1/75. Severe anal ulceration secondary to histoplasma capsulatum in a patient with hiv disease.Severe fungal infections have become increasingly common in the immunocompromised patient, including those infected with human immunodeficiency virus. histoplasma capsulatum occurs in about five per cent of acquired immunodeficiency syndrome patients in the endemic areas of the mississippi and ohio River Valley. Immunocompromised patients who present with severe ulceration and suppuration of the anus require exam under anesthesia and thorough laboratory evaluation for opportunistic infections. Thus, surgeons play a critical role in diagnosis and initiation of treatment. A case of infiltrating H. capsulatum of the anus is presented, including the natural history, presentation, diagnosis, and treatment.- - - - - - - - - - ranking = 1keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
2/75. Disseminated histoplasmosis presenting as bilateral adrenal masses.histoplasma capsulatum is a universal dimorphic fungus found mainly in soil contaminated with excrement of birds and bats. Bilateral adrenal masses with massive tissue destruction are a rare primary presentation of disseminated histoplasmosis. As it behaves as an opportunistic pathogen there is a higher susceptibility for dissemination on those patients with immunodeficiency or immunosuppression. We report a case in an elderly diabetic patient with bilateral adrenal enlargement, diagnosed as histoplasmosis only after surgical exploration, with symptoms probably occurring at least 60 years after the original infection. She was successfully treated with itraconazole.- - - - - - - - - - ranking = 0.10447046155077keywords = immunodeficiency (Clic here for more details about this article) |
3/75. Fine-needle aspiration of cytomegalovirus sialadenitis in a patient with acquired immunodeficiency syndrome: pitfalls of diff-quik staining.A case of cytomegalovirus (CMV) sialadenitis in a patient with acquired immunodeficiency syndrome (AIDS) diagnosed by fine-needle aspiration biopsy (FNAB) is reported. Although a diagnosis of CMV sialadenitis can be established on Diff-Quik-stained slides, the characteristic viral changes are the best appreciated on slides stained by the Papanicolaou (Pap) technique. Differential pitfalls are discussed. It needs to be stressed that clinically unsuspected diagnosis of CMV infection may uncover congenital or acquired defects of cellular immunity, and particularly AIDS. Diagn. Cytopathol. 2000;22:101-103.- - - - - - - - - - ranking = 4.4776476922462keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
4/75. Acute delirium induced by intravenous trimethoprim-sulfamethoxazole therapy in a patient with the acquired immunodeficiency syndrome.The development of a rash in response to trimethoprim-sulfamethoxazole (TMP-SMX) administration is a frequent adverse reaction in people with the acquired immunodeficiency syndrome (AIDS). In contrast, there are no published reports in the English language literature describing TMP-SMX induced delirium in an AIDS patient. This report describes the development of frank delirium in a person with AIDS receiving TMP-SMX. The episode resolved completely within 72 h of withdrawal of the drug.- - - - - - - - - - ranking = 4.4776476922462keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
5/75. histoplasmosis capsulatum as a cause of lower gastrointestinal bleeding in common variable immunodeficiency.Infection with histoplasma capsulatum is the most common systemic fungal infection in the united states, but symptomatic gastrointestinal disease is rare. Gastrointestinal involvement is seen in patients with an established immunosuppressed state that predates any infection. We report a patient presenting with gastrointestinal bleeding ultimately diagnosed with disseminated histoplasmosis. work-up led to the diagnosis of common variable immunodeficiency, a diagnosis not previously described as associated with gastrointestinal histoplasmosis. Resolution of the colonic ulcer was documented after appropriate antifungal therapy, underscoring the importance of including this infectious process in the differential of a patient without other risk factors for colonic ulceration.- - - - - - - - - - ranking = 0.52235230775384keywords = immunodeficiency (Clic here for more details about this article) |
6/75. Disseminated histoplasmosis presenting as pyoderma gangrenosum-like lesions in a patient with acquired immunodeficiency syndrome.A 33-year-old Hispanic woman with newly diagnosed human immunodeficiency virus (hiv) infection, a CD4 T-lymphocyte count of 2, viral load of 730,000 copies/mL, candidal esophagitis, seizure disorder, a history of bacterial pneumonia, and recent weight loss was admitted with tonic clonic seizure. On admission, her vital signs were: pulse of 88, respiration rate of 18, temperature of 37.7 degrees C, and blood pressure of 126/76. Her only medication was phenytoin. On examination, the patient was found to have multiple umbilicated papules on her face, as well as painful, erythematous, large, punched-out ulcers on the nose, face, trunk, and extremities of 3 months' duration (Fig. 1). The borders of the ulcers were irregular, raised, boggy, and undermined, while the base contained hemorrhagic exudate partially covered with necrotic eschar. The largest ulcer on the left mandible was 4 cm in diameter. The oral cavity was clear. Because of her subtherapeutic phenytoin level, the medication dose was adjusted, and she was empirically treated with Unasyn for presumptive bacterial infection. Chest radiograph and head computed tomography (CT) scan were within normal limits. sputum for acid-fast bacilli (AFB) smear was negative. Serologic studies, including histoplasma antibodies, toxoplasmosis immunoglobulin m (IgM), rapid plasma reagin (RPR), hepatitis c virus (HCV), and hepatitis b virus (HBV) antibodies were all negative. Examination of the cerebrospinal fluid was within normal limits without the presence of cryptococcal antigen. Blood and cerebrospinal cultures for bacteria, mycobacteria, and fungi were all negative. Viral culture from one of the lesions was also negative. The analysis of her complete blood count showed: white blood count, 2300/microl; hemoglobin, 8.5 g/dL; hematocrit, 25.7%; and platelets, 114,000/microl. Two days after admission, the dermatology service was asked to evaluate the patient. Although the umbilicated papules on the patient's face resembled lesions of molluscum contagiosum, other infectious processes considered in the differential diagnosis included histoplasmosis, cryptococcosis, and penicillium marnefei. In addition, the morphology of the ulcers, particularly that on the left mandible, resembled lesions of pyoderma gangrenosum. A skin biopsy was performed on an ulcer on the chest. Histopathologic examination revealed granulomatous dermatitis with multiple budding yeast forms, predominantly within histiocytes, with few organisms residing extracellularly. methenamine silver stain confirmed the presence of 2-4 microm fungal spores suggestive of histoplasma capsulatum (Fig. 2). Because of the patient's deteriorating condition, intravenous amphotericin b was initiated after tissue culture was obtained. Within the first week of treatment, the skin lesions started to resolve. histoplasma capsulatum was later isolated by culture, confirming the diagnosis. The patient was continued on amphotericin b for a total of 10 weeks, and was started on lamivudine, stavudine, and nelfinavir for her hiv infection during hospitalization. After amphotericin b therapy, the patient was placed on life-long suppressive therapy with itraconazole. Follow-up at 9 months after the initial presentation revealed no evidence of relapse of histoplasmosis.- - - - - - - - - - ranking = 3.6865886153477keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
7/75. histoplasma capsulatum var. capsulatum occurring in an hiv-positive Ghanaian immigrant to italy. Identification of H. capsulatum dna by PCR from paraffin sample.histoplasmosis, which is highly endemic in the united states, is rare in europe, usually imported but sometimes autochthonous. In africa, histoplasmosis capsulati coexists with "African histoplasmosis", a characteristic skin infection caused by H. capsulatum var. duboisii. Histoplamosis due to H. capsulatum is one of the 12 secondary infections listed in the surveillance definitions of AIDS. We report the case of a 36-year-old black man with acquired immunodeficiency syndrome (AIDS) who was living in italy but originally came from ghana. histoplasmosis was disseminated with fever and cutaneous manifestations. The diagnosis was demonstrated morphologically based on the presence of yeast, observed by light microscopy, in skin lesions and by identification of H. capsulatum var. capsulatum dna by nested PCR from a paraffin sample. No clinical reports of histoplamosis capsulati in ghana have been published until now. The present case stresses the role of immigration of subjects from outside europe who have been infected in their native country.- - - - - - - - - - ranking = 0.89552953844923keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
8/75. Colonic histoplasmosis in acquired immunodeficiency syndrome mimicking carcinoma.Four cases of colonic histoplasmosis in patients with acquired immunodeficiency syndrome mimicking other diseases, primarily colonic adenocarcinoma, are presented. This topic has been extensively discussed from the medical and radiologic standpoint, but very few publications are found in the pathology literature. Emphasis is made on the discussion of the clinical manifestations; endoscopic, radiologic, and pathologic characteristics; differential diagnosis; and treatment.- - - - - - - - - - ranking = 4.4776476922462keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
9/75. Diffuse ulcerations due to disseminated histoplasmosis in a patient with hiv.Disseminated histoplasmosis is a serious disease that affects the skin, lungs, and internal organs. It is one of the diseases that characterize acquired immunodeficiency syndrome (AIDS), and in endemic areas is one of the more commonly observed infections in AIDS patients. The mortality rate in patients with AIDS and histoplasmosis is high if untreated. Disseminated histoplasmosis may have a variety of dermatological manifestations. In this article, we provide the first report of diffuse ulcerations due to disseminated histoplasmosis. These ulcers developed while the patient was on stavudine, lamivudine, and indinavir, and had a CD-4 count of 525 mm3. The patient's histoplasmosis resolved with itraconazole monotherapy. histoplasmosis is a well-described opportunistic infection that accompanies human-immunodeficiency virus (hiv) infection. We report an unlikely victim of disseminated histoplasmosis who suffered this infection while on antiretroviral therapy and with a CD-4 count of 525/mm3. Notably, he had a normal chest x-ray and disseminated cutaneous ulcers. The diagnosis was made by skin biopsy, and his infection responded promptly to itraconazole therapy. This case serves as a reminder that the immunological derangements and cutaneous alterations wrought by hiv remain unpredictable in nature and extent.- - - - - - - - - - ranking = 1keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
10/75. US experience with itraconazole in aspergillus, cryptococcus and histoplasma infections in the immunocompromised host.itraconazole has emerged as an important new oral agent in the treatment of systemic fungal infections. This paper summarizes the data available on its use in aspergillosis, cryptococcosis and histoplasmosis, compiled in the united states with particular attention to the immunocompromised host. Data have been accrued in open-label studies including 57 patients with cryptococcal disease where the overall response rate among patients with meningitis was 86%, and in 28 patients (8 with acquired immune deficiency syndrome (AIDS) or human immunodeficiency virus (hiv) infection) with invasive aspergillosis where the overall response rates were 80% in patients without AIDS and 86% in patients with AIDS. Data are summarized on 6 patients with allergic bronchopulmonary aspergillosis, 5 of whom demonstrated marked improvement on therapy, and 12 patients with histoplasmosis including 8 with AIDS, 11 of whom responded and 1 recrudesced on therapy. In summary, itraconazole showed activity in human studies of aspergillosis, cryptococcosis and histoplasmosis with minimal toxicity. itraconazole offers a new oral alternative to conventional amphotericin b therapy in these infections. Comparative studies are needed to clarify its role.- - - - - - - - - - ranking = 0.10447046155077keywords = immunodeficiency (Clic here for more details about this article) |
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