic disorders in patients with acquired immunodeficiency syndrome (AIDS), including those involving the esophagus. Unfortunately, there are several reports of resistance of hiv-1 to multiple antiretroviral agents, and thus it is possible we will observe an increase in various opportunistic disorders again. The aim of this article is to provide a practical approach to the clinical, endoscopic, and histopathologic evaluation of esophageal ulcers in patients with AIDS.- - - - - - - - - - ranking = 1keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
2/27. Orbital Kaposi's sarcoma in acquired immunodeficiency syndrome.A 28-year-old white male with AIDS-C3 staging, presented with an extensive hemorrhagic dark mass localized in the left orbit. No other ophthalmic findings were disclosed. ultrasonography and computed axial tomographic scans showed orbital involvement. Orbital Kaposi's sarcoma is a rare finding and only a few cases have been reported. Systemic examination revealed other lesions suggestive of disseminated mucocutaneous Kaposi's sarcoma, oral candidiasis, membranous esophagitis and granulomatous hepatitis. Eyelid incisional biopsy disclosed Kaposi's sarcoma. Despite intensive chemotherapy progression was aggressive with a fatal outcome.- - - - - - - - - - ranking = 0.78350619980218keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
3/27. Esophageal candidoma in a patient with acquired immunodeficiency syndrome.Oral thrush and esophagitis caused by candida are common in patients infected with the human immunodeficiency virus. We present the case of a 33-year-old man with acquired immunodeficiency syndrome who developed dysphagia during a hospitalization for pneumonia. signs and symptoms were consistent with candida esophagitis. Despite therapy with fluconazole, the patient's symptoms persisted. At upper endoscopy, a 1-cm, polypoid esophageal mass at 30 cm from the incisors and several other nodular lesions were observed; white plaques were noted throughout the esophagus. biopsy specimens of the mass contained hyphal forms consistent with candida species. Therapy with amphotericin b improved the patient's symptoms, and resolution of the mass was confirmed by repeat upper endoscopy. We believe this is the first case in the medical literature of a candida mass (candidoma) causing dysphagia in a patient with acquired immunodeficiency syndrome. Candidoma should be considered in the differential diagnosis of dysphagia in patients with human immunodeficiency virus infection or immunosuppression due to other causes.- - - - - - - - - - ranking = 1.2164938001978keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
4/27. Esophageal ulcer caused by cytomegalovirus: resolution during combination antiretroviral therapy for acquired immunodeficiency syndrome.A 36-year-old man with a 5-year history of untreated human immunodeficiency virus (HIV) infection had odynophagia for 14 days. Fifteen days earlier, he had begun taking trimethoprim-sulphamethoxazole and combination antiretroviral therapy that included lamivudine, zidovudine, and nelfinavir. He had no history of opportunistic infection. The cd4 lymphocyte count was 67/microL and HIV-rna level was 359,396 copies/mL. Esophagogastroduodenoscopy revealed a large, well-circumscribed esophageal ulceration 31 cm from the incisors. Histopathologic examination of esophageal biopsy specimens showed cytopathic changes diagnostic of cytomegalovirus (CMV). In situ dna hybridization was positive for CMV. While combination antiretroviral therapy was continued, the esophageal symptoms resolved within 4 days of endoscopy without specific therapy for CMV. Follow-up endoscopy 4 weeks later revealed a normal-appearing esophagus, and the patient has remained symptom-free for 10 months.- - - - - - - - - - ranking = 0.80412345004945keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
5/27. Infectious necrotizing esophagitis: outcome after medical and surgical intervention.BACKGROUND: Immunodeficiency predisposes to invasive esophageal infections. The treatment of perforation, respiratory fistula, and necrosis due to transmural esophageal infection is guided by anecdote. We wish to determine treatment and outcome of local complications of necrotizing esophagitis. methods: We report our experience over a 7-year period and review published reports since 1976. We treated 4 patients and found 21 reported patients with perforation (11/25), fistula (8/25), and necrosis (6/25) at a mean age of 35 years. Twenty-one patients were immunodeficient (84%) due to acquired immunodeficiency syndrome in 8, acute leukemia in 6, renal transplant in 3, diabetes mellitus, renal failure, and corticosteroids in 1 each. Pathogenic organisms were fungal in 15 cases, viral in 7, and bacterial in 7. RESULTS: Treatment consisted of antibiotic therapy in 13 patients and surgical intervention combined with antibiotic therapy in 12: esophagectomy in 6, esophageal stenting and drainage in 2, drainage alone in 2, and salivary diversion in 2. overall mortality was 48% (12/25). mortality without surgical intervention was 90% (9/10) and with surgical intervention 27% (3/11). One of 6 patients undergoing esophagectomy (17%) died. The difference in mortality was due to sepsis, which was the cause of death in 8 patients treated with medical intervention and only 1 treated with surgical intervention. CONCLUSIONS: Local complications of necrotizing esophagitis have a high mortality due to sepsis. Surgical intervention, in particular esophagectomy, controls sepsis in published case reports and should be considered in selected patients. Further study is required to determine the true prevalence of these complications and the outcome of intervention.- - - - - - - - - - ranking = 0.19587654995055keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
6/27. candida oesophagitis with hepatitis C virus: an uncommon association.candida oesophagitis is an acquired immune deficiency syndrome (AIDS)-defining illness. We report a 28-year-old woman who presented with candida oesophagitis with underlying chronic hepatitis C. The patient presented with anorexia and weakness and was noted to have raised serum transaminases. Upper-gastrointestinal endoscopy revealed candida oesophagitis involving the whole oesophagus. Oesophageal biopsy demonstrated changes consistent with candida oesophagitis. serology was positive for hepatitis c antibodies, and polymerase chain reaction (PCR) genotyped hepatitis C virus (HCV) as genotype 3. liver biopsy revealed chronic hepatitis with moderately active portal inflammation. A human immunodeficiency virus (HIV) test was non-reactive for types 1 and 2. The development of candida oesophagitis in a patient with chronic HCV infection demands prompt consideration of general debility and immunosuppression as effects of HCV that led to an occurrence of opportunistic infection. Evaluation of this case provides insight into various mechanisms of immune suppression associated with HCV infection.- - - - - - - - - - ranking = 0.02061725024727keywords = immunodeficiency (Clic here for more details about this article) |
7/27. Fatal necrotizing esophagitis due to penicillium chrysogenum in a patient with acquired immunodeficiency syndrome.Although blue-green molds of the genus Penicillium are ubiquitous in the human environment, invasive penicilliosis is uncommon and primarily encountered among immunosuppressed patients. A patient with HIV infection who died of severe necrotizing esophagitis caused by penicillium chrysogenum is reported and the relevant English language literature on human penicilliosis is reviewed. Although infectious esophagitis is commonly associated with AIDS, Penicillium esophagitis has not been described in such patients.- - - - - - - - - - ranking = 0.78350619980218keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
8/27. cytomegalovirus peritonitis in a patient with the acquired immunodeficiency syndrome.peritonitis has been reported infrequently in patients with the acquired immunodeficiency syndrome (AIDS). Intestinal or colonic perforation resulting from cytomegalovirus (CMV) enteritis is the most common cause of peritonitis in these patients. We report a patient with CMV peritonitis occurring in the absence of perforation (primary peritonitis) to alert physicians to this potentially treatable disorder.- - - - - - - - - - ranking = 0.97938274975273keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
9/27. Herpes esophagitis: a cause of upper gastrointestinal bleeding in an immunocompetent patient.Herpes esophagitis presents as dysphagia and odynophagia in the majority of cases. Rarely has hematemesis been reported. We report a case of herpes esophagitis presenting with hematemesis in an immunocompetent patient. This 67-year-old man suffered from herpes esophagitis, proven by a panendoscopic examination, with characteristic histological findings. He presented with hematemesis and passage of tarry stools, but was otherwise healthy with normal humoral, cell-mediated immunity and was negative for human immunodeficiency virus antibody. Only supportive treatment was given. He has been well for the past nine months since the initial diagnosis.- - - - - - - - - - ranking = 0.02061725024727keywords = immunodeficiency (Clic here for more details about this article) |
10/27. cytomegalovirus esophagitis in a child with human immunodeficiency virus-1 infection presenting as fever of unknown origin and stunted growth.We report a 12-year old boy with human immunodeficiency virus-1 infection and cytomegalovirus-associated esophagitis, who presented with an indolent clinical course associated with fever of an unknown origin, failure to thrive and weight loss.- - - - - - - - - - ranking = 0.10308625123635keywords = immunodeficiency (Clic here for more details about this article) |
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