[Fever of unknown origin in patients infected with the human immunodeficiency virus]. / Fiebre de origen desconocido en pacientes infectados por el virus de la inmunodeficiencia humana.

BACKGROUND: To describe the clinical features and the final diagnosis of patients infected with human immunodeficiency virus who presented fever of unknown origin. METHODS: Retrospective study, from November 1989 to January 1994, of all patients infected with HIV who had fever of unknown origin and who were admitted to a community hospital in a Mediterranean area in Alicante (Spain). Fever of unknown origin was defined as fever exceeding 38.3 degrees C lasting for at least three weeks with no diagnosis in the first three days of hospitalization after fulfilling clinical exam, three blood cultures, acid-fast bacilli stain in sputum and chest-X-ray. RESULTS: Of a cohort of 231 patients, 27 (12%) were evaluated because of fever of unknown origin during their follow-up. Patients' mean age was 31 years (interval, 22-75) and intravenous drug use (81%) was the most common risk factor for HIV infection. A total of 31 episodes of fever of unknown origin were reviewed. Twenty-three (74%) episodes occurred in patients with less than 200 CD4 lymphocytes/mm3. A final diagnosis of fever of unknown origin was achieved in 24 (77%) episodes: visceral leishmaniasis (n = 11), tuberculosis (n = 9), non-Hodgkin's lymphoma (n = 1), CNS toxoplasmosis (n = 1), cryptococcal meningitis (n = 1) and drug adverse reaction (n = 1). CONCLUSIONS: HIV-infected patients with fever of unknown origin very often show severe immunodeficiency. Cryptococcal antigen testing should be carried out in the initial evaluation of fever of unknown origin in HIV-infected patients. In our area, 64% of episodes of fever of unknown origin were caused by visceral leishmaniasis or tuberculosis.

[Progressive external ophthalmoplegia]. / Oftalmoplejia externa progresiva.

Progressive external ophthalmoplegia is a myopathic alteration of slow progression which affects the extrinsic ocular muscles; ptosis of the eyelid being the most characteristic sign. Nowadays, it is included as type of muscular dystrophy. Even though mitochondrial changes have been described, they are not specific to this disease. 2 cases are described in this paper, commenting on clinical, electromyographic and pathological aspects.

[Microangiopathic hemolytic anemia and leukoerythroblastosis as the presenting form of a gastric adenocarcinoma]. / Anemia hemolítica microangiopática y leucoeritroblastosis como forma de presentación de un adenocarcinoma gástrico.

Among the hematologic complications associated to cancer, microangiopathic hemolytic anemia and leukoerythroblastosis are rarely reported together. We present the case of a patient with gastric adenocarcinoma that presented clinically with microangiopathic hemolytic anemia and leukoerythroblastosis in peripheral blood as a result of metastatic invasion of the bone marrow. We discuss the probable etiopathogenic relation of these two entities with cancer, the therapeutic possibilities and the primary role of bone marrow biopsy and examination of the peripheral blood smear as more reliable diagnostic methods.