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5. Skin lesions, malaise, and heart failure in a renal transplant recipient

Author

A. Schleich, L.G. Wyler, C. Kocher, Stephan Segerer, J. Blum, V. Müller, Nicolas J. Mueller, R. Caduff, J. Kamarachev, B. Beck, University of Zurich, and Mueller, N J

Subjects
Adult, Chagas Cardiomyopathy, Male, Chagas disease, medicine.medical_specialty, Myocarditis, 2747 Transplantation, Trypanosoma cruzi, Antibodies, Protozoan, 610 Medicine & health, Parasitemia, Malaise, 10234 Clinic for Infectious Diseases, Fatal Outcome, 10049 Institute of Pathology and Molecular Pathology, medicine, Humans, Chagas Disease, Skin Diseases, Parasitic, Screening procedures, Kidney transplantation, Skin, Heart Failure, Transplantation, business.industry, 10177 Dermatology Clinic, 2725 Infectious Diseases, medicine.disease, Kidney Transplantation, Surgery, Infectious Diseases, Heart failure, medicine.symptom, business
Abstract

A male Caucasian patient developed nodular erythematous skin lesions, malaise, and clinical signs of progressive heart failure 4 months after renal transplantation. Bronchoscopy with bronchoalveolar lavage performed for a small infiltrate seen on a computed tomography scan revealed Trypanosoma, which had at this point not been suspected as a cause. Parasitemia was present, and reactivation rather than transmission of Chagas' disease was established by performing polymerase chain reaction and serology in the donor and recipient. Treatment with benznidazole and allopurinol successfully reduced parasitemia, but the clinical course was fatal owing to progression of severe myocarditis. The patient had never lived in an endemic area, but had an extensive travel history in South America. The last visit was more than 5 years before transplantation. In non-endemic countries (United States, Europe), reactivation after transplantation has only been very rarely reported. Given the rising numbers of transplantations in patients with a migration background and extensive travel histories, specific screening procedures have to be considered.

Published
2012
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6. Androgen and gonadotropin patterns differ in HIV-1-infected men who develop lipoatrophy during antiretroviral therapy: a case-control study.

Author

Wunder DM, Fux CA, Bersinger NA, Mueller NJ, Hirschel B, Cavassini M, Elzi L, Schmid P, Bernasconi E, Mueller B, and Furrer H

Subjects
Adult, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Case-Control Studies, Drug Therapy, Combination, HIV Infections complications, HIV Infections metabolism, HIV-Associated Lipodystrophy Syndrome metabolism, Humans, Male, Middle Aged, Treatment Outcome, Viral Load, Androgens metabolism, Gonadotropins metabolism, HIV Infections drug therapy, HIV-1, HIV-Associated Lipodystrophy Syndrome diagnosis
Abstract

Objectives: We compared androgen and gonadotropin values in HIV-infected men who did and did not develop lipoatrophy on combination antiretroviral therapy (cART)., Methods: From a population of 136 treatment-naïve male Caucasians under successful zidovudine/lamivudine-based cART, the 10 patients developing lipoatrophy (cases) were compared with 87 randomly chosen controls. Plasma levels of free testosterone (fT), dehydroepiandrosterone (DHEA), follicle-stimulating hormone and luteinizing hormone (LH) were measured at baseline and after 2 years of cART., Results: At baseline, 60% of the cases and 71% of the controls showed abnormally low fT values. LH levels were normal or low in 67 and 94% of the patients, respectively, indicating a disturbance of the hypothalamic-pituitary-gonadal axis. fT levels did not significantly change after 2 years of cART. Cases showed a significant increase in LH levels, while controls showed a significant increase in DHEA levels. In a multivariate logistic regression model, lipoatrophy was associated with higher baseline DHEA levels (P=0.04), an increase in LH levels during cART (P=0.001), a lower body mass index and greater age., Conclusions: Hypogonadism is present in the majority of HIV-infected patients. The development of cART-related lipoatrophy is associated with an increase in LH and a lack of increase in DHEA levels.

Published
2008
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