Cases reported "HIV Seropositivity"

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1/431. Subacute painful lumbosacral polyradiculoneuropathy in immunocompromised patients.

    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.
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2/431. 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.
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3/431. 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.
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4/431. psoriasis associated with human immunodeficiency virus in an infant.

    psoriasis is commonly reported in association with HIV in adults. A 3-month-old girl with HIV presented with a widespread eruption and was diagnosed with psoriasis. This is the first infant reported with psoriasis in association with HIV infection. The relationship between the two entities is discussed, as is the role of treatment with zidovudine.
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5/431. Variants from the diverse virus population identified at seroconversion of a clade A human immunodeficiency virus type 1-infected woman have distinct biological properties.

    Development of effective therapeutics to prevent new infections with human immunodeficiency type 1 (hiv-1) is predicated on an understanding of the properties that provide a selective advantage to a transmitted viral population. In contrast to the homogeneous virus population that typifies early hiv-1 infection of men, the viral population in women recently infected with clade A hiv-1 is genetically diverse, based on evaluation of the envelope gene. A longitudinal study of viral envelope evolution in several women suggested that representative envelope variants detected at seroconversion had distinct biological properties that affected viral fitness. To test this hypothesis, a full-length, infectious molecular clone, Q23-17, was obtained from an infected woman 1 year following seroconversion, and chimeric viruses containing envelope genes representative of seroconversion and 27-month-postseroconversion populations were constructed. dendritic cells (DC) could transfer infection of seroconversion variant Q23ScA, which dominated the viral population in the year following seroconversion, and the closely related 1-year isolate Q23-17 to resting peripheral blood mononuclear cells (PBMC). In contrast, resting PBMC exposed to DC pulsed with Q23ScB, which was detected infrequently in samples after seroconversion, or the 27-month chimeras were inconsistently infected. Additionally, quiescent PBMC infected with Q23ScA or Q23-17 proliferated more robustly than uninfected cells or cells infected with the other envelope chimeras in response to immobilized anti-CD3. Stimulation with tetanus toxoid led to an increased proportion of CD45RA cells and a decreased expression of CD28 on CD45RO cells in cultures of Q23-17-infected PBMC. These data demonstrate that variants from the heterogeneous seroconversion clade A hiv-1 population in a Kenyan woman have distinct biological features that may influence viral pathogenesis.
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6/431. Use of the polymerase chain reaction for diagnosis of ocular toxoplasmosis.

    OBJECTIVE: To report a cohort of patients in whom polymerase chain reaction (PCR) was performed on vitreous samples and to place in perspective the current role of PCR in the diagnosis of ocular toxoplasmosis. DESIGN: Noncomparative case series. PARTICIPANTS: Fifteen patients in whom toxoplasmic retinochoroiditis was considered in the differential diagnosis and in whom the clinical presentation was not diagnostic and/or response to treatment was inadequate. INTERVENTION: Examination of vitreous fluid by PCR and of serum for the presence of toxoplasma-specific antibodies. MAIN OUTCOME MEASURES: Presence of toxoplasma gondii dna, serologic test results, clinical findings, treatment, and outcome. RESULTS: In 7 of 15 patients, vitreous fluid examination results by PCR were positive for the presence of T. gondii dna. Five of these seven patients had serologic test results consistent with toxoplasma infection acquired in the distant past; the other two patients had serologic test results consistent with retinochoroiditis in the setting of acute toxoplasmosis. The PCR results influenced the management of these patients in six of the seven positive cases. In the eight patients in whom vitreous examination results were negative by PCR, either toxoplasma serology was negative (6), the retinal lesions were caused by cytomegalovirus (1), or, on further consideration, the eye signs were not consistent with those of toxoplasmic retinochoroiditis (1). CONCLUSION: In patients in whom toxoplasmosis is considered in the differential diagnosis but in whom the presentation is atypical, PCR was frequently a useful diagnostic aid.
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7/431. Human papillomavirus-associated penile squamous cell carcinoma in HIV-positive patients.

    Two cases of penile squamous cell carcinoma with distinctive clinicopathologic characteristics are presented. The tumors appeared in patients infected with HIV and were located in the glans of the penis. Histologically, the neoplasms were well-differentiated, infiltrating, squamous cell carcinomas. The entire spectrum from benign condyloma to infiltrative squamous cell carcinoma was present in the two patients. In both cases, human papillomavirus (HPV) could be demonstrated using polymerase chain reaction analysis. The reported cases suggest a synergic interaction of HPV and HIV in the carcinogenic process of some penile carcinomas.
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8/431. The use of human immunodeficiency virus postexposure prophylaxis after successful artificial insemination.

    A case is reported of a woman who was exposed to human immunodeficiency virus through self-insemination. She was artificially inseminated with fresh semen obtained from a gay man in whom HIV seroconversion was taking place. Postexposure prophylaxis with antiretrovirals was initiated 10 days later, and despite successful conception, HIV infection was not established. A healthy male infant was subsequently delivered with no obvious toxicity related to medication.
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9/431. Multicystic autoimmune thyroiditis-like disease associated with HIV infection. A case report.

    BACKGROUND: Human immunodeficiency virus (HIV) infection and resulting acquired immunodeficiency syndrome (AIDS) may involve virtually every organ system, including the endocrine glands. Thyroid dysfunction most commonly reflects advanced disease and generally resembles euthyroid sick syndrome. Rarely do opportunistic infections, hemorrhage, neoplasms and drugs account for alterations in thyroid tissue. Multiple lymphoepithelial cysts of parotid gland and thymus have been identified, but similar findings in thyroid gland have not been reported. CASE: A 41-year-old, HIV-seropositive woman, asymptomatic for seven years, developed a squamous cell carcinoma of the cervix with local-regional extension. At the same time, bilateral complex thyroid cysts and high titers of antimicrosomal antibodies (1/6,400) were detected. Ultrasound-guided fine needle aspiration biopsy of the thyroid showed a heterogeneous lymphocytic population with a reactive appearance and occasional groups of epithelial cells with an immature squamous pattern, along with cytologic features of autoimmune thyroiditis. Immunocytochemistry was positive for CD20, CD3 and CD5. Immunoglobulin heavy chain gene rearrangement by polymerase chain reaction from cytologic material showed a polyclonal lymphoid population. External radiotherapy resulted in a significant reduction in the pelvic lesion. Four months after diagnosis, abdominal ultrasound displayed multiple hepatic metastasis, the patient's condition rapidly deteriorated, and she died about a month later. CONCLUSION: This case had unique features and probably represented an AIDS-related lesion and distinct entity.
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10/431. 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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