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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Since intestinal microsporidiosis might be of importance in the pathogenesis of gastrointestinal symptoms in patients infected with HIV, we examined duodenal biopsies of HIV-infected patients by electron microscopy. Enterocytozoon bieneusi infection of the small intestine was found in one of 23 patients studied, which gives a 95% confidence interval for the prevalence rate between 0.1% and 22%. The infected patient was a 24-year-old homosexual male with AIDS who underwent upper endoscopy because of acute epigastric pain, nausea, and vomiting. These symptoms were obviously due to mesenterial Kaposi's sarcoma obstructing the duodenal passage, as was later revealed at autopsy. However, microsporidiosis might have caused the patient's eight-month history of diarrhea and weight loss, since infected cells showed signs of degeneration, and no other pathogens were ever detected in stool or biopsy. Our finding of Enterocytozoon bieneusi infection in a German AIDS patient supports the concept of a worldwide distribution of this parasite; further studies are needed to define its exact prevalence in HIV-infected patients and its pathogenic relevance.
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PMID:Intestinal microsporidiosis in a German patient with AIDS. 194 57

A 43-year-old homosexual man was hospitalized in April 1988 because of acute epigastric pain. It was known that he had had a HIV infection for a year, and in April 1988 it was defined as stage Walter Reed I. Acute, exudative, nonspecific pancreatitis was diagnosed. Three weeks later cerebral symptoms (disturbances of consciousness), hypoacusis, and impaired vision developed. The ocular fundus displayed areas of edema and whitish clouding in the retina, first in the left eye and later also in the right. These were initially assumed to be anemic infarctions until the differential diagnosis of acute retinal necrosis with possible herpesvirus infection was made. On the basis of ophthalmoscopic findings cytomegalovirus retinitis appeared improbable. Serologic examinations showed increased levels of IgG antibody titers of cytomegalovirus and herpes simplex virus (both 1:20,000). Therapy with intravenous infusions of Acyclovir was instituted (1500 mg/d). After a few days the patient regained consciousness as well as his hearing and vision. There was complete resolution of the retinal exudates. This excellent therapeutic result of Acyclovir therapy confirmed the diagnosis of acute retinal necrosis syndrome, identified the cerebral symptoms as herpes encephalitis, and explained the entire disease process as the first opportunistic infection in HIV infection, i.e., by that time the patient had developed stage Walter Reed 6 (AIDS). Problems of differential diagnosis and the therapeutic schedule with Acyclovir are discussed.
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PMID:[Acute retinal necrosis and herpes encephalitis. The key role of the ophthalmologist in diagnosing opportunistic infections in AIDS, successful therapy with acyclovir (Zovirax)]. 234 17

From January 1992 to August 1993, 150 endoscopies (114 fiber gastroscopies, 29 fiber colonoscopies and 7 CPRE) were carried out in a total of 142 anti HIV positive patients. The most frequent clinical manifestations leading to the exploration were dysphagia, epigastric pain, diarrhea and upper or lower gastrointestinal bleeding. Endoscopic alterations were observed in most of the exploration although specific diagnosis was only achieved in approximately one third of the patients with the most frequent being esophagitis by Candida and CMV (21% and 5%, respectively in the fiber gastroscopies performed). Digestive manifestations were varied in the patients in whom esophagitis by Candida was diagnosed while dysphagia and diarrhea were the symptoms commonly observed in the patients with esophagitis or colitis by CMV. The diagnostic profitability of endoscopy was high in patients presenting dysphagia, diarrhea, gastrointestinal bleeding or in those in whom endoscopy was performed for tumoral staging or to evaluate the possible existence of manifestations secondary to the presence of portal hypertension.
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PMID:[Endoscopic gastrointestinal findings in patients with human immunodeficiency virus infection]. 762 Dec 75

Visceral leishmaniasis (kala-azar) affecting HIV-infected patient is being reported in increasing frequency. A 40-year-old German bisexual patient with full-blown AIDS is described who presented with Kaposi's sarcoma, epigastric pain, diarrhea, and weight loss but without fever. Leishmania amastigotes were initially found in biopsies from stomach, duodenum, and a cutaneous Kaposi's sarcoma lesion but were later also recovered from bone marrow and lymph node. The patient received three courses of a combination of pentavalent antimony and interferon-gamma. In addition to the common side effects such as fever, thrombocytopenia, and elevated amylase and lipase, a vivid progression of the Kaposi's sarcoma was noted. Tumor progression was temporally closely associated with treatment with interferon-gamma. Because this phenomenon has also been observed in other patients, we advise caution when using interferon-gamma in patients with Kaposi's sarcoma.
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PMID:Treatment of atypical leishmaniasis with interferon gamma resulting in progression of Kaposi's sarcoma in an AIDS patient. 771 12

We describe five cases of gastrointestinal leishmaniasis in patients with human immunodeficiency virus infection and review 10 additional cases reported in the literature. All of the patients had CD4+ cell counts of < 200/mm3, and AIDS had been previously diagnosed for 12 patients. Fever and splenomegaly were present in 46% of cases. Thirteen patients had digestive symptoms; these symptoms included diarrhea (6), dysphagia and/or odynophagia (6), abdominal pain (2), epigastric pain (2), gastrointestinal hemorrhage (1), and rectal discomfort (1). The regions of the digestive tract most frequently affected by Leishmania organisms were the duodenal mucosa (90%) and the gastric mucosa (75%). Endoscopy showed normal-appearing mucosa in 45% of cases. In 10 cases the diagnosis of visceral leishmaniasis was first made by biopsy of the gastrointestinal mucosa. In most cases treatment with antimonial agents was not effective.
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PMID:Gastrointestinal leishmaniasis in human immunodeficiency virus-infected patients: report of five cases and review. 757 44

In contrast to the well known chlorpromazine-induced cholestatic hepatitis, we report the case of a schizophrenic patient who presents a cytolytic hepatitis, without any prior hepatic disease. Mr G. was first hospitalized for depressive symptomatology. A pseudo-nevrotic schizophrenia was diagnosed. Pretherapeutic clinical and biological data were normal. A treatment with chlorpromazine 400 mg/day was given. At day 8, the patient was still anxious and began to be agitated. An increase to 500 mg/day of chlorpromazine posology and an addition of haloperidol 200 mg/day was implemented. At day 10, the following clinical symptoms appeared: 38.6 degrees C fever; headache; myalgia; epigastralgia and hypocondrium pain. Biological hepatitis disturbances (ALAT, 984 U/L; ASAT, 414 U/L) and hypereosinophilia with normal white cell count were found. Clinical and biological investigations were normal. Blood-culture, A, B, C hepatitis, HIV and CMV serologies were negative. Neuroleptic treatment was discontinued. Evolution to normality of the disturbances and biological data suggested a cytolytic hepatitis. Mr G... remained treated with flupentixol without side-effects. Phenothiazine-induced cholestatis is frequent, mild, and recovers spontaneously. The biological mechanism is supposed to be immunologic. Prevalence of biological hepatic disturbances is 10 to 20% with chlorpromazine in long-term treatment. More often, symptomatology is the same; jaundice, pruritus, abdominal pain, fever. Although pharmacological data suggest for a cytotoxic activity of phenothiazines, cytolytic hepatitis is poorly described. Maximum range of transaminase blood level reported in previous studies is about 400 U/l. This level is not clearly correlated with hepatic cell lysis. Few cases of hepatic necrosis have been reported. In all cases, preexistent hepatic injuries were observed. Chlorpromazine-induced cytolytic hepatitis is uncommon and cholestatic hepatitis mild. Biological hepatic parameters investigations remain necessary during neuroleptic treatment.
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PMID:[Cytolytic hepatitis during treatment with phenothiazines: apropos of a case]. 903 96

Non-Hodgkin's lymphoma is a common complication in patients with human immunodeficiency virus infection that most frequently affects the gastrointestinal tract. We describe the first case report of non-Hodgkin's lymphoma primarily involving the pancreas in a 27-yr-old white man who presented with epigastric pain, weight loss, and jaundice (and was later found to be HIV seropositive). Endoscopic ultrasound and CT scan of the abdomen showed a large mass arising from the body and head of the pancreas obstructing the common bile duct. An attempted ERCP was unsuccessful due to extrinsic compression and distortion of the second part of the duodenum. A percutaneous CT-directed true-cut needle biopsy of the pancreas revealed a small noncleaved B-cell lymphoma. The patient was started on combination chemotherapy. His pancreatic mass, epigastric symptoms, and jaundice resolved completely. This case report illustrates an otherwise rare presentation of isolated pancreatic involvement of non-Hodgkin's lymphoma in a patient with acquired immunodeficiency syndrome. An approach to its diagnosis and management is summarized.
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PMID:AIDS-related non-Hodgkin's lymphoma of the pancreas. 904 Feb 19

Tuberculosis (TB) is most commonly diagnosed as a pulmonary disease; however, haematogenous spread of the organism can cause disease in any organ system. We report the case of a 30-y-old woman, Human Immunodeficiency Virus (HIV) antibody-negative, who was diagnosed as having a pancreatic mass on computed tomographic (CT) scans. She underwent a laparotomy and the fluid drained from the mass was culture-positive for Mycobacterium tuberculosis. We review the clinical details of 37 similar cases of pancreatic TB in the literature, where each patient's HIV antibody status is negative or unknown. In this series 3 patients died (1 of these had commenced anti-TB therapy, the others had not) but the remaining 34 responded well to radiological-guided drainage and/or surgical intervention and anti-TB therapy. TB should be considered in the differential diagnosis of a pancreatic mass, especially when associated with epigastric pain or discomfort and weight loss.
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PMID:Tuberculous pancreatic abscess in an HIV antibody-negative patient: case report and review. 973 Feb 91

We report the case of a 63 year-old female who presented with a seven-year history of epigastric pain and a sudden overall deterioration. Gastroscopy demonstrated inflammatory aspect and ulceration in the antrum and fundus. Histology showed a lymphocytic infiltrate consistent with low grade mucosa-associated lymphoid tissue lymphoma and cytomegalovirus gastritis. There was no evidence of Helicobacter pylori infection. Other investigations demonstrated two pulmonary foci consistent with lymphomatous infiltration and a reduced CD4 + T-lymphocyte count (85/mm3). Other screening tests including HIV serology were negative. This case of idiopathic CD4 lymphopenia, in conjunction with the other rare cases in the literature, allows us to reevaluate this condition and its unusual clinical presentation with two opportunistic pathologies.
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PMID:[Multifocal MALT lymphoma and acute cytomegalovirus gastritis revealing CD4 lymphopenia without HIV infection]. 1021 14

A 47 year old HIV positive male presented with haematemesis and epigastric pain. A gastrectomy was performed for intractable bleeding. The cause of the haematemesis proved to be a Kaposi sarcoma of the stomach which had resulted in mucosal ulceration. Several other smaller foci of Kaposi sarcoma were also present. Coexistent with the Kaposi sarcoma was a dense lymphoid infiltrate with lymphoid follicles and reactive germinal centres. Centrocyte-like cells caused marked effacement and destruction of gastric glands with the formation of lymphoepithelial lesions, typical of a MALT lymphoma. These cells were of B cell lineage and some expressed the HIV antigen, p24. Follicular dendritic cells and macrophages within germinal centres were also p24 positive. Immunohistochemistry and in situ hybridisation did not detect Epstein-Barr virus. Although Helicobacter pylori was not identified by light microscopy in the sections sampled, this does not preclude its possible role, with other cofactors such as HIV, in the causation of the MALT lymphoma.
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PMID:Coexistent gastric MALT lymphoma and Kaposi sarcoma in an HIV positive patient. 1047 29


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