Cases reported "Opportunistic Infections"

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1/20. Active intestinal tuberculosis with esophageal candidiasis due to idiopathic CD4( ) T-lymphocytopenia in an elderly woman.

    We describe a case of intestinal tuberculosis and esophageal candidiasis in an 85-year-old Japanese woman with idiopathic CD4 T-lymphocytopenia (ICL). The patient exhibited clinical symptoms of odynophagia, bloody diarrhea, and high fever. physical examination on admission showed a poor nutritional status. Endoscopic examination of the upper digestive tract revealed the esophageal mucosa to be covered with yellowish-white plaque-like lesions. Colonoscopic examination revealed multiple annular ulcerations with bleeding. She was diagnosed with intestinal tuberculosis by polymerase chain reaction (PCR) and fecal culture. Her CD4 T-lymphocyte count was 178/mm3 and no evidence of human immunodeficiency virus (hiv) infection was found. She was successfully treated with fluconazole and antituberculosis drugs. This case emphasizes the importance of opportunistic infections in elderly patients with predisposing conditions such as ICL.
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keywords = idiopathic
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2/20. Restriction of T-cell receptor repertoires in idiopathic CD4 lymphocytopenia.

    We report that alpha/beta and gamma/delta T-cell repertoires of three patients with idiopathic CD4 lymphocytopenia, who showed different clinical manifestations and outcomes over time, were highly restricted. The disruption of T-cell repertoires does not influence the susceptibility to infections: the first patient was unable to attain a protective response to mycobacterium, the second showed clinical improvement and the third did not develop opportunistic infections. These results indicate that idiopathic CD4 lymphocytopenia could give rise to mono-/oligoclonal T-cell expansions, but the degree of repertoire disturbance is not indicative of the severity of disease progression.
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ranking = 1.2
keywords = idiopathic
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3/20. Endogenous pneumococcal endophthalmitis followed by pneumococcal-induced uveitis.

    BACKGROUND: We describe the case of a fulminant bilateral endophthalmitis occurring in a patient, who had 9 years earlier a splenectomy for an idiopathic thrombocytopenic purpura. history AND SIGNS: A 40-year-old woman, back from a trip to morocco, presented with high fever, rapid decrease in visual acuity and loss of consciousness. Medical examination revealed a pneumococcal meningitis and bilateral endophthalmitis. THERAPY AND OUTCOME: endophthalmitis was treated with local and intravitreal antibiotics injections (vancomycin and amikacin). Repeated parabulbar betamethasone injections were performed. Intravenous (iv) methylprednisolone pulses were followed by oral steroid therapy while systemic antibiotics were given (ceftriaxone and vancomycin). In spite of this therapy, fundus examination was impossible because the anterior chamber was filled with fibrin. A cataract developed with severe vitritis and we could observe a progressive narrowing of the anterior chamber. The patient underwent a bilateral vitrectomy and lensectomy. The retina had no lesion. No bacteria were found in the vitreous culture. Evolution was characterized by an increased ocular pressure due to anterior synechiae. visual acuity remained under 1/10. The severe ocular inflammation could be the result of a mixed mechanism including an infectious followed by a severe immune response against bacterial components. CONCLUSIONS: This case report is rare. To our knowledge, only 3 similar cases have been reported in the literature.
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ranking = 0.2
keywords = idiopathic
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4/20. Toxoplasmic myositis as a presenting manifestation of idiopathic CD4 lymphocytopenia.

    toxoplasma gondii encysts in skeletal muscle. Although only rarely found at muscle biopsy, this parasite has previously been regarded as a possible cause of polymyositis. We report a case of biopsy-proven toxoplasmic myositis in a non-hiv-infected patient that led to recognition of idiopathic CD4 lymphocytopenia (ICL), a rare condition typically associated with opportunistic infections. Interestingly, the CD25( ) subset that corresponds to the CD4( ) regulatory T cells controlling autoimmune processes was lacking. Steroid and antiprotozoal therapy led to recovery.
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ranking = 1
keywords = idiopathic
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5/20. Cerebral toxoplasmosis after autologous peripheral blood stem cell transplantation.

    toxoplasmosis appears to be a rare opportunistic protozoal infection following haematopoietic stem cell transplantation (HSCT). Most cases have been reported in allogeneic HSCT recipients, with only anecdotal reports of infection occurring after autologous transplantation. Reported here is the case of a patient who developed cerebral toxoplasmosis following autologous peripheral blood stem cell transplantation for non-Hodgkin's lymphoma.
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ranking = 0.15054266312748
keywords = cd
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6/20. legionella pneumonia: infection during immunosuppressive therapy for idiopathic pulmonary hemosiderosis.

    We report a case of legionella pneumonia in a 10-year-old girl with idiopathic pulmonary hemosiderosis who was chronically immunosuppressed and had exposure to a hot tub. Prompt diagnosis with bronchoalveolar lavage and subsequent antimicrobial therapy resulted in full recovery. legionellosis should be included in the differential diagnosis of the immunosuppressed child with respiratory illness. High risk patients should avoid exposure to hot tubs.
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ranking = 1
keywords = idiopathic
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7/20. The causes of death in patients with human immunodeficiency virus infection: a clinical and pathologic study with emphasis on the role of pulmonary diseases.

    The clinical records and autopsy data of 75 patients dying with AIDS were reviewed to determine the frequency of individual diseases diagnosed premortem and postmortem, the significance of pulmonary processes found in the lungs at autopsy, and the clinical and pathologic causes of death. cytomegalovirus (CMV) infection was identified histologically either premortem or postmortem in 81% of patients. The lungs and adrenal glands were infected most commonly. Only one-half of CMV infections were recognized premortem. Pneumocystis pneumonia and Kaposi sarcoma occurred in 68% and 59% of patients, respectively, but were not unsuspected premortem in any patient. Visceral involvement with Kaposi sarcoma, however, was frequently recognized only at autopsy. While disseminated M. avium-intracellulare infection was common (31% of patients), histologically documented pulmonary disease was uncommon (3% of patients). Cryptococcal infection, diagnosed in 10 patients, was confined to the central nervous system in only 1 patient. toxoplasma, in contrast, infected the brain of only 6 patients. All 75 patients had one or more disease processes identified in their lungs or pleurae at autopsy. These processes included opportunistic infections in 76% of patients, neoplasms in 37% (Kaposi sarcoma in 36% and lymphoma in 3%), and other processes in 60%. The most prevalent pathogen, CMV was found in pulmonary tissue from 44 patients and caused significant disease in 21 patients. Five patients died due to CMV pneumonia. pneumocystis carinii was found at autopsy in 24 patients. In spite of treatment, pneumocystis pneumonia was fatal in 11 patients. One patient died with concomitant CMV and pneumocystis pneumonia. Kaposi sarcoma, identified in the lungs of 23 patients, led to death in 5 patients via upper airway obstruction, hemorrhage, or parenchymal destruction. Other fatal pulmonary processes included bacterial pneumonia in 9 patients, idiopathic diffuse alveolar damage in 5, cryptococcosis in 2, and pulmonary hemorrhage in 1. Specific clinical criteria were used to determine the cause of death due to organ system failure. Fifty-one percent of patients died due to respiratory failure; 16% from neurologic disease; 17% from hypotension that was not caused by respiratory, neurologic, or cardiac disease; and 3% from cardiac dysfunction. Thirteen percent of deaths did not meet the clinical criteria defining these 4 categories. This clinical assessment was combined with autopsy data to identify specific diseases as causes of death.(ABSTRACT TRUNCATED AT 400 WORDS)
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ranking = 0.2
keywords = idiopathic
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8/20. Disseminated nocardiosis.

    A middle aged female suffering from idiopathic thrombocytopenic purpura (ITP), on treatment with steroids, developed bronchopneumonia and pyopneumothorax due to opportunistic infection by nocardia asteroides. Aspirates obtained from the lungs, liver, spleen, kidneys and bone marrow were positive for nocardia asteroides, confirming disseminated infection in an immunocompromised host. The patient succumbed to the infection.
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ranking = 0.2
keywords = idiopathic
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9/20. Lower gastrointestinal hemorrhage in renal transplant recipients.

    A review of the literature and our own series revealed 38 patients with lower gastrointestinal (LGI) hemorrhage among 4086 renal transplant recipients (0.9%). These patients represent 30% of 128 patients with major colorectal complications in this group. Of the 32 patients whose treatment and outcome were reported, only 12 (38%) were treated operatively. The overall mortality rate was 72%. The causes of LGI hemorrhage included colitis from opportunistic infections (42%); pseudomembranous, ischemic, or uremic colitis (40%); and idiopathic ulcers of the colon (18%). Colonoscopic, gross, and histopathologic findings of a patient with massive LGI hemorrhage from a fungal ulcer of the colon are the focus of this study, as are the implications of such findings. We propose an algorithm for diagnostic and therapeutic management decisions. We emphasize prompt diagnosis and the importance of colonoscopy. We propose withdrawal of immunosuppression and early operative intervention if the patient survival rate is to improve.
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ranking = 0.2
keywords = idiopathic
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10/20. Susceptibility to infections in children with selective IgA- and IgA-IgG subclass deficiency.

    This study included 36 children with IgA-deficiency, increased susceptibility to infections and/or other disorders. Recurrent, usually bacterial infections were noticed in 23 out of 26 patients (88%) with complete and in 7 out of 10 patients (70%) with partial IgA-deficiency. All patients with severe infections had complete IgA-deficiency. Complete IgA-deficiency was also present in the six children who had autoimmune disorders associated with recurrent infections. In 22 out of the 36 patients studied the serum could be analysed for concomitant IgG subclass deficiencies: one patient had marked decrease of IgG2. In a second patient IgG4 was not detectable. Two patients had combined IgG2-IgG4-deficiency. In a girl with severe acute and chronic infections and relapsing idiopathic thrombocytopenic purpura, IgA-IgG2-IgG4-deficiency was found to be the prodromal stage of common variable immunodeficiency with panhypogammaglobulinaemia.
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ranking = 0.2
keywords = idiopathic
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