RESUMO
PURPOSE: To report treatment of a patient with acquired immunodeficiency syndrome (AIDS) and ocular and paranasal sinus microsporidial infection. METHOD: Case report. RESULTS: A patient with AIDS and ocular microsporidial infection experienced resolution of ocular symptoms with topical fumagillin, but symptoms recurred upon cessation of therapy. Paranasal sinus microsporidial infection was diagnosed. The patient received sequential systemic treatment with itraconazole followed by albendazole. Sinus symptoms resolved with albendazole. He remained symptom-free with a normal examination 17 months after concluding therapy. CONCLUSIONS: Although fumagillin and itraconazole may have played a role, systemic albendazole appears to be responsible for clinical resolution of microsporidial infection.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Oftalmopatias/parasitologia , Microsporida , Doenças dos Seios Paranasais/parasitologia , Infecções por Protozoários/tratamento farmacológico , Sinusite/parasitologia , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças dos Seios Paranasais/diagnóstico por imagem , Radiografia , Sinusite/diagnóstico por imagemRESUMO
PURPOSE: To describe a case of disciform keratitis in a patient with acquired immunodeficiency syndrome (AIDS) in which varicella-zoster virus was the causative agent. METHOD: Case report, Polymerase chain reaction-based assays for varicella-zoster virus, cytomegalovirus, and herpes simplex virus were used to analyze an aqueous aspirate. RESULTS: We examined a 41-year-old man with AIDS but without a history of varicella-zoster virus dermatitis who had disciform corneal edema in his left eye. Varicella-zoster virus was detected by a polymerase chain reaction-based assay in the aqueous of the left eye; however, neither cytomegalovirus nor herpes simplex virus DNA were detected by polymerase chain reaction-based assays. The corneal edema slowly resolved while the patient was treated with famciclovir. CONCLUSION: Varicella-zoster virus may cause disciform keratitis without a preceding skin eruption.
Assuntos
Herpes Zoster , Ceratite/patologia , Ceratite/virologia , 2-Aminopurina/análogos & derivados , 2-Aminopurina/uso terapêutico , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Antivirais/uso terapêutico , Edema da Córnea/patologia , Edema da Córnea/virologia , DNA Viral/análise , Famciclovir , Herpes Zoster/complicações , Herpes Zoster/tratamento farmacológico , Herpesvirus Humano 3/genética , Humanos , Masculino , Reação em Cadeia da PolimeraseRESUMO
AIDS: Eye problems are a significant concern for HIV-positive patients, in whom CMV blindness and vision loss is a devastating side effect. CMV retinitis is the most common eye disease in people with HIV, affecting up to 45 percent of people with AIDS. CMV retinitis is treated with oral or intravenous ganciclovir, although some patients have difficulty absorbing the drug, and an eye implant has been developed. Foscarnet is also used in combination therapy. The Food and Drug Administration (FDA) recommends beginning prophylaxis when CD4 counts drop below 50.^ieng