RESUMO
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.
Assuntos
Complexo AIDS Demência/diagnóstico por imagem , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/diagnóstico , Hipotermia/etiologia , Adulto , Contagem de Linfócito CD4 , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Imunoglobulina G , Imageamento por Ressonância Magnética , Masculino , Pancitopenia , Resultado do Tratamento , Carga ViralRESUMO
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.
Assuntos
Infecções por Citomegalovirus/diagnóstico , Imunocompetência , Pneumonia Viral/diagnóstico , Adulto , Anticorpos Antivirais/análise , Citomegalovirus/genética , Citomegalovirus/imunologia , Infecções por Citomegalovirus/imunologia , DNA Viral/análise , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Imunoglobulina M/imunologia , Pneumonia Viral/imunologia , Reação em Cadeia da Polimerase , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
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.
Assuntos
Transfusão de Componentes Sanguíneos/efeitos adversos , Incompatibilidade de Grupos Sanguíneos/imunologia , Isoanticorpos/imunologia , Síndromes Mielodisplásicas/sangue , Pancitopenia/sangue , Sistema do Grupo Sanguíneo Rh-Hr/imunologia , Idoso , Alelos , Epitopos/imunologia , Evolução Fatal , Feminino , Genótipo , Humanos , Isoanticorpos/sangue , Síndromes Mielodisplásicas/imunologia , Síndromes Mielodisplásicas/terapia , Pancitopenia/imunologia , Pancitopenia/terapia , Mutação Puntual , Imunoglobulina rho(D)RESUMO
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.
