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The diagnosis of multiple opportunistic infections in advanced stage AIDS: when Ockham's Razor doesn't cut it
Pinheiro, Marcos Vinicius Cardoso; Ho, Yeh-Li; Nicodemo, Antonio Carlos; Duarte-Neto, Amaro Nunes.
Afiliação
  • Pinheiro, Marcos Vinicius Cardoso; Universidade de Sao Paulo. Faculty of Medicine. Department of Anatomic Pathology. São Paulo. BR
  • Ho, Yeh-Li; Universidade de Sao Paulo. Faculty of Medicine. Hospital das Clinicas, Infectious and Parasitic Diseases Department. São Paulo. BR
  • Nicodemo, Antonio Carlos; Universidade de Sao Paulo. Faculty of Medicine. Hospital das Clinicas, Infectious and Parasitic Diseases Department. São Paulo. BR
  • Duarte-Neto, Amaro Nunes; Universidade de Sao Paulo. Faculty of Medicine. Hospital das Clinicas, Emergency Department and LIM 06. São Paulo. BR
Autops. Case Rep ; 8(2): e2018028, Apr.-May 2018. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-905529
Biblioteca responsável: BR26.7
ABSTRACT
In the advanced stage of AIDS, the diagnosis of the opportunistic infections may be challenging due to the high risk of performing invasive diagnostic methods in a patient with a critical clinical condition, as well as the correct interpretation of the results of microbiological exams. One of the challenges for the diagnosis and treatment of the opportunistic infections is that they may occur concomitantly in the same patient and they may mimic each other, leading to a high discrepancy between clinical and autopsy diagnoses. We describe the case of a 52-year-old man who was hospitalized because of weight loss, anemia, cough, and hepatosplenomegaly. During the investigation, the diagnosis of AIDS was made, and the patient developed respiratory failure and died on the fourth day of hospitalization. At autopsy, disseminated non-tuberculosis mycobacteriosis was found, affecting mainly the organs of the reticuloendothelial system. Also, severe and diffuse pneumonia caused by multiple agents (Pneumocystis jirovecii, Histoplasma capsulatum, suppurative bacterial infection, non-tuberculosis mycobacteria, and cytomegalovirus) was seen in a morphological pattern that could be called "collision pneumonia." The lesson from this case, revealed by the autopsy, is that in advanced AIDS, patients often have multiple opportunistic infections, so the principle of Ockham's razor­that a single diagnosis is most likely the best diagnosis­fails in this clinical context.
Assuntos


Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: Doenças Negligenciadas Problema de saúde: Tuberculose Base de dados: LILACS Assunto principal: Síndrome de Imunodeficiência Adquirida / Infecções Oportunistas Relacionadas com a AIDS / Pneumopatias Fúngicas Tipo de estudo: Estudo diagnóstico Limite: Humanos / Masculino Idioma: Inglês Revista: Autops. Case Rep Assunto da revista: Anatomia / Patologia Cl¡nica / Patologia Legal Ano de publicação: 2018 Tipo de documento: Artigo País de afiliação: Brasil Instituição/País de afiliação: Universidade de Sao Paulo/BR

Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: Doenças Negligenciadas Problema de saúde: Tuberculose Base de dados: LILACS Assunto principal: Síndrome de Imunodeficiência Adquirida / Infecções Oportunistas Relacionadas com a AIDS / Pneumopatias Fúngicas Tipo de estudo: Estudo diagnóstico Limite: Humanos / Masculino Idioma: Inglês Revista: Autops. Case Rep Assunto da revista: Anatomia / Patologia Cl¡nica / Patologia Legal Ano de publicação: 2018 Tipo de documento: Artigo País de afiliação: Brasil Instituição/País de afiliação: Universidade de Sao Paulo/BR
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