Lymphadenopathy in the HIV-seropositive patient.

The problem of lymphadenopathy in HIV-seropositive patients is reviewed, and indications for further study are presented. Implications for patients who later develop AIDS are discussed.

Cutaneous manifestations of human immunodeficiency virus in Lusaka, Zambia.

Of the 1124 human immunodeficiency virus (HIV)-infected patients studied, one or more cutaneous lesions were found in 113 (98.3%) of the 115 patients with acquired immunodeficiency syndrome (AIDS) and in 541 (53.6%) of 1009 patients with AIDS-related complex (ARC). Kaposi's sarcoma, multidermatomal, necrotic herpes zoster, and pruritic maculopapular rashes are common cutaneous manifestations of AIDS and its related complex (ARC) in Zambia. The maculopapular rash results from a lymphoplasmacytic angiitis in the dermis, possibly in response to the presence of HIV in the dermis. Candidiasis, severe genital herpes, extensive molluscum contagiosum, and tinea corporis were less frequent and usually refractory to treatment. Drug reactions are also frequent in Zambians with AIDS. In seven patients given streptomycin, thiacetazone, and rifampicin for treatment of pulmonary tuberculosis, Stevens-Johnson syndrome occurred shortly after therapy was begun, and two died despite high-dose prednisone and discontinuance of tuberculosis therapy. Extensive seborrheic dermatitis refractory to topical fluorinated corticosteroids is also an associated condition in AIDS patients who have pulmonary tuberculosis.

PIP: Cutaneous manifestations of AIDS and AIDS-related complex were studied in a population of 1124 HIV seropositive patients at a hospital in Lusaka, Zambia. 115 of the patients had AIDS, and 1009 had AIDS-related complex. Drug eruptions occurred in 22 patients; 2 died of Stevens-Johnson syndrome subsequent to drug therapy for tuberculosis. The most frequently seen cutaneous manifestations were candidiasis, Kaposi's sarcoma, herpes zoster, seborrheic dermatitis, herpes genitalis, and papular dermatoses. The pruritic maculopapular eruption occurred in crops, healed, and recurred. It was one of the most unique dermatologic manifestations of AIDS found in Africa. Seborrheic dermatitis occurred frequently in patients who also had pulmonary tuberculosis.

The pathology of AIDS.

The acquired immunodeficiency syndrome (AIDS) is a devastating new disease caused by the human immunodeficiency virus (HIV). This retrovirus causes profound immunoincompetence in its infected hosts, who are thereafter susceptible to develop myriad severe and relapsing protozoal, fungal, bacterial, viral, and arthropodal opportunistic infections, as well as unusual malignancies. The more than 50,000 patients who have developed AIDS in the United States have produced a sudden unexpected deluge of diagnostic dilemmas that are stressing laboratories of pathology everywhere. This paper describes the gross and microscopic pathology of the numerous complications in patients infected by HIV: (a) the prodromal AIDS-related complex with persistent generalized lymphadenopathy, (b) lymphoid infiltration of salivary gland and lung, including the complex of lymphoid interstitial pneumonitis-pulmonary lymphoid hyperplasia, (c) extranodal non-Hodgkin's lymphomas, (d) multifocal mucocutaneous and visceral Kaposi's sarcoma, (e) small cell undifferentiated (oat cell) carcinomas, (f) protozoal infections caused by Pneumocystis carinii, Toxoplasma gondii, Acanthamoeba, Cryptosporidium species (sp.), and Isospora belli, (g) the causes of chronic enteritis, (h) mycotic infections caused by Candida sp., Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, and Sporothrix schenckii, (i) bacterial infections caused by Mycobacterium avium-intracellulare, M. tuberculosis, M. kansasii, Nocardia sp., Listeria monocytogenes, Legionella sp., Treponema pallidum, and others, (j) viral infections caused by cytomegalovirus, herpes simplex and zoster, polyomavirus (progressive multifocal leukoencephalopathy), hepatitis B, molluscum contagiosum, and papillomavirus, (k) oral hairy leukoplakia, (l) subacute encephalopathy, and (m) Norwegian scabies.

Parotid swelling during human immunodeficiency virus infection.

In Europe and in the United States, bilateral parotid gland swelling has been observed as a sign of human immunodeficiency virus (HIV) infection in children, but it has not been associated with HIV infection in adults. We observed a chronic parotid gland swelling in nine HIV-seropositive patients during a nine-month period in Kinshasa, Zaire. Parotid gland enlargement was bilateral in seven patients (78%), slightly painful in seven patients (78%), and painless in two patients (22%). No evidence of inflammation was observed around Stensen's duct. One of the two patients in whom a parotid gland biopsy was performed had a malignant lymphoma of the large-cell, histiocytic type. In the other patient, the parotid gland showed normal morphology with minor inflammation. Among 284 adults and 40 children with symptomatic HIV infection, chronic parotid gland enlargement was observed in none of the patients. However, two (0.7%) of the adults presented with an acute pyogenic parotitis. Further studies are needed to determine whether parotid gland enlargement is associated with HIV infection.

Disseminated extraintestinal isosporiasis in a patient with acquired immune deficiency syndrome.

This report describes a 38-year-old male homosexual with acquired immune deficiency syndrome (AIDS) and a history of Isospora belli infestation treated with trimethoprim-sulfamethoxazole. At autopsy, intracellular and extracellular I. belli organisms were identified in the mucosa and lamina propria of small and large intestine as well as in mesenteric and tracheobronchial lymph nodes, where an associated granulomatous reaction was also present. Until now, Isosporiasis has been observed as intracellular parasites restricted to the columnar cells of the intestinal mucosa in humans hosts. This is, to the authors' knowledge, the first time that this protozoa has been observed invading beyond the intestinal wall. This patient's autopsy also demonstrated intestinal ulcerations proven microscopically to be caused by cytomegalovirus (CMV). In patients with AIDS and CMV enterocolitis, the authors have observed an unusual frequency of extraintestinal disseminated disease by microorganisms heretofore typically restricted to the intestinal mucosa (i.e., bacteremias resulting from Shigella species). The authors propose that, in AIDS patients, the profound immunodeficient state, possibly in conjunction with CMV-induced intestinal mucosal ulcerations, promotes access of other intestinal microorganisms, including I. belli, into lymphatic and vascular spaces, culminating in lymphohematogenous dissemination of their intestinal infestations.

Diagnosis of pulmonary nodules in the cancer patient: the role for routine culture and an unusual application of the human tumor colony-forming assay.

Many solid tumors that occur in humans tend to metastasize to the lungs. The etiology of pulmonary nodules in cancer patients, therefore, presents a diagnostic problem that can be resolved only by histologic evaluation or resection. We present two cases of cancer patients with preoperative and intraoperative diagnoses of metastatic lung tumors. Tissue culture using the Human Tumor Colony-Forming Assay (HTCFA), a procedure that predicts chemosensitivity patterns of tumors, was employed to successfully diagnose those nodules as fungal infections. In one case, results using the HTCFA were crucial in the identification of the opportunistic organism. These cases stress the importance of routine culture of all pulmonary nodules and present an unusual but noteworthy application of the HTCFA system.