Enfermedad de Castleman multicéntrica en pacientes HIV positivos. Reporte de dos casos y revisión de la literatura / Multicentric Astleman disease in HIV positive patients. Two cases. Report and literature review

La enfermedad de Castleman (EC) es un proceso linfoproliferativo poco frecuente que se caracteriza por hiperplasia de los ganglios linfáticos. Existen dos variedades histológicas bien diferenciadas la hialino-vascular y la plasmocelular, que a su vez pueden ser localizadas o multicéntricas. La forma hialino-vascular suele ser asintomática y localizada en mediastino mientras que la plasmocelular se presenta frecuentemente con signo-sintomatología sistémica y suele ser difusa o multicéntrica. En el contexto de la enfermedad debida al virus de la inmunodeficiencia humana (VIH), la EC se asocia en su patogenia a la infección por el herpes virus humano tipo-8 (HHV-8). La mayoría de los casos corresponden a la variante hialino-vascular (80/90%) en tanto un pequeño porcentaje (10/20%) son de la variante plasmocelular. En algunos pacientes, el patrón histopatológico puede ser mixto. Se describen dos casos de enfermedad de Castleman multicéntrica HHV8- positiva en pacientes con enfermedad HIV/SIDA.

Castleman's disease (CD), is a rare hematological condition of uncertain etiology, involves a massive proliferation of lymphoid tissues and typically presents as mediastinal masses. This is considered as a distinct type of lymphoproliferative disorder associated with inflammatory symptoms. In the context of human immunodeficiency virus (HIV) infection, CD is associated with human herpesvirus-8 (HHV8) infection. Most cases of CD represent either the hyaline vascular variant (80­90% of cases) or the plasma cell variant (10­20%); a small percentage present with a mixed histologic appearance. Two cases of Castleman's disease associated with HHV-8 and HIV/AIDS infection are described

Neurosífilis con neuropatía óptica y auditiva simultáneas en un paciente VIH positivo / Neurosyphilis with simultaneous optic and auditive involvement in an HIV-positive patient

Introducción: a partir del año 2000, los médicos han asistido a un retorno de la sífilis vinculado a prácticas sexuales no protegidas y con parejas múltiples, en especial entre hombres que tienen sexo con hombres. La coinfección Treponema pallidum/virus de la inmunodeficiencia humana (VIH) modifica tanto la historia natural de la sífilis, incrementando la incidencia de neurosífilis temprana, como la respuesta al tratamiento con penicilina. Métodos: un paciente varón, peruano, de 36 años, seropositivo para VIH, consulta por dis-minución de la agudeza visual en ojo derecho, pérdida de la audición, tinnitus, mareos y vértigo. Refería antecedentes de sífilis en los 2 años previos. Resultados: el examen oftalmológico efectuado al paciente mostró células en el segmento anterior del ojo derecho. El fondo de ojo reveló la existencia de inflamación del nervio óptico asociada con panuveítis. En base a los hallazgos clínicos, los valores de VDRL en suero y líquido cefalorraquídeo (LCR) se diagnosticó neurosífilis (NS) con neuritis óptica, panuveítis y otosífilis en un paciente coinfectado por VIH. El paciente fue tratado con penicilina G sódica intravenosa, 4 millones de UI cada 4 horas, durante 2 semanas con buena respuesta clínica. Discusión: el compromiso de los pares craneales óptico y auditivo puede representar la manifestación de una NS temprana, en especial, en el contexto de un paciente VIH positivo. De acuerdo con nuestro conocimiento, este sería el segundo caso publicado de compromiso simultáneo del nervio óptico y del aparato vestíbulo-coclear en un paciente con NS.

Introduction: from the 2000s, the physicians experienced a return of syphilis, which may be related to unrestricted sexual behaviour with unprotected contact between multiple partners, especially in men who have sex with men. Concurrent infection with human immunodeficiency virus (HIV) alters the natural history of syphilis by increasing the frequency of early neurosyphilis and the response to penicillin. Methods: a 36-year-old Peruvian man, seropositive for HIV infection, was admitted to the hospital with decreased visual acuity in his right eye, hearing loss, tinnitus, buzzing, and vertigo. He referred history of syphilis in the previous two years. Results: oph-thalmological examination was performed. Ocular anterior segment examination of the right eye showed cells. Fundoscopy revealed swelling of the right optic disc with panuveitis. Diagnosis of neurosyphilis (NS) with optic and ear neuritis, and concurrent HIV infection was made, based on the clinical manifestations and serum and cerebrospinal VDRL titers. The patient was treated with intravenous penicillin (four million units every four hours for two weeks) with an excellent clinical response. Discussion: simultaneous optic and auditive cranial nerve involvement can manifest early neurosyphilis (NS) and HIV coinfection. This is the second report to describe the simultaneous occurrence of syphilitic optic neuritis with vestibulocochlear nerve involvement.

Ramsay-Hunt syndrome: Report of two cases with identification of the varicella zoster virus genome in cerebrospinal fluid / Síndrome de Ramsay-Hunt: a propósito de dos casos en que se identificó el genoma del virus de la varicela-zóster en líquido cefalorraquídeo

Like other alpha-herpesviruses, the varicella-zoster virus (VZV) remains latent in the neural ganglia following the primary varicella infection. The reactivation of the VZV in the dorsal root ganglia results in herpes zoster. Herpes zoster eruption is characterized by localized cutaneous lesions and neuralgic pain mostly in older and immunocompromised persons, especially those living with the human immunodeficiency virus (HIV). The most commonly reported complications include VZV pneumonia, meningitis, encephalitis, and hepatitis. Several neurologic syndromes have been described associated with herpes zoster localized in cranial areas including peripheral nerve palsies and the Ramsay-Hunt syndrome, which has a varied clinical presentation and is the second most common cause of peripheral facial paralysis. Facial paralysis in this syndrome occurs in 60 to 90% of cases and it may precede or appear after the cutaneous lesions with a worse prognosis than idiopathic Bell paralysis. Here we present two cases of herpes zoster from the geniculate ganglia with peripheral facial paralysis that appeared simultaneously with vesicular herpetic otic lesions (multimetameric Ramsay-Hunt syndrome). In the two cases, amplifiable varicella-zoster viral DNA was found in the cerebrospinal fluid by RT-PCR Multiplex.

Como los otros herpesvirus alfa, el virus de la varicela-zóster (VZV) permanece en estado de latencia en los ganglios neurales después de la infección primaria (varicela). La reactivación de una infección latente por VZV en los ganglios de la raíz dorsal, produce el herpes zóster. La erupción que este provoca se caracteriza por lesiones cutáneas metaméricas que se acompañan de dolor neurítico y comprometen con mayor frecuencia a ancianos y sujetos inmunocomprometidos, en especial, aquellos infectados con el virus de la inmunodeficiencia humana (HIV). Las complicaciones que se observan en esta población de pacientes incluyen neumonía, hepatitis y compromiso del sistema nervioso central (meningitis y encefalitis). Varios síndromes clínicos se asocian con el herpes zóster de localización craneal, incluida la parálisis facial periférica y el síndrome de Ramsay-Hunt, el cual constituye la segunda causa de parálisis facial periférica y tiene una gran variedad de presentaciones clínicas. La parálisis facial se presenta en 60 a 90 % de los casos de síndrome de Ramsay-Hunt, puede preceder o aparecer después de las lesiones cutáneas y tiene peor pronóstico que la parálisis de Bell. Se describen aquí dos casos de herpes zóster del ganglio geniculado, con parálisis facial periférica que coincidió con la aparición de las lesiones cutáneas vesiculosas en el conducto auditivo externo y el pabellón auricular (síndrome de Ramsay-Hunt multimetamérico). En ambos casos, se identificó el genoma del VZV mediante PCR en el líquido cefalorraquídeo (LCR).

Síndrome de Ramsay-Hunt: a propósito de dos casos en que se identificó el genoma del virus de la varicela-zóster en líquido cefalorraquídeo / Ramsay-Hunt syndrome: Report of two cases with identification of the varicella zoster virus genome in cerebrospinal fluid

Resumen | Como los otros herpesvirus alfa, el virus de la varicela-zóster (VZV) permanece en estado de latencia en los ganglios neurales después de la infección primaria (varicela). La reactivación de una infección latente por VZV en los ganglios de la raíz dorsal, produce el herpes zóster. La erupción que este provoca se caracteriza por lesiones cutáneas metaméricas que se acompañan de dolor neurítico y comprometen con mayor frecuencia a ancianos y sujetos inmunocomprometidos, en especial, aquellos infectados con el virus de la inmunodeficiencia humana (HIV). Las complicaciones que se observan en esta población de pacientes incluyen neumonía, hepatitis y compromiso del sistema nervioso central (meningitis y encefalitis). Varios síndromes clínicos se asocian con el herpes zóster de localización craneal, incluida la parálisis facial periférica y el síndrome de Ramsay-Hunt, el cual constituye la segunda causa de parálisis facial periférica y tiene una gran variedad de presentaciones clínicas. La parálisis facial se presenta en 60 a 90 % de los casos de síndrome de Ramsay-Hunt, puede preceder o aparecer después de las lesiones cutáneas y tiene peor pronóstico que la parálisis de Bell. Se describen aquí dos casos de herpes zóster del ganglio geniculado, con parálisis facial periférica que coincidió con la aparición de las lesiones cutáneas vesiculosas en el conducto auditivo externo y el pabellón auricular (síndrome de Ramsay-Hunt multimetamérico). En ambos casos, se identificó el genoma del VZV mediante PCR en el líquido cefalorraquídeo (LCR).

Abstract | Like other alpha-herpesviruses, the varicella-zoster virus (VZV) remains latent in the neural ganglia following the primary varicella infection. The reactivation of the VZV in the dorsal root ganglia results in herpes zoster. Herpes zoster eruption is characterized by localized cutaneous lesions and neuralgic pain mostly in older and immunocompromised persons, especially those living with the human immunodeficiency virus (HIV). The most commonly reported complications include VZV pneumonia, meningitis, encephalitis, and hepatitis. Several neurologic syndromes have been described associated with herpes zoster localized in cranial areas including peripheral nerve palsies and the Ramsay-Hunt syndrome, which has a varied clinical presentation and is the second most common cause of peripheral facial paralysis. Facial paralysis in this syndrome occurs in 60 to 90% of cases and it may precede or appear after the cutaneous lesions with a worse prognosis than idiopathic Bell paralysis. Here we present two cases of herpes zoster from the geniculate ganglia with peripheral facial paralysis that appeared simultaneously with vesicular herpetic otic lesions (multimetameric Ramsay-Hunt syndrome). In the two cases, amplifiable varicella-zoster viral DNA was found in the cerebrospinal fluid by RT-PCR Multiplex.

[Hip tuberculosis. Case report and literature review]. / Tuberculosis de la cadera. Presentación de un caso y revisión de la literatura.

Osteoarticular tuberculosis is a rare complication of the disseminated disease and appears, in different series, between 10% to 20%, trough hematogenous spread. Tuberculosis hip involvement is less than 10% of all the cases of osteoarticular tuberculosis. The diagnosis is confirmed by the detection of Mycobacterium tuberculosis in samples obtained from joint fluid or synovial membrane biopsy by direct examination and culture, in order to perform antimicrobial susceptibility testing. Here, we present a patient infected with the human immunodeficiency virus (HIV) who developed a disseminated tuberculosis with affection of the hip in the context of the immunodeficiency related with the retrovirus.

Linfoma primario del sistema nervioso central como primera manifestación de sida. Presentación de un caso y revisión de la literatura / Primary central nervous system lymphoma as first manifestation of AIDS. Report of a case and literature review

El linfoma primario del sistema nervioso central (LPSNC) es una neoplasia infrecuente que comprende solo el 5% del total de los linfomas de localización extranodal. El LPSNC se define como un linfoma de tipo No Hodgkin (LNH) que solo infiltra el eje cerebro espinal sin compromiso sistémico. Esta neoplasia es más frecuente en sujetos con inmunodeficiencias congénitas y adquiridas. En los pacientes con SIDA, el LPSNC ocurre con igual incidencia en todos los grupos de riesgo y edades pero con una mayor prevalencia en aquellos con recuentos de linfocitos T CD4 + de < de 50 células/µL. Se trata de un linfoma de células grandes, de alto grado de malignidad, y fuertemente asociado en su patogenia al virus de Epstein Barr (VEB) cuyo genoma se detecta en las células linfoides atípicas. La presencia del genoma del VEB se detecta en el 100% de los casos de LPSNC asociado al SIDA pero esto no ocurre en otras clases de pacientes con esta misma neoplasia. En pacientes con SIDA y lesiones de masa cerebral ocupante, la detección del genoma del VEB en el líquido cefalorraquídeo (LCR) a través de la reacción en cadena de la polimerasa (PCR) tiene una sensibilidad del 83% a 100% y una especificidad > del 90% para el diagnóstico. El uso difundido de la terapia antirretroviral de gran actividad (TARGA) se asoció con una declinación en la incidencia de LPSNC. El pronóstico de esta neoplasia en pacientes con SIDA es pobre y se asocia con una mediana de supervivencia de 2 a 3 meses en la era previa a la TARGA con una discreta prolongación en la supervivencia con la TARGA. Se presenta un paciente que desarrolló un LPSNC como primera manifestación de SIDA y se efectúa una actualización de la literatura sobre el tema.

MENINGOENCEPHALITIS DUE TO VARICELLA ZOSTER VIRUS IN AIDS PATIENTS. REPORT OF ELEVEN CASES AND REVIEW OF THE LITERATURE / Meningoencefalite pelo vírus varicela-zoster em pacientes com AIDS. Relato de onze casos e revisão da literatura

Neurological complications of varicella-zoster virus (VZV) are infrequent and include various clinical pictures. The reactivation of VZV in patients with AIDS is generally associated with an acute and severe meningoencephalitis. We report the epidemiological, clinical and virological data from 11 consecutive patients with diagnosis of HIV/AIDS and central nervous system (CNS) involvement due to VZV. All patients were male and seropositive for HIV. The primary risk factor for HIV infection was unprotected sexual contact. The median of CD4 T cell count was 142 cells/µL. All of them presented signs and symptoms of meningoencephalitis. Six patients (54.5%) presented pleocytosis; they all showed high CSF protein concentrations with a median of 2.1 g/dL. Polymerase chain reaction of cerebrospinal fluid specimen was positive for VZV in all of them and they were treated with intravenous acyclovir at doses of 30/mg/kg/day for 21 days. Overall survival was 63% (7 of 11 patients). The four dead patients had low cellular counts in CSF, below the median of this parameter. VZV should be included among the opportunistic pathogens that can involve CNS with a diffuse and severe meningoencephalitis in patients with advanced HIV/AIDS disease.

As complicações neurológicas do vírus varicela-zoster (VVZ) são pouco frequentes e incluem vários quadros clínicos. A reativação do VVZ em pacientes com AIDS é geralmente associada com meningoencefalite aguda e grave. Nós relatamos os dados epidemiológicos, clínicos e virológicos de onze pacientes consecutivos com diagnóstico de HIV/AIDS e comprometimento do sistema nervoso central (SNC) devido ao VVZ. Todos os pacientes eram do sexo masculino e soropositivos para HIV. O principal fator de risco para a infecção pelo HIV foi o contato sexual sem proteção. A mediana da contagem de células CD4 T foi de 142 cel/µL. Todos apresentavam sinais e sintomas devido à meningoencefalite. Seis pacientes (54,5%) apresentaram pleiocitose; todos apresentaram hiperproteinorraquia com mediana de 2,1 g/dL. A reação em cadeia da polimerase de amostra do líquido cefalorraquidiano foi positiva para VVZ em todos eles. Todos os pacientes foram tratados com aciclovir por via intravenosa em doses de 30 mg/kg/dia durante 21 dias. A sobrevida global foi de 63% (sete de 11 pacientes). Os quatro pacientes mortos tiveram uma escassa resposta celular no LCR abaixo da mediana para este parâmetro. O VVZ deve ser incluído entre os patógenos oportunistas que podem comprometer o SNC com meningoencefalite difusa e grave em pacientes com doença avançada por HIV/SIDA.

Tuberculosis de la cadera: Presentación de un caso y revisión de la literatura / Hip tuberculosis: Case report and literature review

Osteoarticular tuberculosis is a rare complication of the disseminated disease and appears, in different series, between 10% to 20%, trough hematogenous spread. Tuberculosis hip involvement is less than 10% of all the cases of osteoarticular tuberculosis. The diagnosis is confirmed by the detection of Mycobacterium tuberculosis in samples obtained from joint fluid or synovial membrane biopsy by direct examination and culture, in order to perform antimicrobial susceptibility testing. Here, we present a patient infected with the human immunodeficiency virus (HIV) who developed a disseminated tuberculosis with affection of the hip in the context of the immunodeficiency related with the retrovirus.

La tuberculosis osteo-articular es una localización infrecuente de las formas diseminadas de la enfermedad tuberculosa. Su incidencia, según las distintas series, oscila entre 10% y el 20%. Su patogenia es la diseminación por vía hematógena. La coxitis o afección tuberculosa de la cadera representa menos de 10% de las TB osteo-articulares. El diagnóstico se confirma con la detección de Mycobacterium tuberculosis en las muestras obtenidas del líquido articular o la biopsia de la membrana sinovial a través del examen directo y el cultivo. Presentamos un paciente con infección por el virus de la inmunodeficiencia humana (VIH) que desarrolló una TB diseminada con compromiso de la cadera en el contexto de su inmunodeficiencia.

MENINGOENCEPHALITIS DUE TO VARICELLA ZOSTER VIRUS IN AIDS PATIENTS. REPORT OF ELEVEN CASES AND REVIEW OF THE LITERATURE.

Neurological complications of varicella-zoster virus (VZV) are infrequent and include various clinical pictures. The reactivation of VZV in patients with AIDS is generally associated with an acute and severe meningoencephalitis. We report the epidemiological, clinical and virological data from 11 consecutive patients with diagnosis of HIV/AIDS and central nervous system (CNS) involvement due to VZV. All patients were male and seropositive for HIV. The primary risk factor for HIV infection was unprotected sexual contact. The median of CD4 T cell count was 142 cells/µL. All of them presented signs and symptoms of meningoencephalitis. Six patients (54.5%) presented pleocytosis; they all showed high CSF protein concentrations with a median of 2.1 g/dL. Polymerase chain reaction of cerebrospinal fluid specimen was positive for VZV in all of them and they were treated with intravenous acyclovir at doses of 30/mg/kg/day for 21 days. Overall survival was 63% (7 of 11 patients). The four dead patients had low cellular counts in CSF, below the median of this parameter. VZV should be included among the opportunistic pathogens that can involve CNS with a diffuse and severe meningoencephalitis in patients with advanced HIV/AIDS disease.

Anal squamous cell carcinoma in HIV/AIDS patients in the HAART era: Report of 8 cases and literature review.

BACKGROUND: Anal squamous cell carcinoma is a rare neoplasm with a higher incidence in the HIV-seropositive population. PATIENTS AND METHODS: Epidemiologic, clinic, immunologic, virologic and therapeutic characteristics of 8 HIV-positive patients with anal squamous cell carcinoma were descriptively and retrospectively analyzed from 2005 to 2011. RESULTS: Median of age ofpatients was 39 years, 75% were male and 83% were men who have sex with men. Median elapsed time from HIV infection to anal cancer diagnosis was 10.5 ± 9.5 years. Anal pain and local large tumors detected by physical examination were the most common clinical manifestations; pain with or without itching was marginally correlated with poor survival. The median of CD4 T-cell countfor the whole study group was 330 cells/µL. At the time ofthe neoplasm diagnosis, CD4 T-cell count was more than 200 cell/µL in 62.5% of the patients. In the descriptive analysis, higher CD4 T-cell count was significantly associated with a prolonged survival. In the overall population, 71% were receiving highly active antiretroviral therapy (HAART) and all of them had undetectable viral load at the time ofneoplasm diagnosis. HAART was correlated with better survival in the overallpopulation. Histopathologic examination showed that 4 cases (50%) had in situ carcinoma and 4 patients (50%) had diagnosis of invasive anal carcinoma. One patient underwent surgical tumorectomy plus HAART, 2 patients received chemotherapy plus HAART and 3 patients were treated with fractionated radiotherapy plus systemic chemotherapy plus HAART. One patient died without the possibility of treatment due to his poor clinical condition and for one patient was no available data. After a follow up of 2 years, overall survival rate was 71%. CONCLUSION: A carefully evaluation of anal infiltrative or tumoral lesions is necessary to achieve an early diagnosis and to improve the survival in this kind of patients.

Criptococosis e histoplasmosis diseminadas y simultáneas como primera manifestación de SIDA / Disseminated and simultaneous histoplasmosis and cryptococcosis as a first clinical manifestation of AIDS

La histoplasmosis y la criptococosis son dos de las enfermedades fúngicas de mayor prevalenciaen pacientes con enfermedad HIV/SIDA avanzada y recuentos de linfocitos T CD4 + menores de100 cel/uL. Ambas continúan siendo una importante causa de mortalidad y morbilidad en aquellossujetos que no reciben tratamiento antirretroviral. La reactivación simultánea de ambos patógenoses una eventualidad infrecuente, que ha sido pocas veces publicada en la literatura médica yafecta especialmente a pacientes con marcado deterioro de la inmunidad mediada por células. Sepresenta un paciente con reactivación simultánea de la infección por Cryptococcus neoformanse Histoplasma capsulatum en el contexto de enfermedad HIV/SIDA avanzada y se efectúa unarevisión de la literatura sobre el tema.

Histoplasmosis and cryptococcosis are two of the most frequent fungal opportunistic infectionsin patients with advanced HIV/AIDS disease and CD4 T-cell counts below 100 cell/µL. Also,these mycoses are an important cause of morbimortality in those patients without antiretroviraltherapy. Simultaneous reactivation of disseminated infections due to Histoplasma capsulatum andCryptococcus neoformans have rarely been described in the literature, involving especially those patients with severe impairment of cellular immunity. Here we present a patient with advancedHIV/AIDS disease who developed a simultaneous reactivation of disseminated infections due to H.capsulatum and C. neoformans infections and we review the previously reported cases publishedin the medical literature.

Anal squamous carcinoma: a new AIDS-defining cancer? Case report and literature review / Carcinoma de células escamosas do canal anal: a nova neoplasia associada com AIDS?

Squamous anal cell carcinoma is a rare malignancy that represents the 1.5% to 2% of all the lower digestive tract cancers. However, an increased incidence of invasive anal carcinoma is observed in HIV-seropositive population since the widespread of highly active antiretroviral therapy. Human papillomavirus is strongly associated with the pathogenesis of anal cancer. Anal intercourse and a high number of sexual partners appear to be risk factors to develop anal cancer in both sexes. Anal pain, bleeding and a palpable lesion in the anal canal are the most common clinical features. Endo-anal ultrasound is the best diagnosis method to evaluate the tumor size, the tumor extension and the infiltration of the sphincter muscle complex. Chemoradiotherapy plus antiretroviral therapy are the recommended treatments for all stages of localized squamous cell carcinoma of the anal canal in HIV-seropositive patients because of its high rate of cure. Here we present an HIV patient who developed a carcinoma of the anal canal after a long time of HIV infection under highly active antiretroviral therapy with a good virological and immunological response.

O carcinoma de células escamosas do canal anal é uma malignidade rara que representa 1,5% a 2% de todos os cânceres do trato gastrointestinal inferior. Entretanto, é observada uma incidência aumentada do carcinoma anal invasivo, na população soropositiva para o HIV desde a difusão da terapia antirretroviral altamente ativa. O vírus do papiloma está fortemente associado com a patogênese do câncer anal. Sexo anal e um alto número de parceiros sexuais parecem ser os fatores de risco para desenvolver câncer anal em ambos os sexos. Dor anal, sangramento e lesão palpável no canal anal são as manifestações clínicas mais comuns. O ultrassom endoanal é o melhor método diagnóstico para avaliar o tamanho do tumor, sua extensão e a infiltração para o complexo do músculo esfincteriano. A quimioradioterapia mais terapia antirretroviral é o tratamento recomendado para todos os estádios do carcinoma localizado de células escamosas do canal anal nos pacientes HIV soropositivos, devido a sua alta taxa de cura. Apresentamos um paciente que desenvolveu carcinoma do canal anal depois de um longo tempo de infecção por HIV sob tratamento com a terapia antirretroviral altamente ativa, com boa resposta virológica e imunológica.

Anal squamous carcinoma: a new AIDS-defining cancer? Case report and literature review.

Squamous anal cell carcinoma is a rare malignancy that represents the 1.5% to 2% of all the lower digestive tract cancers. However, an increased incidence of invasive anal carcinoma is observed in HIV-seropositive population since the widespread of highly active antiretroviral therapy. Human papillomavirus is strongly associated with the pathogenesis of anal cancer. Anal intercourse and a high number of sexual partners appear to be risk factors to develop anal cancer in both sexes. Anal pain, bleeding and a palpable lesion in the anal canal are the most common clinical features. Endo-anal ultrasound is the best diagnosis method to evaluate the tumor size, the tumor extension and the infiltration of the sphincter muscle complex. Chemoradiotherapy plus antiretroviral therapy are the recommended treatments for all stages of localized squamous cell carcinoma of the anal canal in HIV-seropositive patients because of its high rate of cure. Here we present an HIV patient who developed a carcinoma of the anal canal after a long time of HIV infection under highly active antiretroviral therapy with a good virological and immunological response.

[Bacteremia by Kocuria rosea in an AIDS patient]. / Bacteriemia por Kocuria rosea en un paciente con SIDA.

Kocuria rosea is an uncommon pathogen may cause opportunistic infections in immunocompromised patient. We report a HIV patient, who presented bacteremia caused by Kocuria rosea. He was successfully treated with vancomycin and by catheter removal.

Bacteriemia por Kocuria rosea en un paciente con SIDA / Bacteremia by Kocuria rosea in an AIDS patient

Kocuria rosea is an uncommon pathogen may cause opportunistic infections in immunocompromised patient. We report a HIV patient, who presented bacteremia caused by Kocuria rosea. He was successfully treated with vancomycin and by catheter removal.

Neurocisticercosis con lesiones cerebrales únicas. Presentación de dos casos documentados por Resonancia Magnética y revisión de la literatura / Neurocysticercosis with single brain lesions. Report of two cases documented by Magnetic Resonance Imaging and literature review

La neurocisticercosis (NCC) es una infección del sistema nervioso central (SNC) originada por el estadio larvario de Taenia solium. Esta importante parasitosis es la causa más frecuente de epilepsia adquirida del adulto.Las manifestaciones clínicas más comunes de las formas parenquimatosas son la cefalea y las convulsiones,mientras que las formas extraparenquimatosas suelen presentarse con hidrocefalia. En este aspecto, es importante destacar que las manifestaciones clínicas de la enfermedad son el resultado de la muerte de la larva del cestodo y de la reacción inflamatoria perilesional que se produce en el SNC. El diagnóstico de NCC se basa en la epidemiología, las manifestaciones clínicas, los hallazgos de las neuroimágenes y la serología, y su tratamiento incluye el uso de fármacos antiepilépticos, corticoesteroides y drogas antiparasitarias, como el albendazol o el praziquantel. En este trabajo se describen dos casos de neurocisticercosis parenquimatosa con lesiones únicas que se manifestaron con cefalea y convulsiones...

Neurocisticercosis con lesiones cerebrales únicas: Presentación de dos casos documentados por Resonancia Magnética y revisión de la literatura / Neurocysticercosis with single brain lesions: Report of two cases documented by Magnetic Resonance Imaging and literature review

La neurocisticercosis (NCC) es una infección del sistema nervioso central (SNC) originada por el estadio larvario de Taenia solium. Esta importante parasitosis es la causa más frecuente de epilepsia adquirida del adulto. Las manifestaciones clínicas más comunes de las formas parenquimatosas son la cefalea y las convulsiones, mientras que las formas extraparenquimatosas suelen presentarse con hidrocefalia. En este aspecto, es importante destacar que las manifestaciones clínicas de la enfermedad son el resultado de la muerte de la larva del cestodo y de la reacción inflamatoria perilesional que se produce en el SNC. El diagnóstico de NCC se basa en la epidemiología, las manifestaciones clínicas, los hallazgos de las neuroimágenes y la serología, y su tratamiento incluye el uso de fármacos antiepilépticos, corticoesteroides y drogas antiparasitarias, como el albendazol o el praziquantel. En este trabajo se describen dos casos de neurocisticercosis parenquimatosa con lesiones únicas que se manifestaron con cefalea y convulsiones.(AU)

Neurocysticercosis is a central nervous system (CNS) infection caused by the larval stage of Taenia solium. This major parasitic infection is the most common cause of adult-onset epilepsy. The most common clinical manifestations of the parenchymal form of this disease are headache and seizures, whereas extraparenchymal forms typically present with hydrocephalus. In this context, it is important to emphasize that the clinical manifestations of this disease are the result of the death of the tapeworm larvae and of the perilesional inflammatory reaction that occurs in the CNS. The diagnosis of neurocysticercosis is based on epidemiology, clinical manifestations, neuroimaging findings and serology. Treatment of neurocysticercosis includes the use of antiepileptic drugs, corticosteroids and antiparasitic therapy with albendazole or praziquantel. We report two cases of parenchymal neurocysticercosis with single lesions presenting with headache and seizures.(AU)

Primary cutaneous B-cell lymphoma successfully treated with highly active antiretroviral therapy alone: a case report and review of the literature.

Cutaneous B-cell lymphoma (CBCL) is an unusual skin neoplasm with a great range of clinical presentations. Here, we report a case of CBCL in an AIDS patient presented as a single and nodular/ulcerative lesion in the perianal area. The patient was started on highly active antiretroviral therapy alone with a good clinical and oncological response. Two years later, the patient is asymptomatic with undetectable viral load and immune reconstitution.

[Infection due to Strongyloides stercoralis: epidemiological, clinical, diagnosis findings and outcome in 30 patients]. / Infección por Strongyloides stercoralis: estudio epidemiológico, clínico, diagnóstico y terapéutico en 30 pacientes.

BACKGROUND: Strongyloides stercoralis is a nematode parasite, which is endemic in tropical and subtropical regions. Infection usually remains asymptomatic, but in immunocompromised hosts severe and life-threatening manifestations such as hyperinfection syndrome and disseminated disease might occur. METHODS: We retrospectively analyzed the epidemiological and clinical characteristics, including HIV co-infection, microbiological findings, and outcome in 30 patients with strongyloidiasis, who attended in the Infectious Diseases F. J. Muñiz Hospital in Buenos Aires from January 2004 to December 2008. RESULTS: The study included 20 men and 10 women with an average age of 33 years. HIV co-infection was present in 21 patients (70%) with a median CD4 T cell count of 50 cells/mm³ (range 7-355) (average 56 cells/mm³). Among HIV negative patients the following comorbidities were detected: tuberculosis (n = 3) and chronic alcoholism, leprosy treated with corticosteroids, immunosuppressive treatment for psoriasis, and diabetes mellitus (each in one patient). Two patients did not have any predisposing diseases or immunosuppressive treatments. Seventeen patients presented with diarrhea and were classified as chronic intestinal strongyloidiasis (57%), asymptomatic infection with peripheral eosinophilia was diagnosed in 7 (23%), and 6 patients (20%) developed hyperinfection syndrome. Seventeen patients (57%) presented peripheral eosinophilia. Diagnosis was achieved by direct visualization of larvae in feces by Baermann technique (n = 20), by multiple stool smears examinations (n = 2), by combination of both (n = 1), by visualization of the filariform larvae in duodenal fluid and stool (n = 1), and in fecal and bronchoalveolar lavage specimens (n = 6). Overall mortality in this series was 20% (6/30). There was no significant correlation between age and mortality. A significant inverse correlation between the survival rate and CD4 T-cell count as well as eosinophilia was observed. There was also a significant correlation between HIV co-infection and mortality. Twenty-two patients responded favorably to treatment with ivermectin.

Infección por Strongyloides stercoralis: estudio epidemiológico, clínico, diagnóstico y terapéutico en 30 pacientes / Infection due to Strongyloides stercoralis: epidemiological, clinical, diagnosis findings and outcome in 30 patients

Background: Strongyloides stercoralis is a nematode parasite, which is endemic in tropical and subtropical regions. Infection usually remains asymptomatic, but in immunocompromised hosts severe and life-threatening manifestations such as hyperinfection syndrome and disseminated disease might occur. Methods: We retrospectively analyzed the epidemiological and clinical characteristics, including HIV co-infection, microbiological findings, and outcome in 30 patients with strongyloidiasis, who attended in the Infectious Diseases F. J. Muñiz Hospital in Buenos Aires from January 2004 to December 2008. Results: The study included 20 men and 10 women with an average age of 33 years. HIV co-infection was present in 21 patients (70 percent) with a median CD4 T cell count of 50 cells/mm³ (range 7-355) (average 56 cells/mm³). Among HIV negative patients the following comorbidities were detected: tuberculosis (n = 3) and chronic alcoholism, leprosy treated with corticosteroids, immunosuppressive treatment for psoriasis, and diabetes mellitus (each in one patient). Two patients did not have any predisposing diseases or immunosuppressive treatments. Seventeen patients presented with diarrhea and were classified as chronic intestinal strongyloidiasis (57 percent), asymptomatic infection with peripheral eosinophilia was diagnosed in 7 (23 percent), and 6 patients (20 percent) developed hyperinfection syndrome. Seventeen patients (57 percent) presented peripheral eosinophilia. Diagnosis was achieved by direct visualization of larvae in feces by Baermann technique (n = 20), by multiple stool smears examinations (n = 2), by combination of both (n = 1), by visualization of the filariform larvae in duodenal fluid and stool (n = 1), and in fecal and bronchoalveolar lavage specimens (n = 6). Overall mortality in this series was 20 percent (6/30). There was no significant correlation between age and mortality. A significant inverse correlation between the survival rate and CD4 T-cell count as well as eosinophilia was observed. There was also a significant correlation between HIV co-infection and mortality. Twenty-two patients responded favorably to treatment with ivermectin.

Antecedentes: Strongyloides stercoralis, parásito endémico de áreas tropicales y subtropicales del planeta, en sujetos inmunodeprimidos puede cursar con formas graves y aun mortales como el síndrome de hiperinfestación y la enfermedad diseminada. Métodos: Análisis retrospectivo de las características epidemiológicas, manifestaciones clínicas, co-infección por virus de inmunodeficiencia humana (VIH), hallazgos microbiológicos y evolución de 30 pacientes con estrongiloidiasis, atendidos en el Hospital de Enfermedades Infecciosas F. J. Muñiz de Buenos Aires, entre enero 2004 y diciembre 2008. Resultados: Se incluyeron en la evaluación 20 hombres y 10 mujeres con una mediana de edad de 33 años. Co-infección por VIH hubo en 21 pacientes (70 por ciento); la mediana de linfocitos T CD4+ en ellos al momento del diagnóstico de la parasitosis fue de 50 céls/mm³ (rango 7 a 355), (media de 56 céls/mm³). En los pacientes seronegativos para VIH, se comprobaron las siguientes co-morbilidades: tuberculosis (n: 3) y un caso de cada una de las siguientes afecciones: alcoholismo crónico, diabetes mellitus, reacción lepromatosa bajo corticotera-pia, y psoriasis en tratamiento inmunosupresor. Hubo dos pacientes sin aparentes enfermedades de base. Diecisiete pacientes presentaron enfermedad intestinal crónica con diarrea (57 por ciento), era asintomática y fue sospechada por la eosinofilia periférica (n: 7, 23 por ciento) y se clasificó como síndrome de hiperinfestación (n: 6, 20 por ciento) diagnosticado por la identificación de larvas en la materia fecal y secreciones broncopulmonares. Diecisiete pacientes (57 por ciento) presentaron eosinofilia periférica. El diagnóstico se efectuó por la visualización directa de las larvas en muestras de heces en fresco mediante la técnica de concentración de Baer-man (n: 20); por el examen copro-parasitológico seriado (n: 2) y por ambos métodos (n: 1); en líquido duodenal y materia fecal (n: 1) y por la identificación de larvas en materia fecal y secreciones respiratorias (n: 6). Letalidad global: 20 por ciento (6/30). Los pacientes con eosinofilia tuvieron una menor letalidad que aquellos sin esta respuesta (p < 0,001). No hubo correlación estadística entre la edad y la supervivencia. Sí fue significativa la correlación entre el recuento de CD4 y la letalidad, incluyendo 18 de los 21 pacientes seropositivos para VIH (p: 0,03). Finalmente, la correlación seropositividad para VIH y letalidad también fue significativa. Veintidós pacientes respondieron a la terapia antiparasitaria con ivermectina y evolucionaron favorablemente.