1/27. Spinal epidural lipomatosis in a human immunodeficiency virus-positive patient receiving steroids and protease inhibitor therapy.We describe a patient who became cushingoid as a result of receiving steroid therapy for thrombocytopenia purpura and who then developed spinal epidural lipomatosis 4 months after he started receiving ritonavir as part of his therapy for human immunodeficiency virus infection. We believe that ritonavir may have contributed to the development of epidural lipomatosis and that clinicians should be aware of this possible association.- - - - - - - - - - ranking = 1keywords = purpura (Clic here for more details about this article) |
2/27. Thrombotic thrombocytopenic purpura in hiv infection: a report of two cases.Thrombotic thrombocytopenic purpura (TTP) is a rare but well-described complication of hiv infection, which occurs equally frequently during the early asymptomatic phase of hiv infection and with clinical AIDS. The clinical spectrum varies from a low-grade asymptomatic thrombocytopenia with mild renal insufficiency to a catastrophic illness with gross neurological deficits and renal failure requiring dialysis. We report two cases of TTP associated with hiv infection seen in our institution over a period of 2 years. The clinical course of these two patients highlights the markedly heterogeneous characteristics of patients with hiv-related TTP. hiv infection may be the most common association of TTP in certain communities with a high prevalence of hiv infection. As early diagnosis and institution of plasmapheresis is crucial for a favorable outcome it is important to be aware of this association.- - - - - - - - - - ranking = 26.399628947937keywords = thrombocytopenic, purpura (Clic here for more details about this article) |
3/27. Thrombotic thrombocytopenic purpura associated with clopidogrel administration: case report and brief review.Clopidogrel has replaced ticlopidine (in the united states but not worldwide). Clopidogrel can either be used independently or in combination with other antiplatelet agents. Clopidogrel has a lower frequency of associated thrombotic thrombocytopenic purpura than ticlopidine, a lower rate of neutropenia, and better gastrointestinal tolerance. We describe a case of thrombotic thrombocytopenic purpura associated with the use of clopidogrel after percutaneous transluminal angioplasty and stent placement. Discontinuation of the drug and transfusion of 17 units of cryodepleted plasma resulted in resolution of the hematological abnormalities. Clinicians should be alert to this adverse effect of clopidogrel and monitor platelet counts in patients receiving it.- - - - - - - - - - ranking = 31.679554737524keywords = thrombocytopenic, purpura (Clic here for more details about this article) |
4/27. Management of a patient with hiv infection-induced anemia and thrombocytopenia who presented with thrombotic thrombocytopenic purpura.A 32-year-old male presented with fever, mental status changes, renal dysfunction, cytopenias and hemolysis. His platelet count was 14,000/microL, hemoglobin 5.7 g/dL and LDH 2,636 U/L. He was diagnosed with thrombotic thrombocytopenic purpura (TTP) and also found to be hiv positive on admission. TTP was confirmed by a low von willebrand factor-cleaving protease level, the gold standard test for TTP, which was 10-15%. No protease-specific antibody was detected. Treatment of this patient consisted of 23 plasmapheresis procedures and trials of vincristine and dextran-70. Despite therapy, the patient remained anemic and thrombocytopenic, though his mental status and renal abnormalities improved. Highly active anti-retroviral therapy (HAART) consisting of efavirenz, 3TC, and d4T was started. Only after plasma exchanges were discontinued and HAART was instituted did the cytopenias resolve. He continued to improve following discharge, and platelet count was 206,000/microL and hemoglobin, 12.5 g/dL one month after the initiation of HAART.- - - - - - - - - - ranking = 30.679554737524keywords = thrombocytopenic, purpura (Clic here for more details about this article) |
5/27. thrombocytopenia and altered mental status in an hiv-positive woman.We present a case of thrombotic thrombocytopenic purpura (TTP) in a human immunodeficiency virus (hiv)-positive woman with altered mental status. Altered mental status with thrombocytopenia may be due to many causes, including consumptive coagulopathy, systemic lupus erythematosis, infection, and as side effects of commonly used anti-seizure medications. Of these, platelet transfusion is ineffective or specifically contraindicated in the consumptive coagulopathies, including TTP. TTP should be considered in all patients with altered mental status or neurologic dysfunction, thrombocytopenia, and hemolytic anemia to prevent morbidity and mortality.- - - - - - - - - - ranking = 5.2799257895874keywords = thrombocytopenic, purpura (Clic here for more details about this article) |
6/27. Reversible posterior leukoencephalopathy in an hiv-infected patient with thrombotic thrombocytopenic purpura.We describe a 37-y-old male with advanced hiv disease who was diagnosed with thrombotic thrombocytopenic purpura after MRI of the brain revealed reversible posterior leukoencephalopathy. We discuss reversible posterior leukoencephalopathy as a diagnostic clue in hiv-infected patients with multi-organ system disease.- - - - - - - - - - ranking = 26.399628947937keywords = thrombocytopenic, purpura (Clic here for more details about this article) |
7/27. Thrombotic thrombocytopenic purpura and human immunodeficiency virus complicating pregnancy.BACKGROUND: Thrombotic thrombocytopenic purpura is a rare but serious medical complication, but is relatively common among patients with human immunodeficiency virus (hiv) infection. It is characterized by the pentad of thrombocytopenia, microangiopathic hemolytic anemia, neurological symptoms, fever, and renal abnormalities. However, the pentad is often incomplete, especially in hiv-positive patients. CASE: An hiv-positive patient complained of easy bruising, hematuria, fever, myalgias, and headache during the second trimester of pregnancy. Laboratory testing revealed hemolytic anemia and severe thrombocytopenia. bone marrow biopsy was consistent with thrombocytopenic purpura. The patient recovered after plasmapheresis. At 36 weeks' gestation, she was delivered for preeclampsia and fetal growth restriction. CONCLUSION: Absence of the classic pentad seen in thrombocytopenic purpura among pregnant hiv-positive patients may make the diagnosis of thrombocytopenic purpura challenging. Frequent monitoring of patients with thrombotic thrombocytopenic purpura for signs and symptoms of preeclampsia and fetal growth assessment is suggested.- - - - - - - - - - ranking = 47.519332106287keywords = thrombocytopenic, purpura (Clic here for more details about this article) |
8/27. Thrombotic thrombocytopenic purpura: a rare cause of thrombocytopenia in hiv-infected hemophiliacs.thrombocytopenia is a common complication in human immunodeficiency virus (hiv)-infected hemophiliacs. The etiology is multifactorial and a majority of the patients with hemophilia exhibit a decreased platelet count within 10 years of seroconversion. thrombocytopenia in these patients is associated with a high risk of bleeding and death. Thrombotic microangiopathy causing thrombocytopenia in hiv-infected hemophiliacs is extremely rare. We describe an hiv-infected hemophilic patient who presented with bleeding, renal insufficiency, and thrombocytopenia. platelet transfusion resulted in deterioration of clinical condition. Examination of blood smears demonstrated a microangiopathic process. The patient responded well to plasmapheresis with normalization of platelet and renal function. Thrombotic thrombocytopenic purpura should be suspected in hiv-infected hemophiliacs who present with a new onset of thrombocytopenia and anemia as delay in treatment may result in fatal sequelae.- - - - - - - - - - ranking = 26.399628947937keywords = thrombocytopenic, purpura (Clic here for more details about this article) |
9/27. Acute human immunodeficiency virus syndrome in an adolescent.Acute human immunodeficiency virus (hiv) seroconversion illness is a difficult diagnosis to make because of its nonspecific and protean manifestations. We present such a case in an adolescent. A 15-year-old boy presented with a 5-day history of fever, sore throat, vomiting, and diarrhea. The patient also reported a nonproductive cough, coryza, and fatigue. The patient's only risk factor for hiv infection was a history of unprotected intercourse with 5 girls. physical examination was significant for fever, exudative tonsillopharyngitis, shotty cervical lymphadenopathy, and palpable purpura on both feet. Laboratory studies demonstrated lymphopenia and mild thrombocytopenia. Hemoglobin, serum creatinine, and urinalysis were normal. The following day, the patient remained febrile. physical examination revealed oral ulcerations, conjunctivitis, and erythematous papules on the thorax; the purpura was unchanged. Serologies for hepatitis b, syphilis, hiv, and Epstein-Barr virus were negative. Bacterial cultures of blood and stool and viral cultures of throat and conjunctiva showed no pathogens. Coagulation profile and liver enzymes were normal. Within 1 week, all symptoms had resolved. The platelet count normalized. Repeat hiv serology was positive, as was hiv dna polymerase chain reaction. Subsequent hiv viral load was 350 000, and the cd4 lymphocyte count was 351/mm3. hiv is the seventh leading cause of death among people aged 15 to 24 in the united states, and up to half of all new infections occur in adolescents. Our patient presented with many of the typical signs and symptoms of acute hiv infection: fever, fatigue, rash, pharyngitis, lymphadenopathy, oral ulcers, emesis, and diarrhea. Other symptoms commonly reported include headache, myalgias, arthralgias, aseptic meningitis, peripheral neuropathy, thrush, weight loss, night sweats, and genital ulcers. Common seroconversion laboratory findings include leukopenia, thrombocytopenia, and elevated transaminases. The suspicion of acute hiv illness should prompt virologic and serologic analysis. Initial serology is usually negative. Diagnosis therefore depends on direct detection of the virus, by assay of viral load (hiv rna), dna polymerase chain reaction, or p24 antigen. Both false-positive and false-negative results for these tests have been reported, further complicating early diagnosis. Pediatricians should play an active role in identifying hiv-infected patients. Our case, the first report of acute hiv illness in an adolescent, emphasizes that clinicians should consider acute hiv seroconversion in the appropriate setting. Recognition of acute hiv syndrome is especially important for improving prognosis and limiting transmission. It is imperative that we maintain a high index of suspicion as primary care physicians for adolescents who present with a viral syndrome and appropriate risk factors.- - - - - - - - - - ranking = 2keywords = purpura (Clic here for more details about this article) |
10/27. Thrombotic thrombocytopenic purpura associated with abacavir in a patient with hiv infection.A 45-year-old woman with hiv infection presented with thrombotic microangiopathy 1 week after initiating therapy with the nucleoside analogue abacavir. She was successfully treated with plasmapheresis and corticosteroids.- - - - - - - - - - ranking = 21.11970315835keywords = thrombocytopenic, purpura (Clic here for more details about this article) |
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