HTLV-1-associated adult T cell leukemia lymphoma presenting as granulomatous pneumocystis jiroveci pneumonia (PJP) and hypercalcemia.

BACKGROUND: Since the initial description of human T cell lymphotropic virus (HTLV-1), clusters of this infection have been detected globally. Unlike HIV infection, most patients infected with HTLV-1 remain asymptomatic throughout their lifetime. CASE REPORT: We report the case of a 39-year-old Afro-Caribbean man with HTLV-1 infection presenting as hypercalcemia and granulomatous pneumocystis jiroveci pneumonia. RESULTS: Interestingly, the hypercalcemia presented with normal parathyroid hormone-related protein and low 1,25 dihydroxyvitamin D levels, and the presence of pneumocystis jiroveci in the granulomas was diagnosed with transbronchial biopsy taken during bronchoscopy. HTLV-1-associated adult T cell leukemia lymphoma (ATLL) was diagnosed in this patient by bone marrow and lymph node biopsy. CONCLUSION: Increased bone resorption, likely cytokine-mediated, is the most likely mechanism of hypercalcemia in this patient. This is believed to be the first description of this type of reaction to pneumocystis jiroveci in a HTLV-1-infected ATLL patient.

Disparities in obstructive sleep apnea and its management between a minority-serving institution and a voluntary hospital.

We assessed disparities in severity of obstructive sleep apnea (OSA) and associated comorbidities, as well as in provision of sleep medicine health care, between patients evaluated for OSA in a voluntary hospital (VH) primarily serving a middle-class population with health-care insurance and a city hospital-based minority-serving institution (MSI) largely treating lower income, uninsured, and indigent patients. A retrospective chart review of patients evaluated for OSA at the VH (n=200) and at the MSI (n=103) was performed. Despite similar age and apnea hypopnea index, MSI patients had a greater body mass index, higher daytime systemic blood pressure, more comorbid medical conditions, and a lower minimum sleep SaO2 than VH patients. Systemic hypertension, diabetes mellitus, asthma, and congestive heart failure were more prevalent in the MSI group. Forty-two percent of the MSI patients diagnosed with OSA failed to follow up for treatment compared with 7% in the VH group, p<0.001. Disparities in OSA-associated comorbid conditions, as well as in delivery of sleep medicine-related health care, were evident between the VH and MSI groups. These findings suggest that OSA may be an important factor contributing to socioeconomic-based differences in morbidity and mortality.

Catamenial hemoptysis and pulmonary endometriosis: a case report.

Hemoptysis can be caused by a variety of pulmonary diseases, including parasitic infections, tuberculosis, chronic bronchitis and malignancies. Rarely, pulmonary endometriosis can present with hemoptysis and pose a diagnostic problem to clinicians. Pulmonary endometriosis can easily be confused with other clinical entities, including pulmonary embolism, pneumonia and pneumothorax. Histopathologic confirmation is difficult, since the bleeding site is not easy to locate. However, a presumptive diagnosis of pulmonary endometriosis can be made with a typical clinical history. Even so, medical therapy may be problematic, with recurrence of symptoms despite hormonal ablation. We report a case of presumptive pulmonary endometriosis in a 32- year-old woman with a history of an induced abortion, who presented with catamenial hemoptysis (approximately one tablespoon per episode) occurring in the first 3 days of menstruation over an 11-month period. She was treated with an oral contraceptive for two months. No recurrence of hemoptysis was noted during 18 months of follow-up. The approach to diagnosis and treatment of pulmonary endometriosis is reviewed.