Multiple pneumonias in a man infected with HIV.

There are many pathogens responsible for pneumonia in persons infected with HIV. This case report describes a patient with pneumonias diagnosed sequentially and caused by Pneumocystis carinii, Mycobacterium gordonae, and Coccidioides immitis. It demonstrates the importance of pursuing a definitive or additional diagnosis in HIV-related pulmonary disease when the response to empiric therapy or to treatment of an identified pathogen is suboptimal.

Fluconazole-resistant Candida albicans after long-term suppressive therapy.

Candida albicans is generally considered to be susceptible, in vivo, to fluconazole. In the population infected with human immunodeficiency virus, recurrent bouts of oral and esophageal candidiasis have led to increasing use of fluconazole for long-term prophylaxis. With prolonged therapy, the issue of developing resistance emerges. We report a case of fluconazole-resistant C albicans esophagitis that developed after fluconazole was used for more than 600 days.

Treatment of herpes zoster and postherpetic neuralgia.

Herpes zoster results from reactivation of latent varicella-zoster virus. It is most common in elderly patients and immunosuppressed patients, especially those with human immunodeficiency virus (HIV) infection. Zoster is often the earliest indicator of HIV infection. The acute course of herpes zoster is generally benign, but systemic complications may be fatal. Postherpetic neuralgia is the major chronic complication and is a difficult management problem. High-dose acyclovir (800 mg orally five times daily) has recently been approved for treatment of herpes zoster and, if started early, decreases the duration and severity of symptoms. In the prevention of postherpetic neuralgia, acyclovir does not appear to be effective, and the efficacy of steroids is questionable. The best therapy currently available for postherpetic neuralgia is amitriptyline, topical capsaicin and transcutaneous electrical stimulation.