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Introduction: Extranodal non-Hodgkin lymphoma (NHL) were commonly described in AIDS patients and are related with an atypical morphology and aggressive clinical course. Materials and Methods: In this single institutional study we evaluated the epidemiological, clinical, immunological, virological, histopathological and the outcome of eleven HIV/AIDS patients with oral cavity lymphomas (OCL). Results: Nine were males and seven intravenous drug abusers. The median of age was 33 years and the median of CD4 T cell counts at the time of diagnosis was 97 cell/μL. The majority of tumors presented as large and ulcerated masses involving the gingiva, the palate and the jaw. Six of these tumors were diffuse large B-cell lymphomas (DLBCL); three were Burkitt's lymphomas and the final case was a plasmablastic lymphoma. An association with Epstein-Barr virus (EBV) was found in three of the ten tested cases by in situ hybridization (EBER 1 and 2 probes) and immunohistochemistry (LMP-1). Human herpes virus-8 (HHV-8) was detected by polymerase chain reaction (PCR) in only one neoplasm. Six patients died without specific treatment; four received chemotherapy and highly active antiretroviral therapy (HAART) and three of them presented a prolonged survival. Discussion Combination: of HAART and chemotherapy should modify the poor prognosis of AIDS patients with OCL. Fil: Corti, Marcelo. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Villafañe, Maria Florencia. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Solari, Ruben. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: De Carolis, Luis. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Cangelosi, Diana. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Santoro, Jose. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Schtirbu, Ricardo. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Lewi, Daniel. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; Argentina Fil: Bistmans, Alicia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina Fil: Narbaitz, Marina. Academia Nacional de Medicina de Buenos Aires; Argentina Fil: Baré, Patricia. Academia Nacional de Medicina de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Paracoccidioidomycosis is a systemic disease endemic to subtropical areas in Central and South America caused by a dimorphic fungus known as Paracoccidioides brasiliensis. Central nervous system involvement is a severe complication of the systemic disease, and has been found in approximately 13% of patients. This paper describes the case of a patient whose computed tomography scan and magnetic resonance imaging showed a single tumor-like lesion in the brainstem. Histopathological and mycological examinations of stereotactic biopsy smears showed the characteristic yeast cells that confirmed the diagnosis of neuroparacoccidioidomycosis.

Non-Hodgkin lymphomas (NHL) of the B-cell type are the second most common neoplasm among patients with human immunodeficiency virus (HIV) infection and AIDS. Here, we evaluated 48 cases of AIDS-related lymphomas (ARL) diagnosed at the Histopathological Division of the Instituto de Investigaciones Hematológicas of the National Academy of Medicine. Five were females and 43 were males with a median of age of 37 years at the time of the diagnosis. Micrometer sections were prepared and stained with hematoxilin-eosin; immunohistochemical examination for the presence of Epstein-Barr virus (EBV) was carried out in 48/48 cases. Additionally, biotinilated oligonucleotides were used to determine the presence of DNA of the Human Herpes virus type-8 (HHV-8) in 14/14 biopsy smears corresponding to plasmablastic lymphomas (PL). All were fenotype B cell lymphomas with an aggressive course and advanced neoplasm disease at the time of diagnosis. Virological findings showed the strong association between EBV and AIDS-related NHL. According to the histopathological subtype, the EBV genome was detected in 16/21 (76%) diffuse large B cell lymphomas, 1/3 Burkitt lymphoma and 3/4 (75%) of primary central nervous system lymphomas. Globally, EBV genome was detected in 20/28 NHL of this series. Detection of HHV-8 was negative in all cases of PL. Hodgkin lymphoma were more frequent in males 18/20 (90%), with an aggressive clinical course and a significant predominance of the subtypes associated with worse prognosis (90% of cases). We detected a significant association between EBV and HL (90% of cases). We consider that all cases of AIDS related lymphomas should be assessed for the presence of EBV because its presence may play a role in the prognosis.

To review the neurological manifestations of Chagas' disease, including its clinical presentation, diagnosis, management, treatment and follow-up.A systematic review of the literature found in MEDLINE, EMBASE, LILACS and SCIELO was performed to search for relevant references on Chagas' disease and neurological manifestations.The involvement of the nervous system in Chagas' disease is well established. The acute phase is described as a meningoencephalitis that more frequently affects children under 2 years old and is almost always fatal in those with coexistent myocarditis and cardiac insufficiency. In the chronic phase, it presents as neuritis that results in altered tendon reflexes and sensory impairment, and is reported in up to 10% of the patients. Isolated cases of central nervous system involvement can also include dementia, confusion, chronic encephalopathy and sensitive and motor deficits. Concurrent immunosuppression, such as that related to human immunodeficiency virus and organ transplantation, can result in the reactivation of the Trypanosoma cruzi infection. In these patients meningoencephalitis and brain abscesses may occur with a high mortality rate despite specific treatment.Although neurological involvement is infrequent, it has a high mortality and morbidity rate when is not well diagnosed and treated on time.

Publisher Summary The identification of latent T. cruzi infection in HIV/AIDS patients is highly important. Continued attempts to do so should be considered both in endemic and nonendemic areas of Chagas disease. Early diagnosis of reactivation of chronic Chagas disease with CNS involvement followed by specific antiparasitic therapy may modify the poor prognosis of this kind of patient. Chagas disease, or American trypanosomiasis, is a zoonotic disease caused by the flagellated protozoan Trypanosoma cruzi, which was first identified by Carlos Chagas in 1909 in Minas Gerais, Brazil. Generally, this zoonotic disease is transmitted to humans and animals by Triatoma infestans (vectors) known as “vinchucas” in Argentina and “barbeiros” in Brazil. Less frequently, T. cruzi can be transmitted by transfusions of infected blood, transplacental route, and organ transplantation from an infected donor. Sharing intravenous needles with an infected person with parasitemia is another possible source of infection. Rarely, the oral route, including breast milk and laboratory accidents, is an alternative source of infection.

Plasmablastic lymphoma is a rare and a relatively new entity that was first described in the jaws and the oral cavity of HIV-AIDS patients. We report a case of plasmablastic lymphoma involving the liver in an AIDS patient. Plasmablastic lymphoma is considered a diffuse large B-cell lymphoma with a unique phenotype and predilection for the oral cavity. The case presented had a unique hepatic lesion, localized in the left lobe of the liver. Diagnosis was confirmed by hepatic biopsy guided by Computerized Tomography scan and histopathology. The smears showed a dense infiltrate composed by atypical lymphocytes with numerous plasmocytes expressing the plasma cell markers MUM-1 and CD138 and negative for the B-cell markers CD3, CD20 and CD45. Immunohistochemical and in situ hybridization revealed the Epstein-Barr virus genome in the atypical cells. Polymerase chain reaction was negative for HHV-8 RNA.

Cryptococcosis is an opportunistic fungal infection caused by Cryptococcus neoformans. Generally, the disease affects the central nervous system, especially in patients with human immunodeficiency virus infection. Central nervous system involvement can be either meningeal or parenchymal. As the infection spreads along the Virchow-Robin spaces these structures may dilate with the mucoid and gelatinous material produced by the organism's capsule. The lesions associated with the dilatation of Virchow-Robin spaces are referred to as gelatinous pseudocysts. Bigger lesions are known as cryptococcomas. In this article we describe five patients with neurocryptococcosis associated with AIDS and parenchymal lesions compatible with gelatinous pseudocysts and cryptococcomas.

Focal brain lesions are frequent complications among HIV/AIDS patients. Between January 1999 and May 2007, 83 procedures of stereotactic brain biopsies in HIV/AIDS patients with focal cerebral lesions were carried out. The inclusion criteria were lack of response to current diagnostic and therapeutic guidelines for brain lesions. All the samples underwent microscopic evaluation during surgery to assert valid material and delayed histopathological and microbiological examination. Forty one patient images demonstrated multiple brain lesions. Sixty two cases had supratentorial localization, 4 lesions were located beneath the tentorium and 17 showed both settings. Fifty one lesions presented peripheral enhancement after contrast computed tomography (CT) or magnetic resonance imaging (MRI). A 100% of useful samples recovery was achieved. Progressive multifocal leucoencephalopathy (PML) was the most frequent diagnosis (29%), followed by primary central nervous system lymphoma (PCNSL) (23%), and toxoplasmosis (15.7%). Statistically significant association was observed between histopathological diagnosis and lesion location and between those and peripheral ring enhancement images. The positive diagnostic rate of the invasive procedure was 90.3%. The morbidity/mortality rate was 2.4% in this series. In conclusion, the stereotactic brain biopsy ordered early during the patient's evolution showed a good performance in order to achieve a prompt and accurate diagnosis and to guide the therapeutic scheme in these AIDS patients with focal brain lesions.

Disseminated Mycobacterium avium complex (MAC) infection is a severe complication of advanced HIV/AIDS disease. Disseminated infection due to MAC appeared later in the natural history of HIV disease and was an independent predictor of mortality in patients before the extended use of highly active antiretroviral therapy (HAART). The use of combination schemes, including three or four antimicrobial agents followed by secondary prophylaxis and HAARTs, improved the survival and reduced mortality rates. However, subjects who ignore their serological status for HIV, or who are not receiving or do not tolerate HAART, are at high risk of developing disseminated MAC disease. In addition, patients who show a good immunological and virological response to HAART can develop episodes of immune reconstitution inflammatory syndrome associated with MAC, including supurative lymphadenitis and subcutaneous or soft-tissue abscesses. In this article, we describe the epidemiological, clinical, immunological, therapeutic and preventive aspects of MAC infection in HIV-seropositive patients in the pre- and post-HAART era.

Adult intussusception is rare. Here, we describe a case of an AIDS adult patient who developed an ileocolic intussusception secondary to a large B cell lymphoma of the cecum. Surgical findings included the ileon free of the tumor and invaginated within the cecum with infiltrating neoplasm. Surgical treatment included the resection of the right hemicolon because of the tumor, located in the cecum, causing intussusception. The English and Spanish literature is reviewed.

Mycobacteria other than tuberculosis (MOTT) have a low incidence as pathogens in human pathology. The most frequent clinical expression is the disseminated disease in subjects with compromised cellular immunity. Bacteriological characteristics in culture can generate confusion with other pathogens, which delays the appropriate diagnosis and treatment. We present a case of a disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess in a man with a medical background of cellular immunity deficit induced by therapeutic drugs. The antibiotic scheme of twenty-one weeks, during the follow-up period, controlled the infection, however, the optimum duration of treatment has not been established.

Pulmonary cryptococcosis is an unusual fungal infection that is most often found in AIDS or in organ transplant recipients. Although in immunocompromised patients, cryptococcal infection often causes pulmonary infections, the diagnosis of lung involvement is generally difficult. The presentation of pulmonary cryptoccosis in HIV-infected patients appears to be more acute and severe than in other immunocompromised patients, probably related with the severe immunosuppression. Diffuse infiltrates, mediastinal and hilar lymph nodes enlargement are the most common radiological findings in AIDS-associated pulmonary cryptococcosis. Cavitation is a rare form of and includes only 10% to 15% of all cases. Only a few case reports or studies with small number of patients of pulmonary cryptococcosis have been published over the past two decades. We report a case of an AIDS patient who developed cavitary pneumonia as the only clinical expression of cryptococcosis.

Summary Objectives The objective of this study was to evaluate clinical and microbiological characteristics of Chagas disease (ChD) with central nervous system (CNS) involvement in AIDS patients. Methods This was a retrospective study of clinical and laboratory findings of HIV-infected patients with a confirmed diagnosis of ChD involving the CNS during the period 1992–2007 at the "Francisco J. Muniz" Infectious Diseases Hospital, Buenos Aires, Argentina. Results Of a total of 15 patients, 14 were male and the median age was 33 years (range 25–54 years). Seven out of nine had lived in a Chagas endemic area and 7/10 were intravenous drug users (IDUs). The disease was reactivated during corticosteroid therapy in three patients. Clinical manifestations were: headache (11/15), focal neurological deficits (9/15), fever (9/15), meningismus (7/15), seizures (7/15), altered mental status (5/15), and cardiac involvement (3/10). The median CD4 T-cell count at the time of reactivation was 64cells/μl (range 1–240). Twelve of 14 had positive serology for Trypanosoma cruzi ; the two negative were IDUs. Cerebrospinal fluid (CSF) findings (median (range)): cell count 5/mm 3 (2–90), protein level 0.68g/l (0.1–1.84), and glucose level 0.45g/l (0.13–0.73). CSF direct examination for T. cruzi was positive in 11/13. Neuroimaging findings showed a single hypodense lesion in 7/14 and normal images in 2/14. Twelve patients were treated with benznidazole. The global mortality was 79% (11/14). Conclusions ChD reactivation should be considered as a differential diagnosis of meningoencephalitis in HIV patients with low CD4 T-cell counts, previous residency in an endemic area, and/or IDUs. Whenever possible, lumbar puncture should be performed because of the high accuracy for early diagnosis.

El síndrome inflamatorio de reconstitución inmune (SIRI) es una reacción atípica e inesperada relacionada con el tratamiento antirretroviral de gran actividad (TARGA) en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). El SIRI representa una respuesta inflamatoria frente a un patógeno oportunista (generalmente Mycobacterium tuberculosis, Complejo Mycobacterium avium, citomegalovirus y herpes varicela-zóster) en pacientes que responden a la TARGA con una marcada reducción de la carga viral en plasma y evidencia de una recuperación inmunológica expresada por el incremento de los niveles de linfocitos T CD4+. Presentamos el caso de un paciente con síndrome de inmunodeficiencia adquirida que desarrolló un absceso subcutáneo en muslo derecho y una adenitis supraclavicular izquierda como manifestación de SIRI por Complejo Mycobacterium avium luego del inicio de un segundo esquema de TARGA. Immune reconstitution inflammatory syndrome (IRIS) is an atypical and unexpected reaction related to highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) infected patients. IRIS includes an atypical response to an opportunistic pathogen (generally Mycobacterium tuberculosis, Mycobacterium avium complex, cytomegalovirus and herpes varicella-zoster), in patients responding to HAART with a reduction of plasma viral load and evidence of immune restoration based on increase of CD4+ T-cell count. We reported a case of a patient with AIDS which, after a first failure of HAART, developed a subcutaneous abscess and supraclavicular lymphadenitis as an expression of IRIS due to Mycobacterium avium complex after starting a second scheme of HAART.

Histoplasmosis is an endemic and systemic mycosis, caused by the dimorphic fungus Histoplasma capsulatum var capsulatum. Disseminated disease in immunocompromised patients generally results from the reactivation of latent foci after a prolonged period of asymptomatic infection. We report a case of laryngeal histoplasmosis as the unique clinical manifestation of a progressive form of the disease in a patient with advanced HIV/AIDS disease. Histopathological analysis of laryngeal biopsy smears revealed granulomas containing Histoplasma-like organisms. Treatment with amphotericin B followed by itraconazole resulted in complete remission of laryngeal lesions. To our knowledge, this is the third case report of laryngeal histoplasmosis in a patient with AIDS.

The objective of this study was to identify prognostic factors of death in patients with tuberculous meningitis (TM) and show the impact of infection by multidrug-resistant strains on the outcome of this disease. We retrospectively analysed clinical charts of HIV-infected patients with culture-confirmed TM attending our institution during 1996-2004. The following variables were associated with death during hospitalization: neurological signs at admission, a CD4 T-cell count less than 50 cells/microl and infection by multidrug-resistant strains.

Non-Hodgkin's lymphoma (NHL) is the second most common neoplasm among patients with AIDS. One of the major clinical characteristics of AIDS-associated NHL is the high frequency of extra-nodal involvement, including the gastrointestinal tract, at initial presentation.From January 1997 to December 2004, 8 cases of NHL of the digestive tract and anexal glands (liver and parotid gland) were observed at the HIV/AIDS division of the Infectious Diseases FJ Muñiz Hospital from Buenos Aires, Argentina. All patients were staged by computed tomography scanning and bone marrow examination, in addition to the endoscopic evaluation.All patients were males; 4 were heterosexual, 2 homosexual, and 1 were a hemophilic and an intravenous drug abuser. The median age was 42 years and the median CD4 T cell count was 87 cells/uL at the time of the diagnosis of neoplasm. No patient was receiving highly active antiretroviral therapy (HAART) at lymphoma diagnosis. The global incidence of AIDS-associated lymphomas (central nervous system lymphomas, non-Hodgkin lymphomas and Hodgkin lymphoma) during the time of study was 2,9% (54 cases); 17 patients (32%) had diagnosis of systemic NHL; 10 (58,8%) of them were extranodal at the onset of clinical symptoms and 8 (80%) involvement the digestive tract and anexal glands (parotid gland, cavum, esophagus, stomach, duodenum, the right colon in 2 patients and the liver), as primary NHL of high grade and "B" phenotype. All patients presented "B" symptoms at the time of diagnosis. Primary duodenal lymphoma was the only Burkitt lymphoma of this serie and we detected the Epstein-Barr virus genome in the biopsy smears of this tumor and in the hepatic lymphoma. Four patients were treated with systemic chemotherapy with granulocitic growth factor support plus highly active antiretroviral therapy (HAART); 2 of them (cavum and one of the colon) had a prolonged survival with immune reconstitution during 5 and 6 years, respectively, after the diagnosis. The median survival of the patients, which received HAART plus chemotherapy, was 33 months. The median survival of the others patients was 90 days.NHL of the gastrointestinal tract is a severe complication of advanced HIV/AIDS disease. Early diagnosis followed by chemotherapy plus HAART are necessary to improve the prognosis and the survival of these patients.

Non-Hodgkin's lymphoma of B-cell type is the second most common neoplasm after Kaposi's sarcoma, among patients with human immunodeficiency virus infection. Most non-Hodgkin's lymphoma cases that are associated with acquired immunodeficiency syndrome involve extranodal sites, especially the digestive tract and the central nervous system. We report a case of primary lymphoma of the duodenum in a patient with AIDS. Upper gastrointestinal endoscopy revealed pseudopolypoid masses found in the second portion of the duodenum. A complete diagnostic study including histological, immunohistochemical and virological analyses showed high-grade B-cell Burkitt's lymphoma. The Epstein-Barr virus genome was detected in biopsies by immunohistochemical and in situ hybridization.

Spinal epidural abscess (SEA) is a rare infectious disorder that often has delayed diagnosis and is associated with significant morbidity and mortality rates. We present a case of an AIDS patient with a SEA due to Mycobacterium tuberculosis. This type of SEA in AIDS patients is characterized by localized spinal pain and prolonged fever. Magnetic resonance imaging is the method of choice in the diagnostic process. Early diagnosis, followed by specific therapy (surgical decompression combined with antituberculous drugs), is necessary to improve the prognosis of these kinds of patients.

Nocardiosis is a bacterial disease that occurs in immunocompromised patients, including those infected by the human immunodeficiency virus (HIV).We retrospectively analyzed the clinical records of 27 HIV-positive patients with nocardiosis seen during the period of 1993 to 2004. Clinical presentations, diagnostic methods, predominant species, antimicrobial therapy and outcome were analyzed.Among the total, 81% were males and the median age was 30 years. There was an elevated percentage of alcoholism (89%), smoking (80%) and intravenous drug use (82%). A previous positive serology for HIV infection was present in 85% of the patients. Plasma CD4+ T cell count at the time of diagnosis in 15 of 17 patients (88%) was below 50 cells/microl (median 15 cells/microl). The most frequent clinical onset was pulmonary in 70%, followed by cutaneous in 11% and disseminated in 11%. The main specimens for diagnostic bacterial isolation were sputum (54%), skin and soft tissues (22%) and bronchoalveolar lavage (19%). The predominant pulmonary radiological pattern was alveolar infiltration (74%), followed by cavitations (32%). The species was identified in 13 patients (48%); Nocardia asteroides was isolated in 84% (n = 11). The main antimicrobial drugs prescribed were cotrimoxazole (78%), amikacin (59%) and ciprofloxacin (33%). Dual therapy was used in 78% of the cases, with cotrimoxazole-amikacin being the most frequent. Overall mortality was 37%.Nocardiosis is an unusual infection among HIV-infected patients. The diagnosis should be considered in patients with CD4+ T cell counts below 50/microL and lung or pericardial involvement.

Non-Hodgkin's lymphomas (NHL) are the second most frequent malignancies in AIDS patients. The majority of NHL associated with AIDS involves extranodal sites, especially the digestive tract and the central nervous system. Primary liver lymphoma (PLL) is an uncommon neoplasm among these patients. Ultrasonography and computed tomography scans may be helpful in the diagnosis of focal hepatic lymphoma. Image-guided fine-needle biopsy with histopathology of the liver lesions is the gold standard for the diagnosis of hepatic lymphoma. We report a case of PLL as the initial manifestation of AIDS in a patient without any previous infection by hepatitis C or B virus, presented as multiple and large hepatic masses.

In order to investigate hepatitis C virus (HCV) persistence and replication in peripheral blood mononuclear cells (PBMC) from a group of haemophilic individuals, HCV production and release to PBMC culture supernatants (SNs) from HCV singly infected patients and HIV/HCV co-infected patients was studied. HCV RNA+ SNs were found more frequently from HIV/HCV co-infected individuals (89.5 %) with poor reconstitution of their immune status than from singly HCV-infected patients (57 %) or from HIV/HCV co-infected individuals with a good response to highly active anti-retroviral therapy (50 %). The presence of the HCV genome in culture SNs was associated with lower CD4+ T-cell counts and with a more severe clinical picture of HIV infection. In spite of prolonged negative HCV viraemia, PBMC from HIV/HCV co-infected patients released the HCV genome after culture. HCV permissive PBMC allowed generation of HCV productive B cell lines with continuous HCV replication. These findings add further weight to the involvement of PBMCs in persistence of HCV infection and emphasize the role of B lymphocytes as HCV reservoirs. © 2005 SGM. Fil: Baré, Patricia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex"; Argentina Fil: Massud, Ivana. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex"; Argentina Fil: Parodi Ramoneda, Cecilia María. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex"; Argentina Fil: Belmonte de Zalar, Liliana Elizabeth. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex"; Argentina Fil: García, Gabriel Hugo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: de Campos Nebel, Ildefonso Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex"; Argentina Fil: Corti, Marcelo. Fundación Argentina de la Haemofilia; Argentina Fil: Tezanos Pinto, Miguel. Fundación Argentina de la Haemofilia; Argentina. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex"; Argentina Fil: Pérez Bianco, Raúl. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex"; Argentina. Fundación Argentina de la Haemofilia; Argentina Fil: de Elizalde, Maria Marta. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex"; Argentina Fil: Campos, Rodolfo Hector. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Ruibal, Beatriz Haydee. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex"; Argentina

Primary lymphoma is the most common neoplasm of the central nervous system (CNS) in AIDS patients.We retrospectively reviewed the clinical manifestations, neuroimaging findings, diagnostic methods used, histological characteristics, detection of Epstein-Barr virus (EBV) DNA by PCR in cerebrospinal fluid (CSF) and brain smears, and outcome of 18 HIV/AIDS patients with primary CNS lymphoma.The overall incidence of primary CNS lymphoma was 2.6%. Fifteen were men and mean age was 33.6 years. The most frequent clinical findings were focal neurological deficits and seizures. The mean CD4 T cell count at the time of diagnosis was 44 cells/microl. Primary CNS lymphoma presented as single, large (2.5 cm) lesions in 14 patients (77.8%). All the lesions were associated with a mass effect and surrounding edema. EBV DNA was detected in nine brain smears. In seven of these nine cases, EBV DNA was also found in CSF by PCR. Median survival after specific diagnosis was 75 days.This study upholds a link between EBV and these tumors. Primary CNS lymphoma was associated with a poor prognosis and short survival in this cohort of patients.

In the setting of HIV infection, cytomegalovirus (CMV) and herpes simplex virus type 1-2 (HSV 1-2) can affect both the central and peripheral nervous systems. These agents can involve the spinal cord and produce a necrotizing transverse myelitis. This usually occurs in AIDS patients with severe immunodeficiency: CD4+ lymphocyte counts typically are less than 50 cell/microL. The clinical presentation, CSF and imaging studies can provide a high level of suspicion diagnosis. Prompt initiation of antiviral specific drugs is essential. We report a patient with an acute necrotizing myelitis (cauda equina syndrome) secondary to CMV and HSV infections.

We analysed the prevalence of hepatitis G virus (HGV) infection in HCV+/HIV+ hemophilic patients determining HGV viremia in plasma by polymerase chain reaction (PCR). The overall prevalence of HGV infection was 13.51%. Viremia by HGV was more frequent in younger patients. Two subgroups of patients were considered taking into account prognosis of HIV disease progression. The prevalence of HGV infection was significantly higher in those with better prognosis and low risk of evolution to AIDS. The results suggest that HGV infection may slow disease progression, directly or indirectly.

Non-Hodgkin's lymphoma (NHL) is the second most common acquired immunodeficiency syndrome (AIDS)-defining cancer. In this population, up to 70-80% of cases may present as extranodal location as the primary clinical manifestation of the neoplasm disease. Gastrointestinal tract is the most frequent location of AIDS-associated NHL. However, salivary gland involvement, including the parotid gland is a rare complication in human immunodeficiency virus (HIV)-patients. Here, we describe a patient seropositive for the HIV, who developed a primary NHL of the parotid gland histologically classified as a high-grade diffuse large B-cell lymphoma. Patient was treated with a combination of chemotherapy plus highly active antiretroviral therapy with a good clinical, virological and immunological response and a prolonged survival, more than 5 years, without evidence of neoplasm relapse.

Clinical presentation of primary human immunodeficiency virus (HIV) infection includes a wide spectrum of manifestations from asymptomatic infection to a symptomatic and severe illness. Central nervous system involvement should be always considered as a severe clinical form of primary HIV infection. Physicians should be aware to the broad clinical spectrum of primary HIV infection. We report a case of a female with diagnosis of mononucleosis-like syndrome and acute aseptic meningoencephalitis during primary HIV infection.

Disseminated histoplasmosis is a relatively common AIDS-defining illness, occurring in almost 4% of patients living in endemic areas and it may be the first clinical expression of the HIV infection. A broad spectrum of clinical skin lesions associated with Histoplasma capsulatum infection have been described in AIDS patients, such as erythematous macules, papules, nodules, and pustules. Herpetic, acneiform, erythema multiforme-like, molluscum contagiosum-like, vasculitic, and exfoliative forms have also been reported. To our knowledge, this is the first case of disseminated histoplasmosis in an AIDS patient presented as a rupioid eruption. A histoplasmose disseminada é uma das doenças associadas à AIDS e relativamente comum, ocorrendo em quase 4% dos pacientes que vivem em áreas endêmicas e pode ser a primeira expressão clínica da infecção pelo HIV. Amplo espectro de lesões de pele associadas com a infecção pelo Histoplasma capsulatum têm sido descritas nos pacientes com AIDS, tais como máculas eritematosas, pápulas, nódulos e pústulas. Foram também relatadas lesões herpéticas, acneiformes, similares ao eritema multiforme, similares ao molusco contagioso, vasculíticas e esfoliativas. Em nosso conhecimento este é o primeiro caso de histoplamose disseminada em paciente com AIDS que se apresenta como erupção de aspecto rupióide.

Evolucion Los examenes directos del esputo y lavado broncoalveolar fueron negativos para bacilos acido-alcohol resistentes (BAAR), bacterias comunes, hongos y parasitos. Se efectuo biopsia de la lesion cutanea, cuyo examen histopatologico mostro epidermis adelgazada, con ulceracion por despegamiento dermoepidermico y perdida de las crestas interpapilares. En la dermis, se observo incremento de los haces de fibras colagenas, escasos macrofagos con citoplasma claro y fibroblastos dispuestos en fasciculos paralelos a la epidermis (fig. 2). Con la coloracion de Ziehl-Neelsen se observaron abundantes bacilos aislados y agrupados, alargados y sin fragmentacion (fig. 3). Las coloraciones de acido peryodico de Schiff (PAS) y Grocott no revelaron otros microorganismos. Los cultivos de esputo, el lavado broncoalveolar y la biopsia cutanea mostraron el desarrollo de Mycobacterium tuberculosis sensible a todos los farmacos antituberculosos. Se realizo tratamiento con isoniacida, rifampicina, etambutol y pirazinamida por via oral durante 2 meses, profilaxis con cotrimoxazol en dosis de 160 mg de trimetoprima y 800 mg de sulfametoxazol 3 veces por semana y suplementos vitaminicos. Evoluciono con excelente respuesta clinica. Al mes de tratamiento, la bacteriologia del esputo fue negativa y la lesion cutanea habia cicatrizado; la radiografia de torax fue normal y la ecografia abdominal mostro la desaparicion de las imagenes hipoecoicas del bazo. Caso clinico

En nuestrocaso, dado que el unico hallazgo de los estudios comple-mentarios fue la alteracion observada en la mucosa gas-trica, la diarrea podria responder a otra etiologia, infeccio-sa o no. No obstante, contamos con varias determinacionesque descartaron potenciales causas de diarrea cronica eneste paciente, lo cual, junto con la rapida respuesta al tra-tamiento antifungico con itraconazol, frecuente en lainfeccion por

Paciente de 39 anos con serologia reactiva para el virusde la inmunodeficiencia humana (VIH) y el virus de la he-patitis C (VHC), heterosexual y adicto a drogas intrave-nosas (ADIV). Sin antecedentes de enfermedades marca-doras de sida ni terapia antirretroviral de gran actividad(TARGA). Ingreso en la Unidad 10 del Hospital de En-fermedades Infecciosas Francisco J. Muniz por fiebre(38,5 °C), perdida de peso (15 kg en los ultimos 3 meses) yuna placa eritematocostrosa en mejilla izquierda y ala na-sal homolateral de un mes de evolucion. El examen der-matologico comprueba la presencia de una placa eritema-toedematosa en la region malar y el ala nasal izquierda,infiltrada en sus bordes, con temperatura local aumenta-da, cubierta de escamocostras, que le provoca asimetria fa-cial (fig. 1) y ademas, compromiso de la mucosa nasal ho-molateral que se observa cubierta de costras. En la zonainferior de la comisura bucal derecha tiene una lesion pe-quena de similares caracteristicas. El resto del examen fi-sico mostro adelgazamiento, hipotonia e hipotrofia muscu-lar generalizada, estertores crepitantes diseminados enambos pulmones y hepatoesplenomegalia.Los examenes de laboratorio arrojaron los siguientes re-sultados: hematocrito 35%; hematies 3.710.000/ l; leuco-citos 5.800/ l; plaquetas 166.000/ l; velocidad de sedi-mentacion globular 107 mm en la primera hora; fosfatasaalcalina 766 U/l. El resto de la quimica sanguinea regis-tro valores normales. La serologia fue negativa para sifi-lis, toxoplasmosis y Chagas. El recuento de linfocitos TCD4+ fue de 57 cel./ l (3%). La radiografia de torax mos-tro un infiltrado intersticial hiliofugal bilateral y la eco-grafia abdominal evidencio una hepatomegalia con au-mento de la ecogenicidad compatible con esteatosis,fibrosis o granulomatosis y esplenomegalia con varias le-siones hipoecoicas, la mayor de 5,4 mm.