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Query: UMLS:C0019209 (hepatomegaly)
 5,798 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Disseminated histoplasmosis (DH) is recognized as an opportunistic infection in patients with the human immunodeficiency virus (HIV), especially in regions where histoplasmosis is endemic. At the Kansas University Medical Center 148 patients were hospitalized with the diagnosis of AIDS from December 1983 to March 1991; 23 of these patients (16%) had disseminated histoplasmosis. The charts of these 23 patients were reviewed. Clinical signs and symptoms included fever (91%), cough (65%), and weight loss (48%). Splenomegaly, hepatomegaly, or lymphadenopathy was present in 52% of all patients. Anemia (39%), leukopenia (65%), and thrombocytopenia (52%) were common, and 22% had pancytopenia. Diagnosis was made by peripheral smear examinations (organisms visualized on 7 of 22 smears [32%]), blood cultures (positive for H capsulatum in 16 of 20 patients, [80%]), bone marrow cultures (positive in 14 of 15 patients, [93%]), and bone marrow aspirate and biopsy examinations (organisms seen on 18 of 21 stains, [86%]). The combination of these four tests revealed the diagnosis of DH in 23 of 23 patients (100%). Induction and maintenance amphotericin B therapy was given to all but 2 patients, and currently 8 of the 23 are alive. DH is a common opportunistic infection in AIDS patients from regions endemic for histoplasmosis. When DH is suspected, a peripheral smear examination, blood cultures, bone marrow cultures and bone marrow aspirate and biopsy should be done to make the diagnosis, since suppression of the disease is possible with appropriate therapy.
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PMID:Disseminated histoplasmosis in patients with AIDS. 147 Sep 57

Since the onset of the AIDS epidemic, disseminated Histoplasma capsulatum infection has been reported with much greater frequency in both endemic and nonendemic areas. Abdominal CT scans of 16 patients with disseminated histoplasmosis were reviewed retrospectively to identify radiologic features of this disease. The diagnosis was confirmed by autopsy (three patients), bone marrow biopsy (10 patients), lymph node biopsy (three patients), bronchoscopic biopsy (three patients), liver biopsy (two patients), and/or colonoscopic biopsy (one patient). Fourteen patients had serologic evidence of human immunodeficiency virus infection. Disseminated histoplasmosis was either the only initial manifestation of AIDS (seven patients) or was accompanied simultaneously by cytomegalovirus infection (four patients), or Kaposi sarcoma, Toxoplasma encephalitis, or cryptosporidiosis (one patient each). Abdominal CT findings included hepatomegaly (63%); splenomegaly (38%); diffuse splenic hypottenuation (19%); bilateral adrenal enlargement or hypoattenuating masses (13%); and enlarged lymph nodes with homogeneous soft-tissue density (44%), diffuse or central low density (13%), or both (19%). Histoplasmosis should be included in the differential diagnosis when abdominal CT scans show such nonspecific findings as hepatomegaly, splenomegaly, enlarged soft-tissue-density or hypoattenuating lymph nodes, or adrenal enlargement or masses in an immunodeficient patient. An uncommon but possibly specific CT finding in histoplasmosis is diffuse splenic hypoattenuation.
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PMID:Disseminated histoplasmosis: abdominal CT findings in 16 patients. 192 16

Patients with the acquired immune deficiency syndrome (AIDS) frequently develop hepatic dysfunction. Although hepatic injury may indirectly result from malnutrition, hypotension, administered medications, sepsis, or other conditions, the hepatic injury is frequently due to opportunistic hepatic infection, directly related to AIDS. Infection with Mycobacterium avium intracellulare typically occurs in patients with advanced immunocompromise and with systemic symptoms due to widely disseminated infection. In contrast, hepatic tuberculosis often occurs with less advanced immunocompromise. Cytomegaloviral infection may produce a hepatitis. Cytomegaloviral and cryptosporidial infections have been implicated as causes of acalculous cholecystitis and of a secondary sclerosing cholangitis. About 10-20% of patients with AIDS have chronic hepatitis B infection. These patients tend to develop minimal hepatic inflammation and necrosis. The clinical findings in patients with hepatic cryptococcal infection are usually due to concomitant extrahepatic infection. Hepatic histoplasmosis usually develops as part of a widely disseminated infection with systemic symptoms. Hepatic involvement by Kaposi's sarcoma is rarely documented ante mortem because an unguided liver biopsy is an insensitive diagnostic procedure. Patients with non-Hodgkin's lymphoma of the liver typically have lymphadenopathy, hepatomegaly, and systemic symptoms. As a pragmatic approach, patients with liver dysfunction and HIV-related disease should have a sonographic or computerized tomographic examination of the liver. Patients with dilated bile ducts should undergo endoscopic retrograde cholangiopancreatography because opportunistic infection may produce biliary obstruction. Patients with a focal hepatic lesion should be considered for a guided liver biopsy. Patients with a significantly elevated serum alkaline phosphatase level should be considered for a percutaneous liver biopsy. When performed for these indications, liver biopsy will demonstrate a significant disease involving the liver in about 50% of patients with AIDS and in about 25% of patients who are HIV seropositive but who are not known to have AIDS. The clinical impact of a diagnostic biopsy is blunted by a lack of efficacious therapy for many opportunistic infections.
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PMID:Hepatobiliary manifestations of the acquired immune deficiency syndrome. 198 33

Although the clinical and epidemiologic features of progressive disseminated histoplasmosis (PDH) in the acquired immunodeficiency syndrome (AIDS) have been well described, the pathologic and pulmonary aspects remain to be fully defined. A retrospective review of three patients and a prospective study of four more with PDH and AIDS recently admitted to an inner city hospital in a non-endemic area were used to elucidate these features more fully. All patients were men aged 23 to 46 years, born in endemic areas, who had immigrated to the US seven to 15 years before the onset of their illnesses. Five had been exposed to human immunodeficiency virus (HIV) through intravenous drug use (one was also a homosexual), and two through heterosexual contacts. Respiratory symptoms were evident in five of the seven patients, fever in seven, weight loss in seven, hepatomegaly in four, splenomegaly in three, peripheral adenopathy in three, and gastrointestinal symptoms in three. PDH was the initial or only opportunistic infection in five patients. Bilateral nodular infiltrates (4/7), bilateral interstitial infiltrates (2/7), and mediastinal adenopathy associated with pleural effusion (1/7) were the chest roentgenographic findings. Histoplasma capsulatum was isolated from five of five bronchoalveolar lavages, four of four transbronchial biopsies, one of one endobronchial biopsy, one of one brushing, one of one pleural biopsy, three of three lymph node biopsies, two of two bone marrow biopsies, one of one liver biopsy, and three of four peripheral blood smears. Granuloma formation was seen in only three of 12 biopsies. There were ten or more fungi per monocyte in almost all tissues, some with extracellular forms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Disseminated histoplasmosis in AIDS. Clinicopathologic features in seven patients from a non-endemic area. 234 42

A 51-year old man presented with a persistent tongue ulcer, fever, cervical lymphadenopathy and hepatomegaly. The diagnosis was initially thought to be tuberculosis. This led to the initiation of antituberculous chemotherapy to which the patient failed to respond. The correct diagnosis of histoplasmosis was made after the detection of Histoplasma capsulatum on further review of the tongue ulcer biopsy specimen. He responded to treatment with amphotericin B.
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PMID:Disseminated histoplasmosis presenting as a non-healing tongue ulcer. 239 8

This article presents electronmicroscopy evidence of retrovirus-like particles with bar shaped cores in salivary and prostate glands as well as testicles of 2 acquired immunodeficiency syndrome (AIDS) patients. The 1st case, a 38-year old black male homosexual, presented in 1982 with diarrhea, malabsorption, and weight loss. In the following 1 1/2 years, he experienced recurrent Candida esophagitis, cutaneous and pulmonary Kaposi's sarcoma, Pneumocystis carinii pneumonia, and cytomegalovirus. Autopsy in 1984 revealed residual Kaposi's sarcoma, disseminated cytomegalovirus, and M avium-intracellulare. The 2nd case, a 31-year old white male homosexual, presented in 1984 with Pneumocystis carinii penumonia and subsequently developed persistent fever, hepatomegaly, headaches, blurred vision, progressive liver function deterioration, and disseminated histoplasmosis infection. Autopsy in 1984 revealed an overwhelming disseminated histoplasmosis infection. Tissues taken at postmortem were examined by electron microscopy. Particles that conformed with the morphologic characteristics of AIDS retrovirus (a size of about 140 nm, a round shape with a double membrane, and an elongated core) were detected in the prostate gland of patient 2 and in the salivary glands and testes of both patients. This finding suggests that saliva and semen may be body fluids by which transmission of the AIDS virus occurs.
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PMID:Retrovirus-like particles in salivary glands, prostate and testes of AIDS patients. 298 94

Disseminated histoplasmosis was diagnosed in a 10-year-old dog suspected of having hepatic carcinoma. Clinical abnormalities included diffuse hepatomegaly, gastrointestinal bleeding, thoracic and abdominal effusion, anemia, leukocytosis, and thrombocytopenia. Histoplasmosis characteristically is a disease of the mononuclear phagocyte system, but in this case was diagnosed by finding Histoplasma capsulatum organisms in neutrophils on the blood smear.
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PMID:Atypical Histoplasma capsulatum infection in a dog. 351 59

We reviewed the clinical data and hepatic histologic findings of 25 patients with the acquired immunodeficiency syndrome who underwent 29 liver biopsies. Our experience indicates that the only hepatic feature characteristic of acquired immunodeficiency syndrome is serologic evidence of exposure to the hepatitis B virus. The most common histologic finding was macrovesicular steatosis. Granulomas appeared in seven patients and were due to mycobacterial disease (3 patients), histoplasmosis (1 patient), adverse reaction to sulfonamide (2 patients) and unknown causes (1 patient). The clinical indication for liver biopsy was not significantly different in the patients without or with granulomas or with granulomas secondary to mycobacteria or fungi. Mycobacteria were cultured from all histologically positive specimens and one histologically negative specimen. Liver biopsy should be performed in any patient with acquired immunodeficiency syndrome who has unexplained fever, hepatomegaly or abnormal results of serum biochemical liver tests, and all specimens should be stained and cultured for mycobacteria and fungi.
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PMID:The liver in the acquired immunodeficiency syndrome: a clinical and histologic study. 397 60

Disseminated histoplasmosis was diagnosed by a computed tomographic (CT) directed needle biopsy of an adrenal mass. A 53-year-old man presented with a nonproductive cough, bilateral flank discomfort, and constitutional symptoms. Physical exam revealed mild hepatomegaly and tenderness. Chest radiograph revealed two destructive bone lesions. An abdominal CT scan demonstrated bilateral adrenal masses. Needle biopsy of the left adrenal mass revealed histoplasmosis. A rib resection or exploratory laparotomy was avoided. He has been completely free of evidence of disease for 6 months following completion of antibiotic therapy.
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PMID:Disseminated histoplasmosis diagnosed by computed tomography directed needle biopsy of an adrenal mass. 399 31

Clinical and laboratory features have been reviewed in 66 episodes of disseminated histoplasmosis that occurred during two large urban outbreaks in Indianapolis. Immunosuppression, age greater than 54 years, and presence of other serious underlying illnesses predisposed to the disseminated form of the disease; only 21% of patients lacked one of these risk factors. Central nervous system findings, splenomegaly, hepatomegaly, and lymphopenia suggested disseminated disease but were present in only about one-third of patients. Miliary or diffuse pulmonary infiltrates also suggested dissemination and were noted in about one-third of patients, while mediastinal lymphadenopathy was present in only 17%. Histoplasmal serologic tests, positive in 90% of patients, provided useful diagnostic clues. The diagnosis could be confirmed by culture in 88% of patients, and special stains were positive in about two-thirds. Although 10% of patients recovered without treatment, 11 patients (17%) died because of failure to suspect the diagnosis and initiate therapy promptly. Amphotericin B was effective in all patients receiving at least 500 mg, but relapse occurred if the total dose was less than 30 mg/kg. Ketoconazole appeared effective in non-immunosuppressed patients but not in those with underlying immunosuppression; however, a controlled trial comparing ketoconazole and amphotericin B is required to establish the role of this new fungistatic oral agent.
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PMID:Clinical and laboratory features of disseminated histoplasmosis during two large urban outbreaks. 631 46


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