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To analyze the usefulness of bone marrow (BM) study in the diagnosis of fever of unknown origin (FUO) in patients infected by the human immunodeficiency virus (HIV) in a single center during a period of 42 months.182 episodes of FUO in 162 patients p3th HIV infection were studied. Age, sex, risk factor for HIV infection, hemoglobin level, counts of leucocytes, neutrophils, lymphocytes, CD4 positive lymphocytes, platelets and levels of hepatic enzymes, albumin and beta 2-microglobulin were studied. BM aspirate was performed in all episodes for cytologic and microbiologic examination, and BM biopsy was done in 43. Analysis of factors related with the probability of diagnosis by BM examination was carried out.The median age was 33 years (range, 22-70), and 123 were males. Drug abuse was the most frequent risk factor for HIV infection (63%). One hundred thirty patients had previous AIDS diagnosis before they were evaluated for unexplained fever. A specific diagnosis was achieved in 161 episodes (88%) and the most frequent diagnoses were Mycobacterium spp. (55%) and Leishmania spp. (14%) infections. Fifty-four episodes (30%) were diagnosed by BM examination, and in 36 (20%) BM study was the only diagnostic tool. Examination of the BM aspirate yielded the diagnosis in 40 out of the 178 episodes (13%), whereas BM biopsy was a diagnostic tool in 8 (19%); in 9 additional cases (21%) granulomas were observed. Microbiologic study of BM smears for mycobacterial infections was positive in 28 of the 143 episodes (19%), and the culture for Leishmania was positive in 2 out of the 42 cases. The presence of thrombocytopenia (75 x 10(9)/l) and elevated serum levels of aspartate-aminotransferase (AST) (100 U/l) were the factors associated with a high probability to obtain the diagnosis through BM study.In patients infected by the HIV and unexplained fever, BM examination is an useful procedure for the diagnosis, particularly in areas where infections by Mycobacterium spp. and Leishmania are prevalent. So that, in our setting, systematic use of this procedure is justified for diagnosis of FUO in those patients.

Disseminated histoplasmosis is frequent in patients with HIV infection from endemic zones of Africa and South America. It is infrequent in Europe. Four cases diagnosed as disseminated histoplasmosis among a total of 1,100 AIDS cases reported from 1984 to 1994 were reviewed. Four males with a mean age of 40 years were reviewed. Two were from Argentina, one from Gambia with HIV-2 infection and the remaining case was a Spanish man who had made numerous travels to endemic zones. Prolonged fever without an apparent focci in the previous weeks was the clinical manifestation at the onset in all the cases. Diagnosis was performed by bone marrow aspirate (1 case), histologic study of the cutaneous lesions (1 case) and on autopsy with the diagnosis not being suspected during life (2 cases). Tracheal ulcers and hyperferritinemia are the main peculiarities of the two cases presented. Antifungal treatment with amphotericin B and secondary prophylaxis with itraconazole were effective in one of the cases. It is important to take histoplasmosis into account in the differential diagnosis of prolonged fever in patients with HIV infection from endemic zones.

Although cardiac infiltration is common in advanced stage of acute leukaemia, it is not usually diagnosed at life and it is extremely rare for it to become pseudotumoral. A 25-years-old patient with an acute monoblastic leukaemia who had a leukaemic infiltration which affected the main part of the left ventricle at the time of diagnosis, is referred. The heart infiltration was detected by a two dimension echocardiography. In spite of a massive infiltration, heart failure was not present and the left ventricle's ejection fraction was 50%. Even though chemotherapy was administered, the patient died four days after diagnosis due to septic shock of respiratory origin. The most relevant autopsy finding was a widespread pseudotumoral infiltration of the left ventricle, the back side of the right ventricle and the interventricular wall. The pseudotumoral infiltration of the heart by acute leukaemia is uncommon and must be differentiated from granulocytic sarcoma. The usefulness of the different diagnostic procedures is discussed.