Pneumocystis carinii pneumonia in HIV infected patients from Mumbai.

OBJECTIVE: Pneumocystis carinii pneumonia (PCP) is believed to be rare in the developing world and no large prospective Indian series have been reported to date. The present study was conducted to study the clinical profile and outcome of PCP in patients with HIV infection. METHODS: All HIV positive patients with PCP admitted over 4 years (2000-2003) to a tertiary referral centre in Mumbai were prospectively studied. RESULTS: There were 38 patients with proven PCP from 300 HIV admissions. The patients with PCP were predominantly male (M: F = 5.4:1), with a mean age of 40.1 years. The median CD4 count of the PCP group was 96 cells/microL. Bronchoscopy was needed to make a definitive diagnosis in 17 of the 38 patients. PCP co-existed with tuberculosis in 4 of the 38 patients. The mortality of the group was high at 15.8% with all patients needing ventilatory support dying. CONCLUSIONS: PCP is not an uncommon infection in Indians with advanced HIV. Lack of recognition has probably been responsible for the absence of any large series from this country. In our series of hospitalised HIV positive patients, PCP was the second commonest pulmonary disease after tuberculosis accounting for 32% of pulmonary admissions and 13 % of all HIV positive admissions.

High incidence of oestrogen receptor negative progesterone receptor positive phenotype in Indian breast cancer: fact or fiction?

The incidence of oestrogen receptor negative and progesterone receptor positive (ER-/PR+) invasive breast carcinoma is reported to be as high as 21% in India, as compared to 3-5% in the western literature. We used automated immunohistochemistry with Biogenex antibodies to re-evaluate the ER status in 37 Indian patients with invasive breast carcinomas previously reported as ER-/PR+ by a different manual staining protocol in two city hospitals. The automated technique utilized different reagents (all US FDA approved for in vitro diagnostic use) and staining protocols from those used in the manual assays. Of the 37 previously ER-tumours, only 9 (24.3%) tumours remained ER-. Twenty-eight (75.6%) tumours were found to be ER+. Our results indicate that the high incidence of ER-/PR+ breast cancer reported from India is most likely due to the use of suboptimal manual assays, rather than true genetic differences. ER expression in breast cancer among Indian women may be much higher than previously believed. These results have important implications for the use of oestrogen modulators such as tamoxifen in developing countries such as India.

Autoimmune hepatitis: a study of 50 patients.

INTRODUCTION: Autoimmune hepatitis (AIH) is a well-defined entity in the West but there are sparse Indian data on this disease. AIM: To study the clinical profile and response to treatment of Indian patients with AIH. METHODS: This is a part retrospective and part prospective study of 50 patients (median age 48 years, range 11-82; 43 women) seen between 1995 to 2001, diagnosed to have AIH as per the revised scoring system. Clinical and laboratory profile, response to treatment, and complications of treatment were analyzed. RESULTS: AIH accounted for 6% of all patients with liver disease seen during the period. The presenting symptoms were gastrointestinal in 43 and non-gastrointestinal in 7, with median symptom duration of 6 months (range 2 weeks to 40 years). Forty patients (80%) had chronic liver disease. Associated illnesses were present in 28 patients. Twenty-six patients were classified as definite and the rest as probable AIH. Forty-nine patients had Type 1 AIH. Five patients had overlap syndrome. Forty-five patients (90%) received immunosuppressive therapy. Twelve of 18 patients receiving only prednisolone and 21 of 27 patients receiving prednisolone and azathioprine combination responded. Thirteen (26%) patients had therapy-related complications (infectious 5, non infectious 8) with two treatment-related deaths. CONCLUSION: Type 1 AIH was the predominant type of AIH. The majority of patients with AIH presented with chronic liver disease. There was good response to immunosuppressive therapy. Therapy-related complications occurred in one-fourth of patients.

Kikuchi Fujimoto disease with unusual features.

An uncommon case of Kikuchi Fujimoto disease with unusual associated serologic-autoimmune abnormalities and aseptic meningitis is reported for its rarity.

Flutamide-induced hepatotoxicity with possible potentiation by simvastatin.

We report a 65 years old male who presented with jaundice in February 2000. He was operated for prostate carcinoma and started on flutamide in May 1999. He developed anorexia in mid January and frank jaundice by end February. LFT showed cholestatic picture. Liver biopsy showed cholestasis. Flutamide was stopped and patient made slow recovery. Possible additional hepatotoxicity of simvastatin is discussed.

Obstructing enterolith as presenting feature in Crohn's disease.

We report a 54-year-old woman with Crohn's disease presenting with intestinal obstruction due to an enterolith impacted at the site of a small bowel stricture. The diseased bowel was successfully resected by laparoscopy-assisted surgery.

Cystic variant of embryonal sarcoma of liver.

Embryonal sarcoma of the liver is an unusual tumor. The cystic form is rare and can mimic hydatid disease. We present a case that was mistakenly treated as a hydatid cyst for 3 months. Surgery was successful in removing the mass.