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1.
Acta Clin Belg ; 68(2): 92-6, 2013.
Article in English | MEDLINE | ID: mdl-23967715

ABSTRACT

BACKGROUND: Few data exist documenting the survival experience of immigrated sub-Saharan patients infected by the human immunodeficiency virus (HIV) on renal replacement therapy (RRT). METHODS: This retrospective single centre pilot study includes 105 consecutive patients of sub-Saharan origin who started RRT in our unit, between January 1986 and April 2010. The aim was to analyse the characteristics and the survival rate on RRT of these patients. RESULTS: Out of 105 patients 81/105 (77%) were HIV-negative and 24/105(23%) were HIV-positive. HIV-positive patients were younger than HIV-negative patients and they were more often treated with peritoneal dialysis (PD) (21/24) than with haemodialysis (HD). Dialysis peritonitis was equally distributed between HIV-positive and HIV-negative patients. Because of opportunistic infections, duration of hospitalisation was longer for HIV-positive than for HIV-negative patients. In PD-treated patients, the number of hospitalisations tended to be greater in patients who experienced at least one peritonitis episode and the duration of hospitalisation also tended to be longer. The survival rate was better in patients younger than 50 years and in patients on HD, but was similar for both positive and negative HIV patients. CONCLUSIONS: To the best of our knowledge, these are the first data concerning patients who have emigrated from sub-Saharan Africa to Belgium, and who are on RTT. Their survival rate is better if they are younger than 50 years and on HD. As the majority of HIV patients were treated by PD in our center, a conclusion regarding survival on different dialysis modalities is not possible for this group of patients. Survival rates were similar for HIV-positive and HIV-negative patients despite longer duration of hospisalization for HIV-positive patients.


Subject(s)
HIV Infections/complications , Kidney Failure, Chronic/therapy , Renal Replacement Therapy , Adult , Africa South of the Sahara/ethnology , Belgium , Female , Humans , Male , Middle Aged , Pilot Projects , Prognosis , Proportional Hazards Models , Retrospective Studies , Statistics, Nonparametric , Survival Rate , Treatment Outcome
2.
Acta Clin Belg ; 65(4): 276-8, 2010.
Article in English | MEDLINE | ID: mdl-20954469

ABSTRACT

We describe a case of recurrent haemophagocytic syndrome (HS) in an HIV-infected patient.The first episode was associated with active human herpesvirus 8 infection and progressive Kaposi's sarcoma which was successfully treated with splenectomy, foscarnet and chemotherapy. The second episode was triggered by a Clostridium difficile colitis and resolved completely after treatment with metronidazole only. Recurrent HS has rarely been described in adult patients out of the setting of relapsing malignancy or autoimmune disease.The chronic immune dysregulation and suppression due to HIV-infection may predispose our patient to development of associated HS. Prognosis of HS remains poor, especially in HIV-infected patients. Rapidly unmasking the causative factor and timely instauration of adequate treatment are critical and may improve outcome.


Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , Lymphohistiocytosis, Hemophagocytic/diagnosis , Sarcoma, Kaposi/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/surgery , Adult , Humans , Lymphohistiocytosis, Hemophagocytic/drug therapy , Lymphohistiocytosis, Hemophagocytic/surgery , Male , Recurrence , Sarcoma, Kaposi/drug therapy , Splenectomy
3.
Int Urol Nephrol ; 42(1): 227-32, 2010 Mar.
Article in English | MEDLINE | ID: mdl-19533407

ABSTRACT

We report a case of extra pulmonary tuberculosis with multiple localizations including bone and kidney in a 21-year-old Pakistani immigrant living in Belgium. Late diagnosis of tuberculosis may lead to end stage renal disease and dialysis. Countries with low prevalence of tuberculosis should be vigilant towards high risk groups for tuberculosis because this preventable and curable disease may lead to devastating complications when diagnosed late.


Subject(s)
Tuberculosis, Renal/diagnosis , Humans , Immunocompetence , Male , Renal Insufficiency/etiology , Time Factors , Tuberculosis, Renal/complications , Young Adult
4.
Clin Drug Investig ; 27(10): 727-9, 2007.
Article in English | MEDLINE | ID: mdl-17803348

ABSTRACT

Encapsulating peritoneal sclerosis (EPS) is a rare but serious life-threatening complication in peritoneal dialysis patients. At present, there is no evidence-based standard therapy for EPS. Tamoxifen has been used and shown good results in non-HIV peritoneal dialysis patients with EPS. We report a case of a patient with HIV treated with antiretroviral therapy (zidovudine, lamivudine and saquinavir) for several years. He had end-stage renal disease and was treated with continuous ambulatory peritoneal dialysis (CAPD). After 11 years on CAPD, he developed EPS and was treated successfully with tamoxifen in combination with corticosteroids. No adverse effects were observed and no changes were noted in CD4 counts or HIV viral load during this therapy. These findings suggest that tamoxifen can be safely given to HIV patients with peritoneal dialysis-related EPS. Nevertheless, caution is required as tamoxifen could interact with certain antiretroviral agents.


Subject(s)
Estrogen Antagonists/therapeutic use , HIV Infections/complications , Peritoneal Diseases/drug therapy , Sclerosis/drug therapy , Tamoxifen/therapeutic use , Anti-HIV Agents/therapeutic use , Drug Therapy, Combination , Glucocorticoids/therapeutic use , Humans , Kidney Failure, Chronic/complications , Lamivudine/therapeutic use , Male , Middle Aged , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritoneal Diseases/etiology , Saquinavir/therapeutic use , Sclerosis/etiology , Zidovudine/therapeutic use
5.
Eur J Intern Med ; 17(7): 503-4, 2006 Nov.
Article in English | MEDLINE | ID: mdl-17098596

ABSTRACT

Hemophagocytic syndrome (HPS) is a clinical entity that combines non-specific clinical and biological features. The diagnosis is usually confirmed by a bone marrow examination. HPS may be primary or secondary to a malignancy or to an infectious or autoimmune disease. Since it was first described, various agents have been implicated, including viruses, bacteria, and parasites. In HIV patients, many cases occur with lymphoma or with a variety of opportunistic infections due to CMV, HHV8, Pneumocystis carinii, Mycobacterium tuberculosis, MAC, toxoplasmosis, and even pneumococcus. We report here a case of an AIDS patient presenting a HPS secondary to an extracerebral form of systemic toxoplasmosis that was only revealed by specific PCR in tissue other than the CNS.

7.
Acta Chir Belg ; 103(3): 321-3, 2003 Jun.
Article in English | MEDLINE | ID: mdl-12914371

ABSTRACT

Renal cell carcinoma has a variable clinical course. Size is a prognostic factor correlated with venous invasion, lymph node or distant metastases. These are more often encountered when the size exceeds 10 cm. For 20 years, incidental renal tumours have represented the majority of diagnosed cases, as a result of more common use of imaging techniques. We report a case of renal cell carcinoma of an unusually large size, without metastatic or locally advanced disease. Histology revealed a pT2 clear cell renal cell carcinoma of 31 x 31 x 10 cm, which was totally resected. It is the first case reported of localized conventional renal cell carcinoma reaching such a size.


Subject(s)
Carcinoma, Renal Cell/pathology , Kidney Neoplasms/pathology , Aged , Carcinoma, Renal Cell/surgery , Humans , Kidney Neoplasms/surgery , Male
8.
Acta Clin Belg ; 57(3): 142-7, 2002.
Article in English | MEDLINE | ID: mdl-12212355

ABSTRACT

OBJECTIVE: Non-infectious uveitis is often associated with systemic diseases severe enough to require corticosteroids (CS) and immunosuppressive drugs, which have potential serious side effects. METHODS: 28 patients with non-infectious uveitis were referred by the ophthalmologist. RESULTS: A systemic disease was found in 17/28 patients (60%): sarcoidosis in 11, spondylarthropathy in 3, Behcet's disease in 2, Crohn's disease in 1 patient. Eighteen patients received CS, 21 patients received immunosuppressive drugs. Most side effects were due to CS treatment: Cushing's syndrome in 12, cataract in 11, glucose intolerance in 3, gastric ulcus in 1, hypertension in 1, osteoporosis in 17, avascular bone necrosis in 3 patients. Prophylaxis or treatment of corticosteroids induced osteoporosis consists in calcium, 500 mg/day and vitamin D 400 IU in most of them with in addition hormone replacement therapy (n = 8) or bisphosphonates (n = 13). CONCLUSION: Sixty percent of patients with severe uveitis had a systemic disease. CS were the most deleterious drugs in spite of bi- or tri-therapy with CS sparing immunosuppressive drugs.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , Patient Care Team , Uveitis/therapy , Vitamin D , Adult , Female , Humans , Immunosuppressive Agents/therapeutic use , Male , Severity of Illness Index , Uveitis/etiology
9.
Clin Rheumatol ; 21(4): 306-8, 2002 Aug.
Article in English | MEDLINE | ID: mdl-12189459

ABSTRACT

Human parvovirus B19 infection may be responsible for acute and chronic arthropathy. We present the case of a woman, who developed a severe chronic parvovirus B19 infection with persistence of DNA parvovirus B19, which was detected in the serum by polymerase chain reaction (PCR). After intravenous immunoglobulin administration she noted a disappearance of the general symptoms and the virus became undetectable by PCR in the serum. However, 1 month later back pain appeared. Magnetic resonance imaging showed bilateral effusions of the apophyseal joints of the lumbar spine (L4-L5). Spine involvement is rarely described during acute or chronic parvovirus B19 infection. In this case it was not possible to determine whether the facet joint arthropathy was reactive or due to persistent articular infection, or induced by immunoglobulin therapy.


Subject(s)
Arthritis, Reactive/pathology , Lumbar Vertebrae/pathology , Parvoviridae Infections/pathology , Parvovirus B19, Human/isolation & purification , Zygapophyseal Joint/pathology , Adult , Arthritis, Reactive/drug therapy , Arthritis, Reactive/virology , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Lumbar Vertebrae/virology , Magnetic Resonance Imaging , Parvoviridae Infections/complications , Parvoviridae Infections/physiopathology , Parvovirus B19, Human/genetics , Parvovirus B19, Human/pathogenicity , Treatment Outcome , Zygapophyseal Joint/virology
10.
Article in English | MEDLINE | ID: mdl-11712694

ABSTRACT

The aim of this study is to evaluate, from 369 routine sera of SLE and control patients, the worth of anti double stranded nuclear DNA, anti nucleosomes autoantibodies and anti membrane DNA for the diagnosis of SLE. Cell membrane associated DNA (mDNA) has been described on B lymphocytes and monocytes, but not on T cells. Antibodies to mDNA were identified by an indirect immunofluorescence assay using a B cell line fixed but not permeabilised. At a 1:40 serum dilution, anti mDNA is almost associated with the diagnosis of systemic lupus erythematosus (SLE). Anti mDNA were shown to be different in specificity as compared with anti double stranded nuclear DNA. We compare its characteristics as diagnostic procedure to the conventional anti dsDNA antibody detection and to the recently introduced anti nucleosome antibody test documented as associated with SLE. It appears that the best sensitivity (0.65) and specificity (0.98) is given by the anti mDNA test.


Subject(s)
Antibodies, Antinuclear/blood , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/immunology , Antibody Specificity , Case-Control Studies , Cell Membrane/immunology , Enzyme-Linked Immunosorbent Assay , Fluorescent Antibody Technique, Indirect , Humans , Nucleosomes/immunology , Predictive Value of Tests , ROC Curve , Sensitivity and Specificity
12.
Acta Clin Belg ; 55(1): 34-6, 2000.
Article in English | MEDLINE | ID: mdl-10783506

ABSTRACT

We report a case of multidrug-resistant spinal tuberculosis complicated by epiduritis and paraspinal abscess in a 68-year-old black woman. Multidrug-resistant tuberculous spondylitis is still rare in Belgium. Two others cases were reported from 1992 to 1997. The optimal therapy is not standardized and the mandatory duration of treatment is not known. Clinical presentation, radiological findings, and treatment are presented. The need for prompt diagnosis and optimal therapy is emphasized.


Subject(s)
Lumbar Vertebrae/microbiology , Spondylitis/microbiology , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Spinal/diagnosis , Aged , Antibiotics, Antitubercular/therapeutic use , Epidural Space/microbiology , Female , Humans , Psoas Abscess/microbiology , Spondylitis/drug therapy , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Spinal/drug therapy
14.
Ann Rheum Dis ; 57(10): 606-13, 1998 Oct.
Article in English | MEDLINE | ID: mdl-9893572

ABSTRACT

OBJECTIVE: Autoantibodies to cell membrane associated DNA are described in systemic lupus erythematosus (SLE). The specificity of these antibodies differ from antibodies to nuclear DNA. METHODS: Using indirect immunofluorescence, a specific IgG was detected giving a characteristic pattern of continuous peripheral membrane fluorescence on cultured B-lymphocytes. RESULTS: This pattern was observed in 53 of 80 serum samples of SLE patients but absent in the serum samples of the control populations: 15 rheumatoid arthritis, 38 ankylosing spondylarthritis, 17 non-inflammatory osteopenic patients, and 224 blood donors. In 34 Sjögren syndrome's patients one only showed a positive test. The cmDNA specificity of these antibodies was confirmed by pattern extinction with DNAse but not RNase or protease pre-treatment of the cells. IgG to cmDNA, separated by absorption/elution from purified cmDNA immobilised on DEAE-nitrocellulose reproduced the immunofluorescence pattern pictures. Extensive serum depletion of anti-double strand or single strand DNA antibodies by absorption to cellulose bound ds- or ss-DNA affected marginally the pericellular fluorescence revealing some minor cross reactivity with nuclear DNA. Moreover, in SLE patients without detectable antibody to ds-DNA, pericellular fluorescence could be visible. CONCLUSION: This novel rapid immunofluorescence method may serve as an identification test of SLE patients. Given its positive (97.1%) and negative (92.9%) predictive value, sensitivity (66%) and specificity (99.5%), it improves on other diagnostic tests such as the detection of antibodies to Sm.


Subject(s)
Antibodies, Antinuclear/blood , DNA/immunology , Lupus Erythematosus, Systemic/diagnosis , Adult , Aged , Aged, 80 and over , Antibody Specificity , Arthritis/diagnosis , Biomarkers/blood , Cell Membrane/immunology , DNA, Single-Stranded/immunology , Diagnosis, Differential , Female , Fluorescent Antibody Technique, Indirect , Humans , Immunoglobulin G/blood , Lupus Erythematosus, Systemic/immunology , Male , Methanol , Middle Aged , Tissue Fixation , Tumor Cells, Cultured
16.
Rev Med Brux ; 18(6): 381-4, 1997 Dec.
Article in French | MEDLINE | ID: mdl-9481158

ABSTRACT

A spontaneous splenic rupture occurred in a 31 year old patient suffering from infectious mononucleosis. An echography and an abdominal CT Scan revealed a rupture of the inferior pole of the spleen with a hemoperitoneum. A conservative surgical treatment was performed. Postoperative course was uneventful. This case-report draws the attention to the possibility of a conservative surgical treatment of a splenic rupture in the course of infectious mononucleosis. This attitude avoids the complications of splenectomy.


Subject(s)
Infectious Mononucleosis/complications , Splenic Rupture/surgery , Splenic Rupture/virology , Adult , Humans , Male , Rupture, Spontaneous , Splenectomy/adverse effects , Splenic Rupture/diagnosis , Surgical Mesh , Tomography, X-Ray Computed
17.
Clin Neurol Neurosurg ; 99(4): 287-90, 1997 Dec.
Article in English | MEDLINE | ID: mdl-9491308

ABSTRACT

In patients with acquired immuno-deficiency syndrome, the differential diagnosis between primary brain lymphoma and toxoplasma encephalitis is not radiologically always straightforward, especially in the presence of a solitary cerebral lesion. In this context, involvement of the corpus callosum is almost exclusively associated with primary brain lymphoma. We describe here an HIV-infected patient who presented with a single and large cerebral lesion affecting the corpus callosum, suggestive of primary brain lymphoma on MRI-scan but who nonetheless responded clinically and radiologically to an anti-toxoplasma drug trial confirming the diagnosis of toxoplasma encephalitis.


Subject(s)
Brain Neoplasms/pathology , Corpus Callosum/pathology , Encephalitis/etiology , HIV Seropositivity/complications , Lymphoma/pathology , Toxoplasmosis, Cerebral/complications , Adult , Animals , Anti-Infective Agents/therapeutic use , Brain Neoplasms/complications , Diagnosis, Differential , Encephalitis/complications , Encephalitis/drug therapy , Humans , Lymphoma/complications , Magnetic Resonance Imaging , Pyrimethamine/therapeutic use , Sulfadiazine/therapeutic use
18.
Am J Gastroenterol ; 91(1): 165-8, 1996 Jan.
Article in English | MEDLINE | ID: mdl-8561126

ABSTRACT

Azole-derived antifungal medications are particularly involved in drug-induced hepatic injury encountered in patients with AIDS. Fluconazole may induce multiple hepatic abnormalities usually characterized by asymptomatic and reversible mild hepatic necrosis. We here describe severe subacute liver damage occurring in a patient with AIDS who was receiving fluconazole maintenance therapy for a cryptococcosis. Hepatotoxicity was essentially characterized by mixed cytolytic and cholestatic liver tests abnormalities which improved after fluconazole discontinuation and worsened on fluconazole rechallenge. Optical microscopy demonstrated nonspecific abnormalities including granular aspect of the cytoplasm of the hepatocytes. In contrast, analysis of electron microscopy revealed unusual unreported features characterized by giant mitochondria with paracrystalline inclusions and enlarged smooth endoplasmic reticulum. All microscopic abnormalities were reversed after discontinuation of fluconazole. We suggest that persistent increased hepatic enzymes in HIV-infected patient taking fluconazole should prompt suspension of the treatment. Prospective studies are needed to determine whether careful monitoring of hepatic tests should be recommended in AIDS patients on prolonged fluconazole maintenance therapy.


Subject(s)
Acquired Immunodeficiency Syndrome/complications , Antifungal Agents/adverse effects , Chemical and Drug Induced Liver Injury/etiology , Fluconazole/adverse effects , HIV-1 , Mitochondria, Liver/drug effects , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/drug therapy , Acquired Immunodeficiency Syndrome/pathology , Acute Disease , Adult , Antifungal Agents/administration & dosage , Biopsy , Chemical and Drug Induced Liver Injury/pathology , Cryptococcosis/complications , Cryptococcosis/drug therapy , Female , Fluconazole/administration & dosage , Humans , Lung Diseases, Fungal/complications , Lung Diseases, Fungal/drug therapy , Mitochondria, Liver/ultrastructure , Time Factors
20.
Rev Med Brux ; 15(3): 132-6, 1994.
Article in French | MEDLINE | ID: mdl-8066358

ABSTRACT

The aim of this study was to compare induced sputum versus bronchoscopy in a non selected population. An induced sputum and a bronchoscopy with aspiration of secretions and bronchoalveolar lavage (BAL) were proposed to 30 patients with suspected lower respiratory tract infection, including 14 subjects with AIDS. Induced sputum failed in 3 patients, while endoscopy could not be performed (contra-indication, refusal or failure due to lack of cooperation) in 7 patients; a technical failure for BAL was observed in 3/23 cases. Contamination by oral germs was significantly less frequent with BAL (4/20) than with aspiration (15/23) or induced sputum (17/27). A relevant pathogen was cultured from induced sputum in 7/27 cases (3 mycobacteria, 4 usual pathogens) from aspiration in 3/23 cases (one mycobacterium, 2 usual pathogens) and from BAL in 4/20 cases (one mycobacterium, 3 usual pathogens). These results suggest that induced sputum is a promising method when difficulties in performing bronchoscopy are expected (severe respiratory insufficiency, psychiatric disease, lack of cooperation).


Subject(s)
Bronchopneumonia/microbiology , Bronchoscopy , Specimen Handling/methods , Sputum/microbiology , Bronchoalveolar Lavage Fluid/microbiology , Female , Humans , Male , Suction
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