Esophageal actinomycosis: a case report and review of the literature.

A 37-year-old African-American male with acquired immunodeficiency syndrome (AIDS) presented with recurrent chest pain. An upper gastrointestinal endoscopy had been performed two months previously and esophageal biopsy revealed extensive candidal infection with ulceration. He temporarily responded to fluconazole. Repeat biopsy revealed actinomyces and continued candidal infection. Review of the original biopsy also demonstrated actinomyces in addition to candida. After initial response to therapy with penicillin, he worsened on outpatient therapy and subsequently expired from progression of disease. Lack of compliance may have been contributary. To date, 8 patients with esophageal actinomycosis have been reported, five of whom had AIDS. Of the remaining three, none was otherwise immunocompromised. This is the first report of esophageal actinomycosis occurring as a superinfection of candidal ulceration. We also describe the findings and utility of thoracic CT in this condition and review the literature.

Cytomegalovirus infection as a cause of pseudomembrane colitis: a report of four cases.

Pseudomembranous colitis is very commonly encountered in patients with acquired immune deficiency syndrome (AIDS), and has been characteristically associated with Clostridium difficile infection. We present four cases of AIDS-related diarrhea and pseudomembrane formation on endoscopy with pathologic features consistent with cytomegalovirus (CMV) colitis. Our findings indicate that CMV colitis should be considered in the differential diagnosis of pseudomembranous colitis in immunocompromised patients.

The diagnostic value of electron microscopy in human immunodeficiency virus-positive patients with gastrointestinal disease.

BACKGROUND: Our aim was to determine the diagnostic value of electron microscopy in evaluating the etiology of gastrointestinal disease in patients infected with the human immunodeficiency virus (HIV). METHODS: A retrospective review of electron microscopic and light microscopic results of all HIV-positive patients with gastrointestinal and liver diseases was made during a 3-year period from June 1995 to June 1998. RESULTS: A total of 145 HIV-positive patients had their electron microscopy specimens reviewed. Of these, 136 were investigated for diarrhea, and the other 9 for increased liver enzymes. Twenty-seven of the 145 (18.6%) HIV-positive patients had a pathogen identified by electron microscopy, compared with only 13 of 145 (9%) identified by light microscopy (P < 0.005). The sensitivity of light microscopy for detecting opportunistic pathogens was 68%. Twenty-one of the 27 (77.8%) patients diagnosed by electron microscopy had microsporidiosis, and the most commonly diagnosed species was Enterocytozoon bieneusi. Light microscopy failed to identify 12 cases of microsporidiosis and 2 cases of leishmaniasis. CONCLUSIONS: Electron microscopy contributes substantially to the identification of pathogens in HIV-positive patients. Light microscopy failed to identify one of every two pathogens diagnosed by electron microscopy.

Anal carcinoma: a 15-year retrospective analysis.

BACKGROUND: Using a 15-year experience in two teaching hospitals to illustrate the clinicopathologic, treatment and survival characteristics of cloacogenic and squamous cell carcinoma of the anus. METHOD: A retrospective analysis over a 15-year period from St Vincent's Hospital (SVH) and the Catholic Medical Center (CMC) in New York City. The patients in the study all had a diagnosis of either squamous or cloacogenic cell carcinoma of the anus. RESULTS: Cloacogenic and squamous cell carcinoma accounted for 2.5% of all large bowel cancers. In the population sample, 28/92 (30.4%) were of the cloacogenic type and 64/92 (69.6%) were of the squamous cell type. The male-to-female ratio was 1:1.5 in those with cloacogenic cancer and 1.8:1 in those with squamous cell carcinoma. The mean age of presentation was 57 +/- 2.8 years for the squamous cell carcinoma patients and 66.3 +/- 3.4 years in those with cloacogenic carcinoma (P < 0.02); 3/28 (10.7%) of patients with cloacogenic cancer were human immune deficiency virus (HIV) positive while 15/64 (23.4%) of the squamous cell cancer patients were HIV positive. The most common clinical presentation in both groups were rectal bleeding, pain, constipation and the presence of an anal mass. Of patients with squamous cell cancer 25% had evidence of infection with the human papilloma virus (HPV) while none of those with cloacogenic cancer had evidence of HPV infection (P < 0.0005). The treatment modality and survival were similar in both histologic groups. The most important factors that affect survival in both groups are female sex and stage of disease. CONCLUSION: Cloacogenic and squamous cell carcinoma account for only a small proportion of large bowel cancers. The squamous cell type is the more common type and presents at a younger age in both sexes. The squamous cell type is also more common in males and is associated with human papilloma and HIV infection. Treatment modality and survival is, however, similar in both histologic variants of anal cancer.