Gelatinous bone marrow in an HIV-positive patient.

Gelatinous bone marrow transformation has been identified in patients with anorexia, malignancy, malabsorption, and HIV/AIDS. This represents a deposition of gelatinous material within the bone marrow, along with atrophy. We report the case of an HIV-seropositive man who presented with low back pain related to his gelatinous bone marrow changes.

Cutaneous reactions with tenofovir disoproxil fumarate: a report of nine cases.

Adverse drug reactions causing the early discontinuation of therapy are common in patients with HIV infection. Hypersensitivity consisting mainly of a maculopapular rash on the face, extremities and trunk has been observed at a rate higher than expected in patients treated with tenofovir at our clinics. We therefore examined nine patients with suspected tenofovir hypersensitivity reactions in two indigent care HIV clinics. Type I and type IV hypersensitivity may be involved as immunological mechanisms.

Achieving American Diabetes Association goals in HIV-seropositive patients with diabetes mellitus.

This retrospective study examined whether the goals set forth by the American Diabetes Association were being attained in an HIV specialty clinic run by internal medicine physicians. The charts of 40 HIV patients with diabetes were reviewed. Patients were divided into two groups: those who had seen a clinical pharmacist for medication adherence counseling (n = 20) and those who had not (n = 20). Overall, less than 50% of patients were achieving goals of therapy for hemoglobin A(1c), cholesterol, triglycerides, and blood pressure. Only 5% were documented as receiving aspirin therapy. The medication adherence counseling was not a significant factor in the results. Clinicians need to be aware of the concomitant disease states that HIV patients have and to treat those disease states to the standard of care set forward.

Iopamidol-induced meningoencephalopathy in an HIV-seropositive patient.

Central nervous system infectious and metabolic abnormalities are common in HIV-positive patients. Drug therapy, opportunistic infections, the clinical course of HIV disease itself, and very rarely iodinated radiographic contrast agents can all be linked to these abnormalities. The following case describes an HIV-seropositive patient who developed encephalopathy after undergoing a cervical myelogram that utilized iopamidol dye (Isovue-M 300 mg/mL).

Tophaceous gout in a patient with rheumatoid arthritis.

Chronic gout and rheumatoid arthritis are common medical manifestations with debilitating effects on patients. However, these conditions are not typically identified concomitantly and can be hard to distinguish from one another. We report a rare case of a 50-year-old white woman with a history of chronic gout and rheumatoid arthritis who presented with intradermal tophaceous gout. Physical examination and laboratory results are described.

A 44-year-old woman with hematemesis and cutaneous hemorrhages as a result of superwarfarin poisoning.

The authors present the case of a 44-year-old American Indian woman with hematemesis, spontaneous cutaneous hemorrhages, and multiple ecchymoses. Coagulation factor analyses demonstrated both prolonged prothrombin time (PT, >40 s) and prolonged partial thromboplastin time (PTT, >120 s). Measurement of the serum level of brodifacoum (37 ng/mL), one of the superwarfarin agents commonly used in rodenticides, confirmed poisoning as the cause of the patient's symptoms. Substantial amounts of fresh frozen plasma and vitamin K were required to obtain normal coagulation parameters and maintain these parameters over a 3-week inhospital period. Oral administration of vitamin K (100 mg daily) maintained normal PT (14.1 s), PTT (33.0 s), and international normalized ratio (INR, 1.48) at 2 weeks after the patient was discharged from the hospital. By 2 months postdischarge, PT, PTT, and INR returned to elevated levels because of patient noncompliance with the prescribed tapering vitamin K regimen.