Unusual aetiology of respiratory compromise in a patient with AIDS

2021 ◽  
Vol 14 (3) ◽  
pp. e240849
Author(s):  
Naji Maaliki ◽  
Aleem Azal Ali ◽  
Carmen Liliana Isache ◽  
Win Aung
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Clinical Status ◽  
Kaposi Sarcoma ◽  
Pulmonary Involvement ◽  
Empiric Therapy ◽  
Respiratory Compromise ◽  
Highly Active ◽  
Hiv Test ◽  
History Of ◽  
Bilateral Lung

A 36-year-old African American man with no medical history presented with a recent history of cough and dyspnoea. Initial chest imaging revealed diffuse bilateral lung infiltrates. A subsequent HIV test resulted positive, and he was presumptively diagnosed with AIDS, later confirmed by a CD4 of 88 cells/mm3. Empiric therapy with trimethoprim–sulfamethoxazole was initiated for presumed Pneumocystis jirovecii pneumonia. The patient’s clinical status deteriorated despite treatment. Further workup with chest CT, bronchoscopy and skin biopsy led to a diagnosis of Kaposi sarcoma with pulmonary involvement. Highly active antiretroviral therapy therapy was initiated, along with plans to start chemotherapy. However, the patient’s clinical status rapidly declined, leading to respiratory failure and eventual death. This case underlines the importance of maintaining a broad differential in immunocompromised patients presenting with respiratory symptoms.

scholarly journals Skin Lesions and Lower Extremity Edema in a newly diagnosed HIV patient

1970 ◽  
Vol 1 (1) ◽  
pp. 12-15
Author(s):  
Andrew B Trotter ◽  
Debra D Poutsiaka
Keyword(s):  
Differential Diagnosis ◽  
Lower Extremity ◽  
Highly Active Antiretroviral Therapy ◽  
Kaposi Sarcoma ◽  
Pulmonary Involvement ◽  
The United States ◽  
Skin Lesions ◽  
Newly Diagnosed ◽  
Mortality And Morbidity ◽  
Highly Active

The differential diagnosis of skin lesions in human immunodeficiency virus patients is diverse and includes both infectious and non infectious causes. In this case presentation, a 37 year old male newly diagnosed with HIV presented to a hospital in the United States with skin lesions and worsening lower extremity swelling. After presentation, he developed respiratory distress and was found to have disseminated Kaposi sarcoma with cutaneous and pulmonary involvement. Kaposi sarcoma has decreased in incidence in the era of highly active antiretroviral therapy. However, it remains an important acquired immunodeficiency syndrome defining illness which may be the presenting complaint in a patient with occult HIV infection. Kaposi sarcoma has substantial mortality and morbidity and should be included in the differential diagnosis of skin lesions in a HIV positive patient. DOI: http://dx.doi.org/10.3126/jaim.v1i1.5833 Journal of Advances in Internal Medicine. 2012; 1(1): 12-15

scholarly journals Persistent Kaposi sarcoma in the era of highly active antiretroviral therapy: characterizing the predictors of clinical response

AIDS ◽  
2008 ◽  
Vol 22 (8) ◽  
pp. 937-945 ◽  
Author(s):  
Huong Q Nguyen ◽  
Amalia S Magaret ◽  
Mari M Kitahata ◽  
Stephen E Van Rompaey ◽  
Anna Wald ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Clinical Response ◽  
Highly Active Antiretroviral Therapy ◽  
Kaposi Sarcoma ◽  
Highly Active

Acquired localised lipoatrophy secondary to transgluteal drainage

2021 ◽  
Vol 14 (7) ◽  
pp. e242964
Author(s):  
Austin Hamp ◽  
Jarett Anderson ◽  
Arjun Bal ◽  
Nate Hansen
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Subcutaneous Fat ◽  
Pelvic Abscess ◽  
Previous Surgery ◽  
Abscess Drainage ◽  
Potential Side Effect ◽  
Highly Active ◽  
History Of ◽  
Focal Fat ◽  
Made In

Acquired localised lipoatrophy is a focal loss of subcutaneous fat, which is commonly secondary to trauma, injections of medications such as antibiotics or corticosteroids, pressure, previous surgery or panniculitis. We present a case of a patient who experienced focal fat loss in the left gluteal region from a previous left transgluteal drainage of a suspected abscess. There was no medical history of corticosteroid, antibiotic injection or use of highly active antiretroviral therapy. Lipoatrophy occurring as a consequence of a deep pelvic abscess drainage has not been reported in the literature; however, based on the lack of other aetiologies, the diagnosis of acquired localised lipoatrophy secondary to a transgluteal drainage was made in this patient. The aim of this report was to present this rare cause of lipoatrophy that has not previously been described and to acknowledge lipoatrophy as a potential side effect of a deep abscess drainage.

scholarly journals Overt Lower Gastrointestinal Bleeding and Pseudotumor: A Rare Presentation of Cytomegalovirus Infection

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Akanksha Agrawal ◽  
Deepanshu Jain ◽  
Sameer Siddique
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
The Body ◽  
Cmv Infection ◽  
Rare Presentation ◽  
Multiple Organs ◽  
Highly Active ◽  
History Of ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

Cytomegalovirus (CMV) is a ubiquitous organism which can infect multiple organs of the body. In an immunocompromised patient, it can have a myriad of gastrointestinal manifestations. We report a case of recurrent hematochezia and concomitant pseudotumor in an AIDS (acquired immunodeficiency syndrome) patient attributable to CMV infection. A 62-year-old man with a history of AIDS, noncompliant with highly active antiretroviral therapy (HAART), presented with bright red blood per rectum. Index colonoscopy showed presence of multiple ulcers, colonic stenosis, and mass-like appearing lesion. Biopsy confirmed CMV infection and ruled out malignancy. Cessation of dual antiplatelet therapy and compliance with HAART lead to clinical cessation of bleeding and endoscopic healing of ulcers with complete resolution of colon mass on follow-up colonoscopy.

scholarly journals Acute gouty arthritis as a manifestation of immune reconstitution inflammatory syndrome after initiation of antiretroviral therapy

2012 ◽  
Vol 54 (4) ◽  
pp. 231-233 ◽  
Author(s):  
Walter de Araujo Eyer-Silva ◽  
Maria Cecília da Fonseca Salgado ◽  
Jorge Francisco da Cunha Pinto ◽  
Fernando Raphael de Almeida Ferry ◽  
Rogério Neves-Motta ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Highly Active Antiretroviral Therapy ◽  
Immune Reconstitution ◽  
Gouty Arthritis ◽  
Infected Male ◽  
Acute Gouty Arthritis ◽  
Highly Active ◽  
History Of ◽  
Inflammatory Syndrome

Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected subjects initiating antiretroviral therapy most commonly involves new or worsening manifestations of previously subclinical or overt infectious diseases. Reports of non-infectious IRIS are much less common but represent important diagnostic and treatment challenges. We report on a 34-year-old HIV-infected male patient with no history of gout who developed acute gouty arthritis in a single joint one month after initiating highly active antiretroviral therapy.

scholarly journals Effect of highly active antiretroviral therapy (HAART) on the natural history of ocular manifestations in HIV-infected children

Eye ◽  
2006 ◽  
Vol 20 (5) ◽  
pp. 595-597 ◽  
Author(s):  
S Esposito ◽  
A Porta ◽  
J Bojanin ◽  
L Gualtieri ◽  
L Cesati ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Natural History ◽  
Highly Active Antiretroviral Therapy ◽  
Ocular Manifestations ◽  
Highly Active ◽  
History Of

scholarly journals Pneumocystis jirovecii Pneumonia in a HIV-Infected Patient with a CD4 Count Greater Than 400 Cells/μL and Atovaquone Prophylaxis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Abigayle Sullivan ◽  
Theresa Lanham ◽  
Ronald Krol ◽  
Shilla Zachariah
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Lung Biopsy ◽  
Cd4 Count ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Silver Stain ◽  
Highly Active ◽  
History Of ◽  
Methenamine Silver ◽  
Methenamine Silver Stain

We describe a rare case of Pneumocystis jirovecii pneumonia (PCP) in a heterosexual man with a pertinent medical history of well-controlled human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) and PCP prophylaxis with atovaquone. The patient presented with recurrent shortness of breath, worsening malaise, and fever, following treatment for hypersensitivity pneumonitis one month prior, including a twenty-four-day course of 40 milligrams daily glucocorticoid with taper. However, transbronchial biopsies, lavage, and cytology from prior admission were inconclusive. The patient refused video-assisted thoracic surgery (VATS) at that time. Upon readmission, bronchoscopy with right VATS and lung biopsy were performed. Grocott’s methenamine silver stain of right lung biopsy was positive for Pneumocystis jirovecii. This case is a rare example of PCP in a patient with a normal CD4 count (>487 cells/μL) and a low viral load (<20 copies/mL) despite PCP prophylactic antibiotics in the setting of recent iatrogenic immunosuppression.

The Response of HIV-Associated Lymphadenopathic Kaposi Sarcoma to Highly Active Antiretroviral Therapy Evaluated by 18F-FDG PET/CT

2012 ◽  
Vol 37 (7) ◽  
pp. 692-693 ◽  
Author(s):  
Satveer K. Mankia ◽  
Robert F. Miller ◽  
Simon G. Edwards ◽  
Alan Ramsay ◽  
Siow Ming Lee
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Fdg Pet ◽  
Kaposi Sarcoma ◽  
Highly Active ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

The Prevalence of HIV-1 DNA in AIDS-Related Lymphoma throughout the Epidemic in the US

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5205-5205
Author(s):  
Leanne C Huysentruyt ◽  
Lawrence D Kaplan ◽  
Michael S. McGrath
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Conflicts Of Interest ◽  
Kaposi Sarcoma ◽  
Sequence Evolution ◽  
Genomic Amplification ◽  
Hiv Dna ◽  
Non Hodgkin Lymphoma ◽  
Highly Active ◽  
Reported Data ◽  
Hiv 1

Abstract Abstract 5205 Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) are the two most common AIDS-defining cancers and significantly contribute to HIV-related deaths. While highly active antiretroviral therapy (HAART) has produce a sharp decline in the incidence of KS and AIDS-related NHL (ARL), HIV-infected patients are still at a high risk for developing these malignancies. Recent studies evaluating HIV-1 DNA in 91 AIDS-related KS cases demonstrated a significant decrease in the prevalence of HIV-1 DNA positive KS cases post-HAART (after 1996; 16.7%) as compared to pre-HAART (before 1996; 45%) corresponding to the decrease in incidence of this cancer since the introduction of HAART. Additionally HIV was more prevalent in sites of visceral KS (51.9%) as compared to skin KS (30.7%). We have recently evaluated the HIV sequence evolution in the context of metastatic ARL and identified lymphoma-specific HIV compartmentalized within tumor sites that was genetically distinct from HIV in non-tumor sites suggesting a specific form of HIV arises within individuals who develop ARL. The goal of this research was to determine the prevalence and quantity of HIV DNA in 119 ARL biopsies representing the entire span of the HIV epidemic (1982–2005). Whole genomic amplification was performed on DNA extracted from three 10um paraffin embedded tissue sections and the presence of HIV-1 DNA was determined by quantitative amplification of the HIV gag gene. Of the 119 cases, 45% contained detectable levels of HIV DNA. The HIV antigen was predominantly localized to macrophages. A subset of the ARL cases in this study contained approximately 1 HIV copy per cell which is extremely high considering previously reported data describing HIV-infected lymph nodes contained approximately 1 HIV copy per 1000 cells. Similar to what was observed for KS, the prevalence of HIV-positive ARLs has decreased in the post-HAART era (39%) when compared to pre-HAART (54%). While the prevalence of HIV-1 DNA positive ARLs declined in the post-HAART era, it was not to the same extent as what was observed for KS. Thus, our data is consistent with a decrease in the incidence of both tumor types in the post-HAART era. The higher prevalence of HIV-1 DNA in visceral sites of KS and lymphoma specific-HIV sequences in sites of metastatic lymphoma suggests that HIV, especially HIV infected macrophages, may play a role in the pathogenesis of KS and ARL disease progression. Disclosures: No relevant conflicts of interest to declare.

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