1/43. Etanercept for the treatment of human immunodeficiency virus-associated psoriatic arthritis.Etanercept may play an important role in modulating the inflammatory activity and progression of human immunodeficiency virus (HIV)-associated psoriasis and psoriatic arthritis. We report the case of a 45-year-old homosexual man with a CD4 cell count of less than 0.05 x 10(9)/L and an HIV viral load of 4200 copies/mL (while receiving highly active antiretroviral therapy) who developed extensive psoriatic plaques, 4.5-kg weight loss, onychodystrophy, and psoriatic arthropathy with severe periarticular bone demineralization. The arthritis progressed despite the use of several disease-modifying medications, including corticosteroids, hydroxychloroquine, and minocycline. Because of uncontrolled, progressive, and disabling arthritis and resulting profound disability, he was treated with etanercept. Within 3 weeks, his psoriasis had improved dramatically and his joint inflammation had stabilized. For the next 4 months, immunologic and viral parameters remained stable, but his clinical course was complicated by frequent polymicrobial infections. Etanercept was thus discontinued despite continued improvements in his psoriasis, psoriatic arthritis, and functional status. While both cutaneous and joint manifestations of psoriasis improved dramatically, the experience with this patient dictates that caution and careful follow-up must be exercised when prescribing etanercept in the setting of HIV infection.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
2/43. Sudden unexpected death as a consequence of indinavir-induced nephropathy. A case report.A 60-year-old male had tested in 1986, at age 46, positive for human immunodeficiency virus (HIV). In mid-1996 he was started on a protease inhibitor regimen, which included indinavir, lamivudine and stavudine, and remained on this therapy until his death. In April 1999 he was hospitalized after a fainting episode. Although examination focusing on cardiac disease did not disclose any remarkable findings, he died suddenly one week after being discharged from hospital. At autopsy the kidneys were enlarged, with a total weight of 500 g, patchy pale gray and pinkish. microscopy showed leukocytic cell casts in many of the tubules and collecting ducts. In many of these casts there were clefts left by crystals. In the interstitium, both in the cortex and the medulla, there was focal inflammation and fibrosis. death was attributed to sudden cardiac dysfunction, probably ventricular fibrillation as a consequence of severe nephropathy with electrolyte disturbances. It is likely that kidney damage developed secondary to the indinavir treatment as indinavir can cause not only nephrolithiasis but also crystal-induced acute renal failure.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
3/43. Successful treatment of idiopathic colitis and proctitis using thalidomide in persons infected with human immunodeficiency virus.Gastrointestinal ulcerations in persons infected with HIV have many causes, the most common being opportunistic infections and neoplasms. Recently, idiopathic ulcerative lesions of the colon and rectum have been described. Two cases are reported of idiopathic colonic and anorectal inflammation and ulceration which failed traditional therapies but responded to thalidomide with complete clinical and histologic resolution.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
4/43. Persistent flank pain, low-grade fever, and malaise in a woman treated with indinavir.This case report describes a 32-year-old woman treated with indinavir who developed mild to moderate flank pain, malaise, and low-grade fever. Sterile pyuria preceded increased serum creatinine levels. Workup revealed persistent pyuria, normal-sized kidneys, a normal intravenous pyelography, and negative urinary cultures. Renal biopsy showed interstitial nephritis and chronic inflammation. Collecting ducts contained crystals. Two months after treatment with indinavir was discontinued, serum creatinine levels returned to normal and pyuria disappeared. Sterile pyuria in patients taking indinavir may help to identify patients at risk for renal dysfunction and interstitial nephritis. Markedly increasing the fluid intake above the recommended dosage may ameliorate or even reverse the process of tubulointerstitial disease.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
5/43. Acute liver failure associated with antiretroviral treatment for HIV: a report of six cases.BACKGROUND/AIMS: Severe hepatotoxicity is a rare but potentially fatal side effect of all antiretrovirals. We report a series of six human immunodeficiency virus (HIV)-infected patients admitted with acute liver failure (ALF) over a 25-month period, of whom five died. All had been treated with a range of antiretroviral therapy and only two had had acquired immune deficiency syndrome (AIDS) defining illnesses. RESULTS: Median duration of antiretroviral therapy was 12.5 months (range 1-23). Median time from the introduction of new antiretroviral therapy to the onset of ALF was 8 weeks (range 2-12). The development of ALF was unrelated to duration of HIV treatment or type of antiretroviral therapy, and was not predicted by close out-patient supervision and monitoring of liver function. Biochemical investigations were variable but revealed a predominantly hepatocellular pattern. Liver biopsy revealed typical features of mitochondrial toxicity in only one case, with confluent hepatocellular necrosis, inflammation and cholestasis seen in the others. CONCLUSIONS: There is a need to increase awareness of the potential hepatotoxicity of antiretroviral therapy and to develop means of predicting its development. With increasing usage of antiretroviral therapy, severe hepatotoxicity and ALF may arise more frequently, and the outcome is poor despite intensive supportive therapy.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
6/43. STIR sequence in infectious sacroiliitis in three patients.magnetic resonance imaging (MRI) provides the most detailed evaluation of the sacroiliac (SI) joint and surrounding soft tissue. Therefore, this technique represents the most sensitive and specific method in early diagnosis of infectious sacroiliitis. Among three patients diagnosed as having infectious sacroiliitis in our hospital, the short tau inversion recovery sequence (STIR) was found to be more effective than the T1 contrast-enhanced sequence, particularly in delineating all findings of the SI joint inflammation and allowing for the early detection of septic sacroiliitis.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
7/43. Necessity for and control of dental treatment in HIV infected children. Inter-professional relationship between dentist and paediatrician.HIV infected children frequently suffer from buccal-dental lesions needing dental treatment. This treatment should improve their systemic affection, localised pathology, psychological and affective state and their general quality of life. Hardly any of these children are ever treated; sometimes because of lack of family motivation (the most frequent cause) and others because of the lack of a Paediatric Dental Unit in the hospitals they attend. For this reason we present here two cases of HIV infected children, with HIV infected mothers, who, thanks to the relationship between the Paediatric and Dental Units of the hospital, have had access to dental treatment for multiple caries and candidiasis. An anatopathological diagnosis of gingival inflammation, which was also infected by candida, was also carried out. The treatment included extraction of teeth, pulpotomy, pulpectomy and the fitting of prostheses. It should be made clear that a good inter-professional relationship is needed and it must also be taken into account the great difficulty that is encountered when trying to make this group of patients understand the need for, and benefits of, dental treatment.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
8/43. Inflammatory bowel perforation during immune restoration after one year of antiretroviral and antituberculous therapy in an hiv-1-infected patient: report of a case.PURPOSE: This article reports an unusual presentation of bowel perforation. methods: We report the case of a 30-year-old HIV-infected male who suffered from an advanced state of CD4 cell depletion (29 CD4 cells per 106/l). abdominal pain and diarrhea led to further examinations. RESULTS: colonoscopy revealed a severe tuberculous ileocecal inflammation. tuberculosis and HIV infection were treated. The patient's response to antiretroviral therapy was excellent. After 11 months of potent antiretroviral treatment and 12 months of antituberculous therapy he suffered from acute abdominal pain with fever and ileus. laparotomy revealed two intestinal perforations of the jejunum and inflammation of the whole ileocecal region. CONCLUSION: Immunopathologic reactions caused by immune restoration are novel presentations of highly active antiretroviral treatment as shown here. The presented patient is an unusual case with a very late onset of inflammatory response, which led to intestinal perforation.- - - - - - - - - - ranking = 2keywords = inflammation (Clic here for more details about this article) |
9/43. Negative images in the fine needle aspiration cytologic diagnosis of mycobacterial infections.Cytologic diagnosis of mycobacterial infection has conventionally depended on the recognition of granulomatous inflammation with caseous necrosis and the identification of acid-fast bacilli with special stains. Immunocompromised patients however may not mount the expected response. Mycobacteria can be seen as negative images in fine needle aspiration cytologic smears from patients with acquired immunodeficiency syndrome. We report the cytologic findings of lymphnode aspiration from four patients where the mycobacteria were seen in the routine May Grunwald Giemsa-stained smear as unstained rod-shaped structures in the background and within histiocytes. These were confirmed to be acid-fast bacilli with the Ziehl-Neelsen stain.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
10/43. simvastatin-induced rhabdomyolysis in an HIV-infected patient with coronary artery disease.As greater numbers of human immunodeficiency virus (HIV)-infected individuals live to middle-age and beyond, there is growing concern that elevated cholesterol and lipid values will lead to cardiovascular complications in such patients. Furthermore, several of the highly active antiretroviral therapies (HAART) used to reduce levels of circulating HIV and extend acquired immunodeficiency syndrome (AIDS)-related survival are associated with a rise in plasma lipids. Anecdotal reports suggest such rises may be linked to cardiovascular complications. Herein, we review the case of a 74-year-old HIV-infected man with advanced coronary artery disease. He was prescribed simvastatin for control of hyperlipidemia and within 4 weeks developed muscle pain, proximal muscle weakness, myoglobinuria, and a markedly elevated creatinine phosphokinase (CPK). simvastatin was discontinued, and rhabdomyolysis improved rapidly with conservative care. This report emphasizes this rare, but potentially significant, side effect of statin anticholesterol agents. Medical providers who prescribe statins must remember to check CPK levels when their HIV-infected patients complain of muscle pain. Discontinuing the offending drug will usually result in rapid diminution of muscle pain and inflammation and improve muscle strength.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
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