RESUMO
Lymphocytic visceral infiltration has recently been noted in association with lymphadenopathy-associated virus infection. A homosexual man, who had clinical and immunologic features of the acquired immune deficiency syndrome (AIDS)-related complex, is described. The patient presented not only with peripheral blood lymphocytosis but also with extensive lymphocytic infiltration involving lungs, lymph nodes, nerves, muscles, and esophagus. Lymphocyte subset immunostaining analysis showed that the lymphocytes were T8-positive. Thirty months after the clinical onset of the disease, no evidence of progression to AIDS was seen. Moreover, clinical improvement was observed, even though the patient did not receive long-term treatment. The clinical history of this patient suggests that lung T8-positive lymphocytic infiltration is associated with an increased risk of infectious episodes such as pneumonia and bronchitis.
Assuntos
Complexo Relacionado com a AIDS/imunologia , Linfócitos T/classificação , Vísceras/imunologia , Adulto , Homossexualidade , Humanos , Masculino , Linfócitos T/análiseRESUMO
Methotrexate-induced pneumonitis is a well-known clinical entity, but the mechanism for the induction of the pulmonary disease is ill defined. In three patients with this disorder, evidence was obtained for elaboration of a lymphokine, leukocyte inhibitory factor (LIF), by peripheral blood lymphocytes after incubation with methotrexate (MTX) in the direct leukocyte migration inhibition test. Control lymphocytes from normal subjects, as well as from patients receiving methotrexate but without pneumonitis, failed to elaborate LIF in the presence of the drug in this test. Along with these results, we obtained bronchoalveolar lavage (BAL) cell data displaying high grade lymphocyte alveolitis with a lymphocyte subset inverted ratio. This production of LIF suggests that pneumonitis associated with methotrexate therapy is also associated with a specific cellular immune response to the drug.
Assuntos
Metotrexato/efeitos adversos , Pneumonia/induzido quimicamente , Adolescente , Adulto , Feminino , Humanos , Imunidade Celular , Fatores Inibidores da Migração de Leucócitos , Pessoa de Meia-Idade , Pneumonia/imunologiaRESUMO
In AIDS a variety of severe pulmonary disorders may occur. The authors report 110 cases of bronchoalveolar lavage (BAL) in 43 AIDS and 41 ARC. In AIDS P. carinii pneumonia is the major cause of respiratory illness. BAL alone is a safe and valuable tool for diagnosis of P. carinii pneumonia and others opportunistic infections. Moreover, pulmonary hemorrhage diagnosed by the finding of hemosiderin laden macrophages, is very suggestive of broncho-pulmonary Kaposi' sarcoma. Finally, BAL demonstrates a severe depletion of T4 lymphocytes and an increased number of T8 lymphocytes. The T8 lymphocytosis is observed whatever the pulmonary involvement (nonspecific alveolitis, opportunistic infections, Kaposi's sarcoma), and is also found in ARC, and lymphocytosis, open lung biopsy shows a lymphoid interstitial infiltration with respect of the alveolar septa, thus differing from the classical lymphoid interstitial pneumonia described by Carrington. The prognosis of lymphocytosis in ARC remains unknown.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Citodiagnóstico , Pneumonia por Pneumocystis/diagnóstico , Irrigação Terapêutica , Adulto , Brônquios , Neoplasias Brônquicas/diagnóstico , Criptococose/diagnóstico , Criptococose/parasitologia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/parasitologia , Diagnóstico Diferencial , Humanos , Pneumopatias/diagnóstico , Pneumopatias/parasitologia , Neoplasias Pulmonares/diagnóstico , Masculino , Pneumonia por Pneumocystis/etiologia , Alvéolos Pulmonares , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/parasitologia , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/diagnóstico , Neoplasias Cutâneas/complicações , Linfócitos T/classificação , Toxoplasmose/diagnóstico , Toxoplasmose/parasitologiaRESUMO
Seventy out of 125 patients with HIV infection had diffuse alveolo-interstitial pneumonia usually caused by an opportunistic infection, notably pneumocystosis. Nineteen patients had only localized lung opacities due either to usual or tuberculous bacterial infections or to Kaposi's sarcoma. In 10 patients with pleural effusion or mediastinal adenopathy, the condition was due to Kaposi's sarcoma (n = 4) or to mycobacteriosis (n = 3). An opportunistic or usual infection was demonstrated in 17 of the 51 patients with normal radiography of the chest. Finally, 37 patients free from infectious or tumoral pathology had isolated lymphocytic alveolitis.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Líquido da Lavagem Broncoalveolar/patologia , Pneumopatias/epidemiologia , Infecções Oportunistas/epidemiologia , Adulto , Métodos Epidemiológicos , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/diagnóstico por imagem , Pleurisia/diagnóstico por imagem , Pleurisia/epidemiologia , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/epidemiologia , Radiografia , Testes de Função Respiratória , Tuberculose Pulmonar/epidemiologiaRESUMO
Two cases of isolated pleural actinomycosis are reported. This form is much less frequent than the pulmonary form, and it accounts for only 20% of thoracic actinomycoses. The bacteriological diagnosis is easily obtainable by pleural puncture, provided it has not been obscured by previous antibiotic therapy and provided the organism has systematically been cultured under anaerobic conditions. Pleural actinomycosis has a very favourable prognosis. Local treatment, sometimes surgical, is indispensable. If the condition is diagnosed at an early stage, systemic antibiotic therapy can be reduced to 6 to 12 weeks.
Assuntos
Actinomicose/complicações , Doenças Pleurais/etiologia , Actinomicose/tratamento farmacológico , Adulto , Empiema/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/tratamento farmacológico , RadiografiaRESUMO
The onset of non-cardiogenic acute pulmonary oedema during resection of a vesical paraganglioma is reported. Such oedema may be caused by the intravascular injection of massive doses of catecholamines in the animal. Aetiopathogenic mechanisms are suggested on the basis of experimental data.
Assuntos
Paraganglioma/cirurgia , Edema Pulmonar/etiologia , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Humanos , Complicações Intraoperatórias , Masculino , Edema Pulmonar/fisiopatologiaRESUMO
We report the case of a male patient with AIDS who had been hospitalized for various opportunistic infections, from which he recovered, and was readmitted on account of a round opacity in the lower lobe of his right lung. There was no evidence of extrapulmonary pathology. Transtracheal aspiration, alveolar lavage and transbronchial biopsy failed to identify the lesion. Lung biopsy after thoracotomy resulted in a diagnosis of malignant lymphoma type B with anti-IgA and anti-kappa antibodies. Despite chemotherapy the patient died within one month, the lymphoma having spread to both lungs.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Neoplasias Pulmonares , Linfoma não Hodgkin , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Pulmão/patologia , Masculino , Infecções Oportunistas/etiologia , PrognósticoRESUMO
Toxoplasmosis is an infection frequently observed in patients with acquired immunodeficiency syndrome. Its first manifestations usually are cerebromeningal symptoms, but others may occur. A pulmonary lesion is sometimes present; it is discovered at post-mortem examination in most cases. The authors report a case of pulmonary toxoplasmosis diagnosed by bronchoalveolar lavage (BAL). Three points are emphasized: toxoplasmosis of the lung may produce an interstitial pneumonia similar to that of pneumocystosis; diagnosis can be made non-invasively by BAL, and provided an appropriate treatment is administered, the outcome may be favourable.