[Tumoral cutaneous form of kaposi's sarcoma: Diagnosis difficulties case report]

Kaposi's sarcoma is the most frequent neoplasia related to AIDS. We report here the difficulties of diagnosis and therapeutic of an atypical cutaneous form of Kaposi's sarcoma. A 31-year-old woman HIV- infected with severe immunodeficiency [CD4 cell count is 50 cell/mm[3] and HIV RNA viral load is 539000 copies /ml] was admitted for an atypical cutaneous kaposi's sarcoma. She was first treated by antiretroviral therapy combined stavudine, lamivudine and indinavir added to bleomycm monochimiotherapy. One month after, she developed persistent cough and new lesions of Kaposi sarcoma which a big pseudotumoral frontal one. Bronchoscopy showed pulmonary Kaposi's sarcoma. Polychimiotherapy [bleomycin, donorubicin et vinblastin], and local treatment were instituted with regression of lesions. Combined antiretroviral therapy, by increasing immune restoration, leaded to recovery

[Bilateral aseptic osteonecrosis of fernoral head in an HIV-infected patient]

The incidence of osteonecrosis has increased in HIV-infected patients. The femoral head is the most frequent localization and bilateral in the 60% of cases. Common risk factors include the use of corticosteroids, ethanol and the hyperlipidemia. We report one case of bilateral femoral head of osteonecrosis in an HIV-infected patient. A 40-years-old HIV-infected patient, with advanced immunodeficiency [CD4+ cell count of 55/mm3]. His past medical history included cervical zoster, significant alcohol abuse, chronic smoking and use of corticosteroids by himself in 1992. He is currently treated with antiretroviral therapy combined Zidovudine, Lamivudine and Efavirenz. He was admitted to hospital in December 2003 with progressive bilateral hip pain and limp without fever. Osteonecrosis was diagnosed by magnetic resonance imaging and skeletal scintigraphy .Laboratory test showed hypercholesterolemia, positive antiphospholipid and antinuclear antibody. He was treated with nonsteroidal anti-inflammatory drugs. Total joint arthroplasty was not realised due to severe immunodeficiency and high risk of infection. In accordance with the literature, the risk factors for osteonecrosis are multiple in our patient. This fact, a large vigilance is necessary among HIV-infected patients having a dyslipidemy and/or received corticosteroids

[Tuberculosis and acquired immunodeficiency syndrome]

From January 1987 to July 1990, 16,2% of patients followed with Human Immunodeficiency Virus [HIV] infection, of which six were ill [all with AIDS], had tuberculosis. Pulmonary tuberculosis was present in four patients [66,6%], and extrapulmonary tuberculosis in six. The extrapulmonary infections were located in the mediastinal lymph nodes in two cases, the peripheral lymph nodes in two cases, and in the pleura in two cases. Pulmonary infection was multilobar in four cases with cavitary infiltrates in one case. An intradermal skin test, using 10 TU PPD, was positive in only one case. The diagnosis of tuberculosis was confirmed by evidence of Mycobacterium Tuberculosis [MT] in direct examination in three cases, by cultures in the same three cases, and histology in four cases. Preliminary results of antibacterial treatment were favorable in five patients. However, these five patients died within an average of twelve months after diagnosis of tuberculosis, corresponding with the CDC which includes extrapulmonary tuberculosis in their case definition of AIDS. A study of a larger series would allow clarification of the epidemiological aspects of tuberculosis associated with HIV infection in Morocco

[Mediterranean spotted Fever. [64 observations]]

A retrospective study about 64 cases of Mediterranean Spotted Fever was conducted from January 1981 to November 1990. A pic of frequency was observed during summer [59%] with 26% of cases in July. 63% of patients were aged between 20 and 40 years. Males were more frequent than females [63%]. The contact with a dog was present in 14 cases [22%].Diagnosis was established in emergency only in 10 cases. A contact with a dog was found in 55% of cases. A treatment with cyclines or phenicoles was realised in all cases. None case of death was deplored. This retrospective study permits us to emphazise the frequency of Mediterranean Spotted Fever in our unit

[Clinical aspects and evolution of lymph node tuberculosis [77 Cases]]

Clinical Aspects and Evolution of Lymph Node Tuberculosis Between July 1981 and May 1990, 77 patients were hospitalized for tubercular adenopathy; the majority had a low economic status and only 7% had received the BCG vaccination. The infected lymph node was either isolated [n = 36] or associated with other infections the adenopathy was profond [n = 21] and / or more frequently peripheral [n = 72]. Cervical adenopathy was the most common. The tuberculin PPD test was positive in 61% of the patients. Wheras confirmation by diagnosis was available in 66 cases [86%]. Evolution following anti-tuberculosis treatment, with multiple therapies most often used, was favorable in 65 cases; treatment was unfavorable in 7 patients having multiple associated visceral infections

Treatment of urinary tract infections

Antibiotic treatment of urinary tract infections is based upon natural history and clinical signs of the infection. The epidemiological, the bacteriological and pharmacological data are reviewed and the treatment of the major clinical situations is discussed

Treatment of urinary tract infection with a daily and unique dose of gentamycin

Twenty nine patients with Gram negative urinary tract infection have received gentamicin in a single daily dose of 2,5 mg per kilogram of body weight for 10 days. Follow up is based on bacteriologic and biologic data and on dosage of gentamicin. The mean values of gentamicin levels obtained in blood and urine are efficient and non toxic. In 14% of cases, failure of treatment is due to a local cause of urinary tract infection. A single daily dose of gentamicin is efficient and non toxic if adapted to the patient's weight