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M94A3124.TXT
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1994-10-25
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Document 3124
DOCN M94A3124
TI Toxoplasmic myocarditis in an AIDS patient: diagnosis with an
endomyocardial biopsy.
DT 9412
AU Zucman D; Lebras P; Bicetre Hospital, France.
SO Int Conf AIDS. 1994 Aug 7-12;10(1):148 (abstract no. PB0017). Unique
Identifier : AIDSLINE ICA10/94369451
AB INTRODUCTION: Cardiac involvement is frequent although rarely
symptomatic in AIDS patients. There are multiple causes of heart failure
in this setting and when cardiac signs appear isolated it represents a
difficult diagnostic problem. CASE RECORD: a 37-year-old homosexual man,
diagnosed with HIV infection in 1986, is hospitalized in september 1992
for cardiogenic shock. AIDS had declared 6 month ago (Pneumocistis
pneumonia) and the patient had been treated with zidovidine since two
years, replaced by ddI four month ago because of neutropenia. The last
CD4+ count was 50/mm3 and toxoplasmosis serology was positive (IgG). The
patient described an increasing exertional breathlessness and
intermitent fever during the past three weeks. At admission, physical
examination showed signs of severe acute heart failure. Neurological
examination was normal and temperature 37 degrees 5 C. Chest X rays
showed an important cardiomegaly and bilateral pleural effusion. An
echocardiogram showed a four chamber dilatation with a marked global
hypokinesis and a circomferantial non compressive pericarditis. The
cerebral CT scan was normal. The endomyocardial biopsy revealed a severe
toxoplasmic myocarditis with extensive myocyte necrosis and evidence of
toxoplasma pseudocysts and trophozoites. A treatment with pyrimethamine
and clindamycine was immediately begun and the clinical pattern of the
patient subsequently improved. DISCUSSION AND CONCLUSION: Cardiovascular
dysfunction is an important complication of AIDS that is reported with
increasing frequency. Myocarditis can be related to opportunistic
infections, especially toxoplasmosis. However, other causes are
possible, among them, non specific myocarditis possibly due to HIV, and
drugs toxicity such as ddI. In the case of isolated congestive heart
failure, an endomyocardial must be performed in order to find a curable
cause, in this case a toxoplasmic myocarditis.
DE Acquired Immunodeficiency Syndrome/DRUG THERAPY Adult AIDS-Related
Opportunistic Infections/*PATHOLOGY Biopsy Case Report
Clindamycin/THERAPEUTIC USE Didanosine/THERAPEUTIC USE
Heart/*PARASITOLOGY Human Male Myocarditis/COMPLICATIONS/*PATHOLOGY
Myocardium/*PATHOLOGY Pyrimethamine/THERAPEUTIC USE
Toxoplasmosis/COMPLICATIONS/DRUG THERAPY/*PATHOLOGY
Zidovudine/THERAPEUTIC USE MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).