1/8. autopsy case of alcoholic hepatitis and cirrhosis treated with corticosteroids and affected by pneumocystis carinii and cytomegalovirus pneumonia.A case of the very early phase of pneumocystis carinii pneumonia in a human immunodeficiency virus (hiv)-negative man with alcoholic hepatitis and cirrhosis treated with steroids is presented. A 40-year-old man with a 10-year history of alcohol abuse was admitted to hospital with jaundice, fever and macrohematuria. Laboratory examinations revealed neutrophilic leukocytosis and a serum bilirubin level of 13.9 mg/dL. The serum bilirubin level rose to 28.5 mg/dL over 1 month. prednisolone administered orally for 10 days produced a slight improvement in the jaundice and fever. After an interval of a week, it was resumed and maintained for 22 days (total dose, 1555 mg) until the patient died of a massive hemorrhage from ruptured vessels of a gastric ulcer. An autopsy disclosed P. carinii pneumonia in the lower lobe of the left lung, cytomegalovirus infection in both lungs and the esophagus, and esophageal candidiasis. To our knowledge, this is the first report of P. carinii pneumonia together with cytomegalovirus infection in an hiv-negative alcoholic patient. The present case suggests that a rare opportunistic infection such as P. carinii pneumonia might be caused by treating cirrhosis and alcoholic hepatitis with corticosteroids, even if only for a relatively short period.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
2/8. pneumocystis carinii infection in bilateral aural polyps in a human immunodeficiency virus-positive patient.pneumocystis carinii is an opportunistic infection found in patients with impaired immunity. Under favourable conditions the parasite can spread via the blood stream or lymphatic vessels and cause extrapulmonary dissemination. We report a case of P carinii infection presenting as bilateral aural polyps, otitis media and mastoiditis in human immunodeficiency (hiv)-positive patient with no history of prior or concomitant P carinii infection.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
3/8. pneumocystis carinii and mycobacterium avium-intracellulare infection of the choroid.It has been hypothesized that coinfection with mycobacteria occurs in patients with pneumocystis carinii choroiditis, but cases demonstrating ocular infection by both organisms have not been reported. This study reports the case of a patient with P. carinii choroiditis who was treated with intravenous trimethoprim and sulfamethoxazole, followed by intravenous trimethoprim and dapsone. The choroidal lesions failed to resolve despite 6 weeks of treatment, and the patient died from massive pulmonary infection caused by P. carinii, Mycobacterium avium-intracellulare, and cytomegalovirus infections. Ocular histologic and electron microscopic examinations revealed choroidal infection by both P. carinii and M. avium-intracellulare. serum levels of sulfamethoxazole were below the recommended therapeutic range for treating P. carinii infection during the first week of therapy, but adequate drug levels were subsequently obtained. Failure of choroidal lesions of P. carinii to resolve in some cases may suggest insufficient antimicrobial levels in the blood or raise the possibility of coexistent M. avium-intracellulare or other opportunistic infection.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
4/8. pneumocystis carinii peritonitis. Antemortem confirmation of disseminated pneumocystosis by cytologic examination of body fluids.Histologic confirmation of extrapulmonary pneumocystis carinii infection in the acquired immunodeficiency syndrome has usually required organ biopsy when the diagnosis was made antemortem. Three cases of Pneumocystis peritonitis were studied in which confirmation of extrapulmonary dissemination was achieved by cytologic examination of ascitic fluid. patients presented with characteristic choroidal lesions, transudative ascites, profound hypoalbuminemia, and hepatic dysfunction. Cytologic examination of ascitic fluid confirmed extrapulmonary dissemination of pneumocystis. All three patients died despite a minimum of 2 weeks of standard therapy. Cytologic examination of body fluids to confirm dissemination of Pneumocystis may obviate the need for organ biopsy. Disseminated pneumocystosis should be included in the differential diagnosis of ascites or peritonitis in a patient at risk for human immunodeficiency virus--associated opportunistic infections. The presence of transudative ascites may be characteristic of this syndrome.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
5/8. Disseminated pneumocystosis without pulmonary involvement during prophylactic aerosolized pentamidine therapy in a patient with the acquired immunodeficiency syndrome.Pneumocystosis, the most common opportunistic infection associated with the acquired immunodeficiency syndrome, is usually restricted to the lungs and results in severe bilateral pneumonia, which is fatal unless vigorously treated. Rare cases have been reported in which involvement of other organs or disseminated disease occurred in addition to the pulmonary lesions. pentamidine, an efficient drug used intravenously for the treatment of pulmonary pneumocystosis, has also recently been used in aerosolized form for the prevention of Pneumocystis infection in patients with the acquired immunodeficiency syndrome. In the present case, widely disseminated, though symptomless, pneumocystosis developed in a human immunodeficiency virus-positive individual treated prophylactically with aerosolized pentamidine. Despite heavy multiorgan infection with pneumocystis carinii, the lungs revealed no microorganisms or characteristic inflammatory lesions. This case indicates that aerosolized pentamidine, while efficient against the pulmonary infection, may not produce fungicidal blood levels sufficient for the prevention of disseminated pneumocystosis.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
6/8. Perforation of the small intestine in a patient with disseminated pneumocystis carinii infection in AIDS.Perforation of the small intestine due to a segmental transmural pneumocystis carinii infiltrate of the whole circumference was found in a surgical resection specimen as the cause of an acute abdomen in a 48-year-old heterosexual male patient suffering from acquired immunodeficiency syndrome. On autopsy, a disseminated pneumocystis carinii infection was found involving spleen, thyroid gland and lymph nodes. The origin of this disseminated infection was a recurrent and severe pneumocystis carinii pneumonia, which was first diagnosed two years before death and was treated with success. The hitherto unknown complication of an extrapulmonary pneumocystis carinii infection described here extends the spectrum of lethal complications of opportunistic infections in acquired immunodeficiency syndrome.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
7/8. skin involvement with Pneumocystis despite dapsone prophylaxis: a rare cause of skin nodules in a patient with AIDS.pneumocystis carinii pneumonia is among the most common life-threatening opportunistic infections that occurs in those with hiv infection and a depleted absolute CD4 T-lymphocyte count. Fortunately, with the advent of effective prophylaxis, this AIDS-defining complication is diminishing. Rarely, pneumocystis carinii (P carinii) occurs outside the lungs, typically in the setting of prophylaxis with aerosolized pentamidine or no prophylaxis at all. This is the case of a man with advanced AIDS and bilateral hyperpigmented axillary nodules secondary to cutaneous pneumocystosis. Unlike most other examples of extrapulmonary P carinii, dissemination occurred without documented pulmonary infection and despite prophylaxis with high-dose dapsone. A biopsy should be performed on unusual cutaneous lesions in the setting of advanced AIDS because unexpected findings may have important therapeutic implications.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
8/8. pneumocystis carinii infection of the small intestine.Extrapulmonary pneumocystis carinii infections are rare in comparison to other opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS). In recent years, however, the number of reported cases of extrapulmonary pneumocystosis has increased. It is therefore important for physicians to recognize the various presentations of extrapulmonary P carinii infection. This article reports a case in which the initial clinically detected AIDS-related infection was extrapulmonary P carinii infection of the small intestine diagnosed after perforation of the jejunum.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |