| We describe the case of an hiv-perinatally exposed child who was treated with zidovudine prophylaxis for reduction of perinatal transmission. At 4 weeks of age, he developed severe paronychia of the great toes as a result of candida albicans and escherichia coli. At that time, laboratory tests showed anemia and neutropenia. zidovudine-related hematologic toxicity resolved after completion of the prophylactic regimen and the infant became hiv-antibody negative (seroreverter) at 8 months of age. paronychia resolved after treatment with oral fluconazole and topical antiseptics but the soft tissue of the nailfold was penetrated by the edge of the nail plate, resulting in the formation of a cutaneous bridge over the nail that resolved by spontaneous necrosis. To our knowledge, this rare complication has not previously been described in an hiv-perinatally exposed child treated with zidovudine. ( info) |
| Haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are thrombotic microangiopathies increasingly reported in patients with hiv infection. However, characteristic features of thrombotic microangiopathies associated with hiv disease have not been defined yet. The typical courses of HUS and TTP in two patients are presented. The data as well as the analysis of cases published in the literature demonstrate the association of thrombotic microangiopathies with late-stage hiv disease. Moreover, differences between HUS and TTP can be detected. patients with HUS present with more severe immunologic deterioration. Although clinical symptoms are fewer, HUS implicates a very poor prognosis. life expectancy rarely exceeded 1 year after diagnosis. HUS and TTP should therefore be added to the international AIDS classification. ( info) |
| The syndrome of inflammatory subacute lumbosacral polyradiculoneuropathy (SLP) has been reported in acquired immunodeficiency syndrome (AIDS) patients in association with cytomegalovirus infection and is only partially amenable to anti-viral therapy. We report three cases of relatively benign inflammatory painful SLP in two non-AIDS, immunosuppressed patients and one who hiv-seroconversed at the time of clinical presentation. SLP developed: (1) in association with hiv seroconversion; (2) during ECHO virus infection in a patient with common variable immune deficiency; and (3) after a severe systemic infection that induced transient immunosuppression due to Epstein-Barr virus reactivation. This report expands the spectrum of viruses associated with acute and subacute lumbosacral polyradiculoneuropathy and may shed light on its possible pathogenesis. ( info) |
4/867. breast cancer and hiv: what do we know? The present acquired human immunodeficiency syndrome-defining neoplasms are Kaposi's sarcoma, non-Hodgkins lymphoma, and cervical cancer. However, other malignancies have recently been associated with human immunodeficiency virus (hiv) infection. Is there also a link between breast cancer and hiv infection? breast cancer seems to be more aggressive in the setting of immunocompromise by hiv infection, as demonstrated by the clinical course of two patients recently treated at this institution and review of the available literature. As the acquired human immunodeficiency syndrome epidemic affects increasing numbers of women and survival improves, surgeons will be frequently called on to diagnose and treat breast cancer in the hiv patient. ( info) |
5/867. Potential complication associated with removal of ganciclovir implants. PURPOSE: To describe the complication of separation of the medication pellet from the tab during the removal of a ganciclovir implant. METHOD: case reports. RESULTS: Separation of the pellet from the tab upon removal of ganciclovir implants occurred at the time of reimplantation in two human immunodeficiency virus (hiv)-positive patients with cytomegalovirus (CMV) retinitis. CONCLUSIONS: Our cases show the possibility of pellet separation from the tab during the removal of a ganciclovir implant. Although pellet separation from its tab is rare, surgeons should be aware of this potential complication. Modifying recommended techniques to remove the ganciclovir implant may reduce the incidence of pellet-tab separation. ( info) |
| OBJECTIVE--treatment of hiv-related vasculitis, avoiding prolonged immunosuppressive therapy. DESIGN--prospective pilot study of hiv-related neurological vasculitis. patients--two hiv-infected patients with histologically proven vasculitis. INTERVENTION--short-term corticosteroid followed by zidovudine combined with plasmapheresis. MAIN OUTCOME MEASURES--clinical, biological, immunological and electromyographic evaluation. RESULTS--complete neurological recovery. CONCLUSION--excellent tolerance and efficacy of combined zidovudine and plasmapheresis therapy in peripheral neurological hiv-related vasculitis. ( info) |
7/867. Protease inhibitor-induced lipodystrophy. The development of lipodystrophy as evidenced by central obesity, "moon facies," and a "buffalo hump" is a classical feature of Cushing's disease. Recently an association of "lipodystrophy" with the use of protease inhibitors has been reported. We describe a patient with lipodystrophy secondary to protease inhibitor therapy for hiv infection. ( info) |
8/867. 'Naive' and 'memory' CD4 T-cells and T-cell receptor (TCR) V beta repertoire dynamics are independent of the levels of viremia following hiv seroconversion. The progression of 'naive' and 'memory' T-cells and the T-cell receptor Vbeta (TCR Vbeta) repertoire dynamics within the peripheral CD4 T-cell compartment were studied in individuals following hiv seroconversion. Profound TCR Vbeta repertoire perturbations were observed within the CD4 T-cell pool in treatment-naive patients regardless of their levels of viremia during the first 6-8 months after seroconversion. The ratio of 'naive' to 'memory' CD4 T-cells as well as the TCR Vbeta repertoire dynamics did not appear to correlate with absolute numbers of CD4 T-cells. ( info) |
9/867. Gastro-intestinal Kaposi's sarcoma, with special reference to the appendix. Kaposi's sarcoma (KS) of the gastro-intestinal tract is a common disease in the AIDS setting, although it is often asymptomatic. In this paper we wish to highlight the occurrence of gastro-intestinal KS with appendiceal involvement. Two of the patients presented with features of acute appendicitis, and KS of the appendix was not suspected at the time of surgery. In the remaining patient KS of the appendix was part of generalised gastro-intestinal involvement. It is important to remember that KS can cause appendicitis by producing a submucosal nodule that abuts into the lumen and thereby causes obstruction. KS of the gastro-intestinal tract may therefore masquerade as 'simple' appendicitis, or indeed remain asymptomatic. ( info) |
10/867. Successful use of levonorgestrel intrauterine system in a hiv positive woman. After trying other contraceptive methods a woman with hiv disease found use of the levonorgestrel intrauterine system (IUS) very satisfactory, and benefited from the amenorrhoea it induced. She continued to use condoms. Other advantages of using the IUS were freedom from regular clinic visits, no need for daily pill taking, and absence of drug interactions. ( info) |