[ case of idiopathic CD4+ lymphocytepenia]

Opportunistic infections are common in patient with cell mediated immunodeficiency. We report here a case of multiple opportunistic infections and lymphoproliferative disease in patient eith idiopathic cd4+ lymphocy topenia. A 45 years old man was admitted in our hospital due to respiratory distress and diffuse skin lesions

BX of skin lesions and cdture of synovied fluid contained TB infection and prepared smear of synovid fluid contained aspergilus. The white blood cde count was 1000/ml with pmn [63%] and lymphocyte[28%] and cd4 [10.4%]. persistent cd4+ lymphocy to penia below 300/ml and lack of evidence for HIV1, 2 infection and also HTLV1, 2 infection svggests that immunosupression was due to idiopathic cd4+ lymphocytopenia [ICL] the paticnt was treated with antifungal and antibiotics and clinically improved. One years lates he almittes due to left side paresis. In brain MRI a lesion was seen in frontal. Also there was multiple lymph in inguinal region. Biopsy of lymph node showed lympo proliferative disordes. Unfortunately despite treatmen he died

Report of a patient with concomitant abdominal aortic aneurysm and colorectal carcinoma

We present a 73 year-old severely ill Iranian patient who had a cardiac arrest and a successful cardiopulmonary resuscitation [CPR] one hour after admission in N.I.O.C Hospital. He was a known case of abdominal aortic aneurysm which was accidentally diagnosed by ultrasonography two years ago, so he was emergently operated with probable diagnosis of rupture of aneurysm. Meanwhile, he had a history of painless rectorrhagia unrelated to defecation during the past six months. Tissue diagnosis of rectal adenocarcinoma was defined following a total colonoscopy. Colorectal carcinoma and abdominal aortic aneurysm are common diseases in similar age group. Co-existence of these diseases is rare. Treatment strategy is a big challenge for these patients. In this patient, aneurysmectomy was performed first, because of emergent condition of the patient, and treatment of the colorectal carcinoma was postponed

[ response to Hepatitis B virus vaccine in HIV-infected patients [HIV/AIDS counseling and care center in Kermanshah]]

Background and Objective: HBV infection is preventable by effective vaccination in general population, but response to vaccine among HIV infected people seems to be low

Methods: In this prospective study, 48 HIV position patients with anti HBs-Ab and HBs Ag had hepatitis B vaccination [0, 1, 6 months]. Anti-HBs levels were measured two months after the last dose by ELISA method. Cellular immunity was evaluated by flowcytometry

Findings: Only 14 [29.1%] of vaccinated HIV-infected patients had positive anti-HBs titers [11 males, 3 females]. Among them, 4 [28.6%] were over 40 years and from 34 HIV positive patients who did not respond to hepatitis B vaccine, 10 [29.4%] were over 40 years old. The mean number of CD4+ T lymphocytes was 352.5 in responders and 283.9 in non-responders. 2 [17.6%] of 17 HIV positive patients with CD4+ T <200 AND 6 [31.5%] of 19 HIV positive patients with 200500 responded to hepatitis B vaccine

Conclusion: Hepatitis B vaccination is better to be administered at the early stage of HIV infection. Conventional dose HIV vaccine is not enough for immunity. Therefore, it is recommended two-fold dose and repeated conventional dose or increasing interval administration of hepatitis B vaccine