RESUMEN
We report an unusual case of human immunodeficiency virus (HIV) infection initially presenting with hypothermia and bradycardia associated with an HIV encephalitis. Searches reveal only five reported cases of spontaneous episodic hypothermia in the context of HIV infection. In our case, magnetic resonance imaging revealed the presence of a persistent cavum septum pellucidum (CSP), an anatomical and functional neuro-developmental abnormality, as well as changes compatible with an HIV encephalitis. Episodic hypothermia can occur in association with agenesis of the corpus callosum, known as Shapiro's syndrome, and the presence of a persistent CSP in our case suggests it may have contributed to the clinical presentation.
Asunto(s)
Complejo SIDA Demencia/diagnóstico por imagen , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/diagnóstico , Hipotermia/etiología , Adulto , Recuento de Linfocito CD4 , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Inmunoglobulina G , Imagen por Resonancia Magnética , Masculino , Pancitopenia , Resultado del Tratamiento , Carga ViralRESUMEN
A 38 year-old woman, who was previously fit and well, presented with a 10 day history of fever and non-specific symptoms. Initial chest X-ray demonstrated patchy nodular infiltrates bilaterally. She became increasingly hypoxaemic. Cultures to this point were all negative. A high-resolution CT thorax showed diffuse multilobular ground glass appearance with peripheral nodular shadowing, consistent with a viral pneumonia. CMV IgM antibody was positive and CMV PCR was positive on two subsequent occasions. She was commenced on oral valganciclovir. She made a full recovery and was discharged seven days later.
Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Inmunocompetencia , Neumonía Viral/diagnóstico , Adulto , Anticuerpos Antivirales/análisis , Citomegalovirus/genética , Citomegalovirus/inmunología , Infecciones por Citomegalovirus/inmunología , ADN Viral/análisis , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Inmunoglobulina M/inmunología , Neumonía Viral/inmunología , Reacción en Cadena de la Polimerasa , Radiografía Torácica , Tomografía Computarizada por Rayos XRESUMEN
Antibodies of apparent D specificity may be found in D+ patients. We report a D+, multi-transfused Caucasian woman with myelodysplasia who exhibited several alloantibodies. One antibody was a moderately strong (2+) anti-D that persisted for 9 months, until the woman died. Molecular analysis of the patient's RHD gene identified the rare weak D type 21 (938C > T) allele. D alloantibodies do not occur in patients with most weak D types, but some patients with a weak D phenotype, including those with type 21, can produce antibodies to nonself epitopes of the wild-type D antigen.
Asunto(s)
Transfusión de Componentes Sanguíneos/efectos adversos , Incompatibilidad de Grupos Sanguíneos/inmunología , Isoanticuerpos/inmunología , Síndromes Mielodisplásicos/sangre , Pancitopenia/sangre , Sistema del Grupo Sanguíneo Rh-Hr/inmunología , Anciano , Alelos , Epítopos/inmunología , Resultado Fatal , Femenino , Genotipo , Humanos , Isoanticuerpos/sangre , Síndromes Mielodisplásicos/inmunología , Síndromes Mielodisplásicos/terapia , Pancitopenia/inmunología , Pancitopenia/terapia , Mutación Puntual , Globulina Inmune rho(D)RESUMEN
A 29 year-old Nigerian studying in the UK presented with a neck lump and otitis media. Paragonimus-like trematode eggs were found in the neck lump aspirate. Morphologically these eggs resembled Paragonimus uterobilateralis or Achillurbainia congolensis. We favoured the diagnosis of achillurbainiasis over extrapulmonary paragonimiasis on the basis of clinical features and because we could not amplify DNA sequences using PCR primers specific for Paragonimus species. We discuss current diagnostic challenges for this rare parasitic infection.