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M94A0707.TXT
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1994-10-21
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Document 0707
DOCN M94A0707
TI Case presentation: a 35 year old man with cystic pneumocystis pneumonia,
cerebro-ocular lymphoma and recurrent bacteraemia.
DT 9412
AU Paterson DL; Allworth AM; Hospital Brisbane, Australia.
SO Annu Conf Australas Soc HIV Med. 1993 Oct 28-30;5:27 (abstract no.
TC-3). Unique Identifier : AIDSLINE ASHM5/94348948
AB A 35 year old man HIV antibody positive since 1986 presented in February
1993 with pleuritic chest pain haemoptysis and dyspnoea. His past
history included syphilis, bacillary angiomatosis, Kaposi's sarcoma and
CMV retinitis. His CD4 lymphocyte count was 70 x 10(6)/L. He was on
didanosine and monthly nebulised Pentamidine. Physical examination
revealed a low-grade fever (37.8 degrees C) and a left pleural rub. CXR
revealed marked cystic changes in the left lower lobe and a small apical
pneumothorax. Pneumocystis carinii was isolated from an induced sputum
sample. In view of a Bactrim allergy, he was treated with intravenous
Pentamidine for 3 weeks. He made a dramatic improvement with total
clearing of the cystic changes over a number of weeks. He re-presented
in May 1993 with dysphasia and poor balance. MRI of his head showed
multiple low intensity lesions in both cerebral hemispheres. The lesions
increased in number despite 2 weeks of anti-Toxoplasma treatment
delivered by a peripherally inserted central catheter (PICC). A
stereotactic cerebral biopsy was performed revealing a high-grade B cell
lymphoma. He was treated with radiotherapy (40 Gy in 15 fractions) with
good clinical response. However the vision in his left eye deteriorated
due to orbital recurrence of lymphoma. The patient had 2 bacteraemic
episodes with Gram negative organisms during his illness. These were
with Serratia marcescens and then Acaligenes denitrificans. Cystic
pneumonia due to Pneumocystis carinii and the spectrum of bacteraemic
illnesses seen in HIV-infected people will be reviewed.
DE Adult AIDS-Related Opportunistic Infections/*DIAGNOSIS/DRUG THERAPY
Bacteremia/*DIAGNOSIS Brain Neoplasms/*DIAGNOSIS Case Report
Cysts/*DIAGNOSIS/DRUG THERAPY Human Lung Diseases/*DIAGNOSIS/DRUG
THERAPY Lymphoma, AIDS-Related/*DIAGNOSIS Male Orbital
Neoplasms/*DIAGNOSIS Pentamidine/THERAPEUTIC USE Pneumonia,
Pneumocystis carinii/*DIAGNOSIS/DRUG THERAPY MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).