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Query: UMLS:C0019693 (HIV)
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Tuberculous splenic abscesses do virtually not occur in immunocompetent patients. Tuberculous abscesses have been reported only from areas, where the prevalence of both HIV infection and tuberculosis is very high such as Central Africa. In our institution two of seven patients with AIDS and disseminated tuberculosis who were treated during the year 1994 developed tuberculous splenic abscesses. Both patients were resident in Central Europe and had fever and weight loss prior to admission. Multiple hypoechoic lesions up to 1.5 cm in diameter developed in the spleen of both patients on day 11 and 16 after admission, respectively. Initially no symptoms related to the splenic involvement and no leucocytosis were seen in both patients. One patient developed leucocytosis and left sided flank pain caused by a subtotal splenic abscess because the diagnosis and therapy of tuberculosis was delayed. Both patients responded promptly to triple drug antituberculous therapy without surgical intervention. We conclude that also in European patients multiple hypoechoic/hypodense lesions in the spleen of HIV positive patients are highly suggestive of disseminated tuberculosis. Follow-up by ultrasound may help to establish the correct diagnosis and may further prevent unnecessary complications in these patients.
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PMID:Splenic abscesses and abdominal tuberculosis in patients with AIDS. 879 44

Primary renal mucormycosis is a rare infection capable of acute illness with sepsis. Few cases have been reported. We report a case of an acute primary renal mucormycosis and review the published reports. The incidence of primary renal mucormycosis has risen in recent years. The most frequently reported underlying predisposing disorders are human immunodeficiency virus infection, intravenous drug abuse, and diabetes mellitus. Primary renal mucormycosis should be suspected in patients with an immunocompromising illness or particular risk factors, when persistent flank pain and fever with sterile urine not responding to appropriate antibiotics are associated with enlarged heterogeneous kidneys.
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PMID:Primary renal mucormycosis. 980 Nov 27

Indinavir sulfate is a protease inhibitor that has been found to be extremely effective in increasing CD4+ cell counts and in decreasing HIV-RNA titers in patients with HIV and AIDS. However, patients receiving indinavir also have been noted to have a significant risk for developing urolithiasis. Published reports of indinavir urolithiasis estimate its incidence at between 4 and 13%. Indinavir has a high urinary excretion with poor solubility in a physiologic pH solution. Consequently, patients develop urinary stones that are principally composed of indinavir or of a mixture of indinavir and other substances, such as calcium oxalate. Similar to other forms of urolithiasis, acute flank pain and hematuria are the typical symptoms of indinavir urolithiasis. Indinavir urolithiasis is unique in that computed tomography, which was once thought to be efficacious in identifying all urinary calculi, is not useful in imaging stones that are composed of pure indinavir. Indinavir urolithiasis generally responds to a conservative regimen of hydration, pain control, and the temporary discontinuation of the medication. Only a minority of patients need surgical intervention. Approximately 10% of patients ultimately need to discontinue indinavir therapy altogether. Indinavir is an antiviral agent that has a significant role in the treatment of AIDS. Although urolithiasis is a significant side effect of indinavir use, limiting its clinical application is not the answer. Rather, physicians need to know more about indinavir urolithiasis to help their patients cope with its potential complications.
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PMID:Indinavir urolithiasis. 1114 25

Three HIV-seropositive patients were diagnosed with urolithiasis related to the use of indinavir. The first patient was a 45-year-old white male with severe haemophilia who presented with fever and flank pain referred to the glans penis. Ultrasound and intravenous pyelography (IVP) revealed a concrement in the left renal pelvis. Discontinuation of indinavir and acidification of the urine did not reduce the stone load. Percutaneous nephrolithotripsy was then performed. The second patient, a 41-year-old white male, presented at the emergency ward with flank pain and fever. Ultrasound examination showed dilatation of the left kidney. A percutaneous nephrostomy catheter was inserted. Antegrade contrast imaging showed a concrement in the proximal ureter. The patient underwent extracorporeal shock wave lithotripsy. A second antegrade image made a few days later showed no evidence of stone material. The third patient was a 56-year-old white male with a previous history of indinavir-associated urolithiasis. He presented at the emergency ward with flank pain and haematuria. A CT urography showed dilatation of the right kidney and distal portion of the right ureter with no evidence of concrement. The symptoms resolved after a percutaneous nephrostomy catheter was inserted and the antiviral medication was modified. The catheter was removed 2 weeks later. At last follow-up, none ofthe 3 patients had symptoms of urolithiasis. These cases illustrate that, although conservative therapy for indinavir-related urolithiasis can be sufficient, minimally invasive endourological surgery is sometimes necessary.
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PMID:[Three patients with indinavir-related urolithiasis]. 1787 43

Renal aspergillosis is an extremely uncommon complication in HIV-infected patients. In general, prognosis is poor and the need for nephrectomy is emphasized. We report the case of a 37-year-old patient with AIDS since April 2003 (CD4 count 10 cells/mm(3), a high viral load, Candida esophagitis, bilateral pneumonia, HIV encephalopathy). Treatment with zidovudine, lamivudine, nevirapine, and lopinavir/ritonavir was started. Adherence to this medication proved to be a problem, but after 18 weeks of HAART the CD4 count was 110 cells/mm(3) and viral load was undetectable. One year later, he presented with hematuria and flank pain. Computed tomography (CT) scan revealed multiple lesions in both kidneys. Cultures of the abscess aspirates yielded Aspergillus fumigatus. Our review of 18 reported cases shows that prognosis of renal aspergillosis is poor if nephrectomy is not performed. However, in the present case a conservative approach was chosen to avoid life-long dialysis. The patient was treated successfully with a combination of voriconazole, percutaneous drainage, and highly active antiretroviral therapy (HAART). Renal function was completely preserved. Reported cases from the literature of renal aspergillosis in HIV-infected patients are summarized in this paper.
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PMID:Bilateral renal aspergillosis in a patient with AIDS: a case report and review of reported cases. 1809 36

A 51-year-old HIV-positive man treated with atazanavir for 9 months presented with anuria following right flank pain. Laboratory examination indicated renal insufficiency, and abdominopelvic computed tomography scanning showed bilateral hydroureteronephrosis, but no stones were visualized. Endoscopic procedures were performed to investigate the causes of ureteral obstruction and, if possible, to insert Double-J stents in the ureters. A yellowish stone composed of pure atazanavir was found at the right ureteral orifice, and retrograde pyelography revealed a filling defect in the left ureter found to be caused by an atazanavir stone. The patient's renal function recovered after removal of these stones.
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PMID:Acute renal failure due to bilateral ureteral stone impaction in an HIV-positive patient. 1863 5

We report here the first case to add amprenavir to the growing list of antiretroviral drugs associated with urinary stones. The first reported case of a nelfinavir urinary stone was reported in 2002 in a 37-year-old HIV-infected woman. In September 2007, the same female patient was referred to our department with recent onset of right flank pain and recurrent urinary tract infections. Abdominal computed tomography revealed three obstructing stones in the distal right ureter, another stone in the right renal pelvis with hydronephrosis and a stone in the left kidney. After stone retrieval, analysis of the stone by liquid chromatography with mass spectrometry revealed a stone composition of 95% unmodified amprenavir and 5% ritonavir.
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PMID:Same patient, new stone composition: amprenavir urinary stone. 1877 Oct 58

A 51-year old male patient with a three-month history of constant and dull left flank pain was investigated by ultrasonography, computed tomography (CT) scan and magnetic resonance imaging (MRI) of the abdomen, which disclosed a 8 x 7 x 6 cm retroperitoneal pararenal mass with heterogeneous imaging characteristics and bright enhancement following intravenous contrast injection. Based on the hypervascularity of the mass and the lack of specific signs in the imaging investigation, lymphoma, sarcoma or vascular tumour were considered as probable, diagnoses and the patient underwent an exploratory laparotomy. The histologic examination of the surgically resected specimen disclosed "a hyaline type of Castleman's disease". Further evaluation of the patient with antibody testing for HIV 1 and 2, as well as viral load by PCR for Herpes Virus-8 (HHV-8) were negative. Bone marrow aspiration, biopsy and immunophenotypic study did not disclose any evidence of lymphoma. Molecular study of the bone marrow for immunoglobulin heavy chain rearrangement showed a polyclonal pattern; serum protein electrophoresis did not show any evidence of hypergammaglobulinaemia and serum immunofixation electrophoresis did not show any monoclonal protein. A diagnosis of localized-unicentric type of Castleman's disease was made. Castleman's Disease should be included in the differential diagnosis of any solitary, heterogeneous and hypervascular retroperitoneal mass. Discovery of Castleman's disease at any area of the body should be followed by a thorough imaging and laboratory work-up in order to exclude the multicentric type of the disease and the co-existence of lymphoma.
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PMID:Retroperitoneal pararenal Castleman's disease. 1956

A 63-year-old man was admitted for investigation of blurred vision and multiple ring-enhancing lesions on cranial MRI. Histopathological examination of tissue obtained at brain biopsy showed multiple Toxoplasma gondii cysts. He was started on a combination of sulphadiazine and pyrimethamine for cerebral toxoplasmosis and was subsequently diagnosed with HIV-1 infection. He then developed acute renal failure and flank pain and was diagnosed with bilateral vesico-uretric calculi requiring bilateral stent insertion. The retrieved renal calculi were negative for the common stones that are routinely tested for in our laboratory and had the macroscopic characteristics of a sulphadiazine stone. His renal failure responded to cessation of the sulphadiazine.
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PMID:Sulphadiazine-induced renal stones in a 63-year-old HIV-infected man treated for toxoplasmosis. 2300 Oct 98

A 64-year-old man with HIV on antiretroviral therapy (including atazanavir, a protease inhibitor) presented with left flank pain, nausea and vomiting. A kidney stone was suspected, and a CT scan demonstrated left hydronephrosis but failed to demonstrate nephrolithiasis or extrinsic compression. The patient had a ureteral stent placed which relieved his symptoms. A few months later, he underwent left ureteroscopy and a large ureteral calculus was found. The stone was removed and analysis showed 43% atazanavir and 57% calcium oxalate. Several months later, the patient developed flank pain on the opposite side. A renal ultrasound suggested right-sided nephrolithiasis and he subsequently underwent ureteroscopy with laser lithotripsy of two stones. Stone analysis showed that they were composed of 100% atazanavir. This case highlights the fact that patients treated with protease inhibitors remain at risk for developing nephrolithiasis. Ultrasonography can be a useful diagnostic tool in the setting of these radiolucent calculi.
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PMID:Recurrent nephrolithiasis associated with atazanavir use. 2440 82


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