Giant cell arteritis associated with acute Q fever - A case report.

Q fever is a worldwide spread zoonotic disease, caused by the gram-negative intracellular bacillus Coxiella burnetii. Apart from its most common manifestations, Q fever has been reported to occasionally mimic autoimmune diseases. We herein present a case of acute Q fever in a 69-year-old man, manifesting as prolonged fever with pneumonitis, in whom biopsy of the temporal artery revealed giant cell arteritis. Moreover, PCR testing of the biopsy specimen was positive for Coxiella burnetii, thus further supporting the possibly infectious etiology of some cases of biopsy proven giant cell arteritis, with implications for treatment.

Successful Treatment of immune Reconstitution Inflammatory syndrome-related Hemophagocytic Syndrome in an HIV Patient with Primary Effusion Lymphoma.

Although the connection of [secondary hemophagocytic syndrome (sHS)] with HIV has been well documented, optimal treatment regimen is not well established. This is due not only to the rarity of the syndrome, but also to the heterogeneity of the involved population. Most cases are related to opportunistic infections or malignancies in advanced stage, but many cases are also related to seroconversion, in the primary infection setting. Moreover, in the [antiretroviral treatment (ART)] era, rare cases of ART-related sHS have been reported. In these, often fatal cases, an [immune reconstitution inflammatory syndrome (IRIS)] process is involved, posing a serious challenge to the treating physician. We hereby report a case of successful treatment of an HIV patient with primary effusion lymphoma who experienced sHS shortly after ART onset. Our patient, treated with high dose dexamethasone and gamma globulin, achieved complete remission. This case might hint possible therapeutic insights in the treatment of IRIS-related sHS.

Body composition in asymptomatic HIV-infected men: cross-sectional and prospective assessment.

Data on body composition changes in HIV infected patients is sparse and controversial. The aim of this study was to assess body composition in asymptomatic HIV-infected men with normal body weight in comparison to healthy HIV-negative control men and to investigate possible body composition changes in HIV-positive patients over a 2-year observation period. One hundred eight asymptomatic seropositive men, aged 19-62 years, and 20 healthy sex, age and weight - matched controls were recruited for the cross-sectional part of the study. Fifty-eight of the HIV+ patients were followed up for 2 years. Body weight, BMI, Bone Mineral Content (BMC), body Fat mass (Fat), % Fat, body Lean mass (Lean) and % Lean was recorded for each subject at the beginning and at the end of the follow-up period. The same analysis was repeated separately for arms, trunk and legs. HIV+ men had increased fat mass and reduced lean mass compared to controls (%Fat in HIV+ 24.3, %Fat in controls 19.2, p=0.012; %Lean in HIV+ 72.1, %Lean in controls 77.0, p=0.014). Lean mass was lower in extremities while fat mass was higher in the trunk region in HIV+ in comparison to controls, irrespective of antiretroviral therapy. Longitudinally, patients with higher baseline %Fat (>24.2, median) presented 20% decrease in fat mass while patients with lower baseline %Fat (< or =24.2) showed a smaller, non-significant decrease in fat mass accompanied by a significant decrease (2.52%) in lean mass. Fat loss occurred in all subjects predominantly in the extremities (16.5-36.45% loss), with relative preservation of trunk fat. It is concluded that otherwise asymptomatic HIV+ men exhibit subtle body composition changes involving reduced lean mass and increased central fat mass. The pattern of weight loss over time depends on baseline fat store: patients with adequate fat stores lose predominantly fat while patients with lower baseline fat stores lose both fat and lean mass. In the entire cohort, there is a tendency towards central adiposity, with the majority of fat being lost from the extremities, a picture resembling metabolic x syndrome.