[Cytomegalovirus retinitis: clinical and therapeutic aspects]

CYTOMEGALOVIRUS [CMV] is a frequent infection, which is usually asymptomatic. It is a significant pathogen in terminal acquired immunodeficiency syndrome [AIDS] patients causing major opportunistic events. Retrospective study of 5 AIDS patients with CMV retinitis treated between 1990 and 2001 in the department of ophthalmology in Sfax Hospital centre was conducted to determine clinical and therapeutic featuring, and efficacy of intraveinous and intravitreal ganciclovir to control retinitis in AIDS patients. The results showed that retinitis was controlled in 4 cases and visual acuity improved within three weeks. Serious ocular complications were encountered in 1 case. Concomitant tritherapy was used in 3 cases. In 1 case we noted necrotizing retinitis at the periphery enlarging centrifugally and progressing to the fovea. In immunocompromised patients, Ganciclovir may offer good alternative to control CMV retinitis. Fortunately, with the use of highly active antiretroviral therapy very few patients have disease related to CMV

Spinal aspergillus osteomyelitis in immunocompetent patient

Aspergillus osteomyelitis of the spine has rarely been reported in immunocompetent patients. This report describes a case of aspergillus osteomyelitis in an immunocompetent diabetic patent. A 73-year-old lady developed pulmonary infection with spreading of the infection to the spine [T10-T11] leading to spinal cord compression and paraparesis. Bronchial lavage and needle biopsy isolated aspergillus fumigatus. The patient was treated with amphotericine B and itroconazole without surgical debridement. Six months later, the patient was fully independent and had only minimal gait spasticity. Although rare, aspergillus spondylitis should be included in the differential diagnosis of spondylodiscitis. Its distinction from Pott's disease is difficult but of paramount importance in the therapeutic management

Multicentric pleomorphic xanthoastrocytoma

Multiple brain lesions may include a variety of differential diagnosis mainly infections, inflammatory and tumoural lesions. The authors present an unusual case of multicentric brain gliomas. A 35-year-old male was investigated for seizures and intracranial hypertension. Brain magnetic resonance imaging revealed 2 superficial distinct left fronto-parietal homogeneous lesions with severe perilesionnal oedema, a dural tail and bone infiltration. A diagnosis of multiple meningiomas was evoked. Surgically, it was seen that the 2 lesions were totally independent. Pathologically, they were considered as typical pleomorphic xanthoastrocytoma [PXA]. To the authors' knowledge, only one similar case with multiple simultaneous PXA has been reported