Bilateral subclavian vein thrombosis in a patient with acquired immunodeficiency syndrome.

Bilateral subclavian vein thrombi developed, in the presence of a Groshong catheter, in a patient with the acquired immunodeficiency syndrome (AIDS) and disseminated cytomegalovirus infection. Thrombosis is an uncommon complication of AIDS, and bilateral subclavian thrombi are rare. Although localized, unilateral thrombi occur in patients with indwelling central venous catheters, unexpectedly extensive bilateral clot formation is seen to develop in patients with human immunodeficiency virus infection. Potentially predisposing factors for thrombosis in AIDS include central venous catheterization, malignancy, elevated anticardiolipin antibodies, alteration of vascular endothelial cell function reflected in low free protein S levels, and enhanced endothelial procoagulant activity related to cytomegalovirus. Anecdotal data strongly suggest that cytomegalovirus enhances the risk for thrombosis, but studies are needed to confirm the association. Physicians should be aware of the enhanced risk for extensive thrombi in AIDS, especially in patients with disseminated cytomegalovirus infection.

Infective endocarditis due to Pasteurella dagmatis: case report and review.

We report a case of endocarditis due to Pasteurella dagmatis complicated by vertebral osteomyelitis in a 55-year-old former alcoholic woman. To our knowledge, this is the second report of endocarditis attributed to that organism in the English-language medical literature. Rare cases of endocarditis due to other Pasteurella species and their varied clinical features are summarized.

Sinusitis due to Pseudomonas aeruginosa in patients with human immunodeficiency virus infection.

Community-acquired sinusitis due to Pseudomonas aeruginosa developed in four patients with advanced human immunodeficiency virus (HIV) infection who had no local predisposing factors or neutropenia. Two persons were bacteremic. Combination antibiotic therapy and surgical drainage were necessary for adequate treatment. Ciprofloxacin-resistant strains were isolated possibly because of the chronic use of the drug as part of a treatment regimen for disseminated infection with Mycobacterium avium complex. Physicians treating patients with HIV infection must have an increased index of suspicion for P. aeruginosa as a causative agent of sinusitis.

Seronegative acquired immunodeficiency syndrome (AIDS).

The case reported here fulfilled the Centers for Disease Control surveillance case definition for acquired immunodeficiency syndrome without laboratory evidence of human immunodeficiency virus. The patient, a 63-year-old man, had received transfusions of several units of packed red blood cells after a coronary bypass graft. He had recurrent fever and lymphopenia. He had a depressed helper T-cell count, esophageal and tracheobronchial candidiasis, and Pneumocystis carinii pneumonia. Results of all tests for human immunodeficiency virus were negative or inconclusive. However, the patient may have been seroconverting at the time of his death.

Rapid detection of cytomegalovirus by fluorescent monoclonal antibody staining and in situ DNA hybridization in a dram vial cell culture system.

By using dram vial cell culture methods, three commercially available tests for cytomegalovirus (CMV) detection were compared: direct fluorescent monoclonal antibody staining for CMV-specific early and late antigens (direct FA), indirect fluorescent monoclonal antibody staining for a CMV-specific early antigen (indirect FA), and in situ DNA hybridization with a biotinylated CMV-specific DNA probe kit (DNA probe). Of those tests, only the indirect FA provided consistent, reliable virus detection within the initial 24 h postinfection for serial 10-fold dilutions of CMV AD169 (laboratory strain) and for three selected urine samples. However, when used prospectively, the indirect FA failed to detect virus within the initial 10 days postinfection in 15 of 78 consecutive specimens that were eventually positive by cell culture. Although the indirect FA was more sensitive than the direct FA or DNA probe, its utility appeared limited to specimens with high CMV concentrations. On the basis of these data, we recommend that indirect FA be reserved as an adjunct to standard cell culture for selected samples in diagnostic hospital laboratories.