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1/170. Adipsic hypernatremia in two patients with AIDS and cytomegalovirus encephalitis.

    In patients with acquired immune deficiency syndrome (AIDS), hypoosmolality is frequently observed, whereas hypernatremia is distinctly rare. We report two patients with advanced AIDS and cytomegalovirus (CMV) encephalitis, who developed severe hypernatremia without any thirst sensation, that is, adipsic hypernatremia. Both developed severe hypernatremia of up to 164 and 162 mmol/L, with serum osmolalities of 358 and 344 mOsmol/kg while remaining alert and denying thirst. serum antidiuretic hormone (ADH) levels were 0.9 and 1.5 pg/mL, inappropriately low for the concomitant serum osmolalities. vital signs were stable. During hypernatremia, urine osmolalities were 327 and 340 mOsmol/kg, and urine Na levels were 56 and 119 mmol/L, respectively. Periventricular white matter lesions were seen on cerebral nuclear magnetic resonance imaging (NMRI) in case 1, but the pituitary appeared normal in both cases. survival after onset of hypernatremia was 6 and 4 weeks, respectively. autopsy in case 1 showed typical findings of CMV encephalitis but normal pituitary, confirming that infection with hiv or CMV most likely caused the dysfunction of the central osmostat.
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ranking = 1
keywords = encephalitis
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2/170. Simultaneous treatment of cytomegalovirus and varicella zoster infections in a renal transplant recipient with ganciclovir: use of viral load to monitor response to treatment.

    Disseminated zoster occurring simultaneously with cytomegalovirus (CMV) disease in a renal transplant recipient is potentially life threatening. We describe the use of intravenous ganciclovir to treat both infections. The efficacy of treatment was assessed clinically and by the measurement of CMV viral load using the hybrid capture (Murex version 2) and varicella zoster (VZV) viral load using an in-house assay. Results from this case suggest that clinical resolution in severe viral infections such as described below may be related to early control of viraemia.
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ranking = 0.077427099761469
keywords = varicella zoster, varicella, zoster
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3/170. cytomegalovirus-induced syringosquamous metaplasia.

    An unusual case of syringosquamous metaplasia of the eccrine ducts caused by cytomegalovirus (CMV) is presented. The patient was hiv positive and had extensive excoriation of the perineum and vulva. biopsy revealed the presence of herpes simplex virus (HSV) inclusions in the necrotic exudate, a CMV vasculitis and extensive involvement of the eccrine ducts. In addition to containing typical CMV inclusions, the eccrine ducts showed proliferation and squamous metaplasia. Inclusions of HSV were not seen within the eccrine ducts by light microscopy or immunohistochemistry. The extensive proliferation with accompanying squamous metaplasia superficially can resemble an infiltrating squamous carcinoma, but this was not evident to a great extent in this case. To the best of our knowledge, our case represents the first of syringosquamous metaplasia of eccrine ducts caused by CMV infection.
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ranking = 0.0047588518537457
keywords = herpes
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4/170. Vasculitis-induced membranous fat necrosis.

    Membranous fat necrosis (MFN) a distinct degenerative process of adipose tissue, is characterised by the presence of membranocystic lesions (MCLs) superimposed on a background of typical traumatic-type fat necrosis. MCLs are cysts, of varying size and shape, that are lined by an eosinophilic, crenulated membrane, having the staining properties of ceroid. Although MFN has been documented in varying systemic adipose tissue sites and in tumours, the pathogenesis of this pathological curiosity is unknown. To date, an ischemic basis for MFN has been the most proximate, and atherosclerosis and venous insufficiency, due to large and medium vessel disease, have been the most popular underlying clinical disorders. Although systemic vasculitis has been quoted as the underlying ischemic disorder in some patients, vasculitis has not been commented on nor demonstrated in tissue sections in association with MFN. In,reporting vasculitis-induced MFN, we document the occurrence of MFN in association with uncommon causes of vasculitis, namely: 1) Granulomatous vasculitis in a post-herpetic zosteriform scar; 2) cytomegalovirus-induced vasculitis in the clinical setting of systemic lupus erythematosus; and 3) Lymphocytic vasculitis in a tetanus toxoid immunization site reaction.
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ranking = 0.0018440742486558
keywords = zoster
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5/170. cytomegalovirus encephalitis: diagnosis with clinical approach, EEG and PCR techniques.

    cytomegalovirus (CMV) encephalitis is particularly evident in immunodepressed patients. Often diagnosis is difficult and time-consuming because of the complex basic clinical picture of these patients. We describe the diagnostic steps taken in a case of cytomegalovirus encephalitis affecting an elderly patient, classified as immunodepressed and deceased on the thirty-fifth day of hospitalisation in the intensive care unit due to acute myocardial infarction. Treatment with ganciclovir, 30 mg/kg per day, begun at the time of diagnosis, appears to have had a positive effect on the neurologic symptoms.
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ranking = 1
keywords = encephalitis
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6/170. Fatal herpesvirus-6 encephalitis in a recipient of a T-cell-depleted peripheral blood stem cell transplant from a 3-loci mismatched related donor.

    Human herpesvirus-6 (HHV-6), like all the other herpes viruses, remains latent in host cells after primary infection but can be reactivated in immunocompromised patients causing fever, skin rash, bone marrow (BM) suppression, pneumonitis, sinusitis and meningoencephalitis. We describe the case of a man with chronic myelogenous leukemia who developed encephalitis associated with acute graft-versus-host disease two months after a T-cell-depleted mismatched peripheral blood stem cell transplant. Magnetic resonance images of the brain revealed multiple bilateral foci of signal abnormality. HHV-6 was the only pathogen detected in cerebrospinal fluid by PCR. Treatment with both ganciclovir and foscarnet was unsuccessful and the patient gradually deteriorated and died. Other cases of HHV-6 encephalitis after bone marrow transplantation are reviewed.
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ranking = 1.2480258177642
keywords = encephalitis, herpesvirus, herpes, meningoencephalitis
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7/170. Synchronous herpes simplex virus and cytomegalovirus esophagitis.

    Infective esophagitis is a rare disease, affecting mostly immunocompromised patients. Very few cases of a multiple viral infection have been reported. We present a case of combined cytomegalovirus (CMV) and herpes simplex virus (HSV) esophagitis in an 81-year-old female with extracapillary sclerosing glomerulonephritis treated for five months with steroids and chemotherapy. She died of septic shock. At autopsy, erosive and ulcerative esophagitis was found in the distal half of the esophagus. Slides were stained by HE, and the immunohistochemical avidin-biotin method was used to detect HSV and CMV infection. On histological examination of the esophagus, epithelial giant cells with intranuclear viral inclusions showing HSV immunopositivity were found at the margin of the ulcerations. giant cells with intranuclear inclusions with CMV immunopositivity were also found in the mesenchymal cells obtained from the ulcer bed. Long-term immunosuppressive therapy provoked an immune deficiency, evidenced by grave leukopenia and depletion of all bone marrow elements. diagnosis of HSV and CMV esophagitis is important to evaluate the risk of hemorrhage and esophageal perforation in esophagitis.
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ranking = 0.023794259268728
keywords = herpes
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8/170. Ocular side-effects from systemic HPMPC (Cidofovir) for a non-ocular cytomegalovirus infection.

    PURPOSE: To report a case of anterior uveitis and ocular hypotony during HPMPC treatment of a cytomegalovirus infection without ophthalmic involvement. methods: A 61-year-old bisexual white man with AIDS presented with moderate anterior uveitis and ocular hypotony after 8 weeks of intravenous HPMPC and oral probenecid co-treatment of a presumed recurrence of cytomegalovirus encephalitis. RESULTS: There was no evidence of an ocular cytomegalovirus infection. Cidofovir-related uveitis was diagnosed, and the HPMPC-probenecid co-treatment was switched to ganciclovir monotherapy. The ocular inflammation was successfully managed with topical steroids and mydriatics. CONCLUSIONS: This description of ophthalmic side effects from systemic HPMPC in the absence of ocular cytomegalovirus infection supports the hypothesis that anterior uveitis and ocular hypotony result from a direct interaction between the drug and the ciliary body.
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ranking = 0.16666666666667
keywords = encephalitis
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9/170. Histopathologic findings in cutaneous cytomegalovirus infection.

    When cytomegalovirus (CMV) involves the skin, viral inclusions are typically present within mesenchymal cells, e.g., endothelial cells, fibrocytes, and sometimes within inflammatory cells, e.g., macrophages, in contrast to infection in other organs in which inclusions are usually present within ductal epithelial cells. Two cases of cutaneous CMV are presented, one showing prominent findings within eccrine ductal epithelium and the other revealing mostly endothelial cells affected by CMV. Due to the range of cytologic changes induced by CMV observed in these cases, there seem to be early, fully developed, and late cellular changes brought about by CMV analogous to how herpesvirus (varicella, zoster, simplex) induces different changes depending on its stage of infection.
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ranking = 0.018902577258749
keywords = herpesvirus, herpes, varicella, zoster
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10/170. cytomegalovirus meningoencephalitis with paroxysmal course in immunocompetent adults: a new nosographical entity. Clinical, diagnostic and therapeutic correlations, and pathogenetic hypothesis.

    An immunocompetent adult developed cytomegalovirus (CMV) meningoencephalitis with paroxysmal neurologic symptoms of a self-limited nature and with a favourable outcome. Consistent with known cases in the clinical literature, two clinical forms of CMV meningoencephalitis will be identified: a monophasic form and a paroxysmal form. The clinical, diagnostic and therapeutic aspects of the two types will be analysed, and a pathogenetic hypothesis for the paroxysmal type will be proposed.
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ranking = 1.021366005317
keywords = encephalitis, meningoencephalitis
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