ABSTRACT
Soft tissue calcification are common in chronic hemodialysis patients and often affect the periarticular tissues, where they occasionally form tumoral masses. In a retrospective study of 254 hemodialysis patients we identified three such cases. Affected sites were the wrist, shoulder, and chest wall. None of the patients had secondary hyperparathyroidism. A discussion is provided of the roentgenographic and clinical features of tumoral calcinosis, of current pathogenic hypotheses, and of available treatments.
Subject(s)
Calcinosis/etiology , Kidney Failure, Chronic/therapy , Renal Dialysis/adverse effects , Shoulder Joint , Wrist Joint , Adult , Aged , Calcinosis/diagnostic imaging , Calcinosis/physiopathology , Calcinosis/therapy , Female , Humans , Joint Diseases/diagnostic imaging , Joint Diseases/etiology , Joint Diseases/physiopathology , Joint Diseases/therapy , Male , Middle Aged , Radiography , Retrospective StudiesABSTRACT
A 39-year-old HIV-infected man had manifested a typical varicella successfully treated with intravenous acyclovir. Despite oral acyclovir, he developed 10 days later a widespread eruption of pinpoint-sized erythematous papular lesions. Histologic examination and viral culture showed a persistent varicella-zoster virus (VZV) infection. Intravenous acyclovir and foscarnet were both efficient. However, each withdrawal of intravenously administered treatment resulted in a rapid relapse. Among the atypical forms of chronic varicella, this eruption appears to be unique. As in our case, chronic VZV infection appears often to be a difficult therapeutic challenge.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , Chickenpox/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/pathology , Acyclovir/administration & dosage , Acyclovir/therapeutic use , Adult , Antiviral Agents/therapeutic use , Chickenpox/drug therapy , Chickenpox/pathology , Chronic Disease , Fatal Outcome , Foscarnet/administration & dosage , Foscarnet/therapeutic use , Humans , Male , RecurrenceSubject(s)
Arthritis, Infectious/etiology , Aspergillosis/etiology , Aspergillus fumigatus , Itraconazole/therapeutic use , Kidney Transplantation , Shoulder Joint , Arthritis, Infectious/drug therapy , Aspergillosis/drug therapy , Aspergillus fumigatus/isolation & purification , Cyclosporine/blood , Cyclosporine/therapeutic use , Drug Monitoring , Fatal Outcome , Humans , Immunosuppression Therapy/adverse effects , Kidney Transplantation/immunology , Middle Aged , Osteoarthritis/drug therapy , Osteoarthritis/microbiology , Synovial Fluid/microbiologyABSTRACT
We report a case of Aspergillus arthritis of the shoulder in a renal transplant recipient. Cultures of three joint fluid specimens grew Aspergillus fumigatus. Itraconazole as sole treatment resulted in initial clinical and roentgenographic improvements but failed to prevent deterioration in joint function. A relapse with fatal neurologic involvement occurred. Immune deficiency-inducing risk factors for aspergillosis include neutropenia and corticosteroid therapy. Previously published cases of Aspergillus arthritis of limb joints are reviewed. The advantages and limitations of itraconazole as single drug therapy are outlined.
