RESUMO
BACKGROUND: Disseminated Kaposi sarcoma (DKS) is present in patients with advanced HIV infection in whom co-infection with other opportunistic pathogens can occur. Bone marrow (BM) aspirate and biopsy comprise a robust diagnostic tool in patients with fever, cytopenias, and abnormal liver tests. However, the yield in patients with DKS has not been determined. OBJECTIVE: The aim of this study was to evaluate the utility of BM aspirate and biopsy in patients with DKS. METHODS: We included 40 male patients with a recent diagnosis of DKS. BM aspirate and biopsy was performed as part of the workup to rule out co-infections. RESULTS: In four patients, Mycobacterium avium complex (MAC) was recovered from culture. In other four patients, intracellular yeasts were observed in the Grocott stain, diagnosed as Histoplasma. The yield of BM was calculated in 20%. Only 12 patients (30%) had fever and 11 (27.5%) had pancytopenia. Alkaline phosphatase (ALP) above normal values and C-reactive protein (CRP) were higher in patients with positive results for BM than in those with negative results (63% vs. 21.9%, and 3.0 vs. 1.2 mg/L; p = 0.03 in both comparisons). No differences were found when complete blood-count abnormalities were compared. CONCLUSION: We recommend performing a BM aspirate for stains, culture, and biopsy in all HIV patients with DKS, as this will permit the early diagnosis of co-infections and prevent further complications in those who receive chemotherapy.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Medula Óssea/microbiologia , Infecções por HIV/diagnóstico , Histoplasma/crescimento & desenvolvimento , Histoplasmose/diagnóstico , Sarcoma de Kaposi/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/patologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Fosfatase Alcalina/metabolismo , Biomarcadores/metabolismo , Biópsia , Hemocultura , Medula Óssea/metabolismo , Medula Óssea/cirurgia , Medula Óssea/virologia , Proteína C-Reativa/metabolismo , HIV/crescimento & desenvolvimento , HIV/patogenicidade , Infecções por HIV/microbiologia , Infecções por HIV/patologia , Infecções por HIV/virologia , Histoplasma/isolamento & purificação , Histoplasma/patogenicidade , Histoplasmose/microbiologia , Histoplasmose/patologia , Histoplasmose/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Sarcoma de Kaposi/microbiologia , Sarcoma de Kaposi/patologia , Sarcoma de Kaposi/virologiaRESUMO
Vibrio vulnificus is an etiologic agent of septicemia and skin lesions. Patients with chronic diseases, and more frequently chronic liver disease, are specially susceptible to this infection. The main risk factor is shellfish ingestion. In this report we present a patient with chronic liver disease who suffered fulminant sepsis and necro-hemorrhagic bullaes secondary to a V. vulnificus infection. The patient had ingested shrimps two days before. A review of the recent literature on the subject is also presented.
