An Aggressive Plasmablastic Lymphoma of the Oral Cavity as Primary Manifestation of Acquired Immunodeficiency Syndrome: Case Report and Literature Review

Introduction Plasmablastic lymphoma is a rare entity that was first described in the jaws and the oral cavity of patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Plasmablastic lymphoma is considered as a diffuse, large, B-cell lymphoma with a unique phenotype and a predilection for the oral cavity. Objectives The authors describe a case of an aggressive plasmablastic lymphoma of the oral cavity as the primary manifestation of AIDS. Resumed We report a case of plasmablastic lymphoma involving only the oral cavity as the first manifestation of AIDS. Diagnosis was confirmed by the oral lesion biopsy and the histopathologic examination that showed a dense infiltrate composed of atypical lymphocytes with numerous plasmocytes that expressed the plasma cell markers MUM-1 and CD138 and that were negative for the B-cell markers CD3, CD20, and CD45. Immunohistochemical and in situ hybridization revealed the Epstein-Barr virus genome in the atypical cells. Polymerase chain reaction was also positive for human herpesvirus-8 RNA. Conclusion The HIV serologic status should be evaluated in all patients with plasmablastic lymphoma of the oral cavity or extraoral sites.(AU)

MENINGOENCEPHALITIS DUE TO VARICELLA ZOSTER VIRUS IN AIDS PATIENTS. REPORT OF ELEVEN CASES AND REVIEW OF THE LITERATURE / Meningoencefalite pelo vírus varicela-zoster em pacientes com AIDS. Relato de onze casos e revisão da literatura

Neurological complications of varicella-zoster virus (VZV) are infrequent and include various clinical pictures. The reactivation of VZV in patients with AIDS is generally associated with an acute and severe meningoencephalitis. We report the epidemiological, clinical and virological data from 11 consecutive patients with diagnosis of HIV/AIDS and central nervous system (CNS) involvement due to VZV. All patients were male and seropositive for HIV. The primary risk factor for HIV infection was unprotected sexual contact. The median of CD4 T cell count was 142 cells/µL. All of them presented signs and symptoms of meningoencephalitis. Six patients (54.5%) presented pleocytosis; they all showed high CSF protein concentrations with a median of 2.1 g/dL. Polymerase chain reaction of cerebrospinal fluid specimen was positive for VZV in all of them and they were treated with intravenous acyclovir at doses of 30/mg/kg/day for 21 days. Overall survival was 63% (7 of 11 patients). The four dead patients had low cellular counts in CSF, below the median of this parameter. VZV should be included among the opportunistic pathogens that can involve CNS with a diffuse and severe meningoencephalitis in patients with advanced HIV/AIDS disease.

As complicações neurológicas do vírus varicela-zoster (VVZ) são pouco frequentes e incluem vários quadros clínicos. A reativação do VVZ em pacientes com AIDS é geralmente associada com meningoencefalite aguda e grave. Nós relatamos os dados epidemiológicos, clínicos e virológicos de onze pacientes consecutivos com diagnóstico de HIV/AIDS e comprometimento do sistema nervoso central (SNC) devido ao VVZ. Todos os pacientes eram do sexo masculino e soropositivos para HIV. O principal fator de risco para a infecção pelo HIV foi o contato sexual sem proteção. A mediana da contagem de células CD4 T foi de 142 cel/µL. Todos apresentavam sinais e sintomas devido à meningoencefalite. Seis pacientes (54,5%) apresentaram pleiocitose; todos apresentaram hiperproteinorraquia com mediana de 2,1 g/dL. A reação em cadeia da polimerase de amostra do líquido cefalorraquidiano foi positiva para VVZ em todos eles. Todos os pacientes foram tratados com aciclovir por via intravenosa em doses de 30 mg/kg/dia durante 21 dias. A sobrevida global foi de 63% (sete de 11 pacientes). Os quatro pacientes mortos tiveram uma escassa resposta celular no LCR abaixo da mediana para este parâmetro. O VVZ deve ser incluído entre os patógenos oportunistas que podem comprometer o SNC com meningoencefalite difusa e grave em pacientes com doença avançada por HIV/SIDA.

An Aggressive Plasmablastic Lymphoma of the Oral Cavity as Primary Manifestation of Acquired Immunodeficiency Syndrome: Case Report and Literature Review.

Introduction Plasmablastic lymphoma is a rare entity that was first described in the jaws and the oral cavity of patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Plasmablastic lymphoma is considered as a diffuse, large, B-cell lymphoma with a unique phenotype and a predilection for the oral cavity. Objective The authors describe a case of an aggressive plasmablastic lymphoma of the oral cavity as the primary manifestation of AIDS. Resumed Report We report a case of plasmablastic lymphoma involving only the oral cavity as the first manifestation of AIDS. Diagnosis was confirmed by the oral lesion biopsy and the histopathologic examination that showed a dense infiltrate composed of atypical lymphocytes with numerous plasmocytes that expressed the plasma cell markers MUM-1 and CD138 and that were negative for the B-cell markers CD3, CD20, and CD45. Immunohistochemical and in situ hybridization revealed the Epstein-Barr virus genome in the atypical cells. Polymerase chain reaction was also positive for human herpesvirus-8 RNA. Conclusion The HIV serologic status should be evaluated in all patients with plasmablastic lymphoma of the oral cavity or extraoral sites.

Clinical features of AIDS patients with Hodgkin's lymphoma with isolated bone marrow involvement: report of 12 cases at a single institution.

OBJECTIVE: To study the main clinical and histopathological features of 12 patients with Hodgkin's lymphoma (HL) diagnosed primarily from bone marrow (BM) involvement. METHODS: We included 12 acquired immunodeficiency syndrome (AIDS) patients with HL assisted in the F. J. Muñiz Infectious Diseases Hospital since January 2002 to December 2013. The diagnosis of HL with primary BM involvement in patients was confirmed by clinical, histopathological, and immunohistochemical findings. RESULTS: All patients presented "B" symptoms and pancytopenia. All of them had stage IV neoplasm disease because of BM infiltration. The median of CD4(+) T-cell counts was 114 cells/µL, and mixed cellularity (MC) was the most frequent histopathological subtype of 92% cases. CONCLUSION: When other causes are excluded, BM biopsy should be performed in AIDS patients with "B" symptoms and pancytopenia to evaluate BM infiltration by atypical lymphocytes.

MENINGOENCEPHALITIS DUE TO VARICELLA ZOSTER VIRUS IN AIDS PATIENTS. REPORT OF ELEVEN CASES AND REVIEW OF THE LITERATURE.

Neurological complications of varicella-zoster virus (VZV) are infrequent and include various clinical pictures. The reactivation of VZV in patients with AIDS is generally associated with an acute and severe meningoencephalitis. We report the epidemiological, clinical and virological data from 11 consecutive patients with diagnosis of HIV/AIDS and central nervous system (CNS) involvement due to VZV. All patients were male and seropositive for HIV. The primary risk factor for HIV infection was unprotected sexual contact. The median of CD4 T cell count was 142 cells/µL. All of them presented signs and symptoms of meningoencephalitis. Six patients (54.5%) presented pleocytosis; they all showed high CSF protein concentrations with a median of 2.1 g/dL. Polymerase chain reaction of cerebrospinal fluid specimen was positive for VZV in all of them and they were treated with intravenous acyclovir at doses of 30/mg/kg/day for 21 days. Overall survival was 63% (7 of 11 patients). The four dead patients had low cellular counts in CSF, below the median of this parameter. VZV should be included among the opportunistic pathogens that can involve CNS with a diffuse and severe meningoencephalitis in patients with advanced HIV/AIDS disease.

An Unusual Case of Primary Human Immunodeficiency Virus Infection Presenting as Mononucleosis-like Syndrome and Acute Aseptic Meningoencephalitis. Report of a Case and Review of the Literature.

Clinical presentation of primary human immunodeficiency virus (HIV) infection includes a wide spectrum of manifestations from asymptomatic infection to a symptomatic and severe illness. Central nervous system involvement should be always considered as a severe clinical form of primary HIV infection. Physicians should be aware to the broad clinical spectrum of primary HIV infection. We report a case of a female with diagnosis of mononucleosis-like syndrome and acute aseptic meningoencephalitis during primary HIV infection.

Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly.

INTRODUCTION: Cryptococcosis is an opportunistic mycosis, especially in patients that are human immunodeficiency virus (HIV)-positive, and frequently involves the central nervous system. METHODS: We assessed the potential of ventriculoperitoneal shunting (VPS) in preventing mortality due to uncontrollable intracranial hypertension (ICH) in 15 patients with acquired immunodeficiency syndrome (AIDS)-related cryptococcal meningitis. RESULTS: After 2 weeks of antifungal therapy consisting of amphotericin B deoxycholate with or without fluconazole, patients with persistent ICH underwent VPS, despite having persistent Cryptococcus neoformans infection. In 12 patients, the uncontrollable ICH was resolved by VPS. CONCLUSIONS: Patients with cryptococcal meningoencephalitis who have ICH must be considered for VPS even with positive cerebrospinal fluid cultures.

Primary Extranodal Non-Hodgkin Lymphoma of the Head and Neck in Patients with Acquired Immunodeficiency Syndrome: A Clinicopathologic Study of 24 Patients in a Single Hospital of Infectious Diseases in Argentina

Introduction: Extranodal non-Hodgkin lymphomas (NHLs) are commonly described in patients with acquired immunodeficiency syndrome (AIDS) and are related with an atypical morphology and aggressive clinical course. AIDS-associated lymphomas are characterized by their rapid progression, frequent extranodal manifestations, and poor outcome. Objective: The aim of this article is to remake the clinical features of head and neck (HN) NHL in patients with AIDS to facilitate early diagnosis and treatment. Methods: We evaluated the epidemiologic, clinical, immunologic, virologic, and histopathologic characteristics of 24 patients with human immunodeficiency virus (HIV)/AIDS with primary HN NHL treated at a single institution between 2002 and 2012. Histopathologic diagnosis was made according to the criteria of the World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues. Additional immunohistochemical stains were applied in all cases. Results: Eighteen patients (75%) were men and the median of age was 39 years. The gingiva and the hard palate were the most common sites of the lesions (15 patients, 62.5%). Lactate dehydrogenase levels were elevated in 16 cases (84%). Bone marrow infiltration was detected only in 4 cases (16.6%). The median CD4 T-cell count was 100 cells/µL. According to the histopathologic evaluation, the most common subtype was diffuse large B-cell lymphoma (12 cases, 50%), followed by plasmablastic lymphoma (9 cases, 37.5%) and Burkitt lymphoma (3 cases, 12.5%). Conclusion: HN NHL is a severe complication of advanced HIV/AIDS disease. Early diagnosis followed by chemotherapy plus highly active antiretroviral treatment is necessary to improve the prognosis and the survival of these patients...

Anal squamous cell carcinoma in HIV/AIDS patients in the HAART era: Report of 8 cases and literature review.

BACKGROUND: Anal squamous cell carcinoma is a rare neoplasm with a higher incidence in the HIV-seropositive population. PATIENTS AND METHODS: Epidemiologic, clinic, immunologic, virologic and therapeutic characteristics of 8 HIV-positive patients with anal squamous cell carcinoma were descriptively and retrospectively analyzed from 2005 to 2011. RESULTS: Median of age ofpatients was 39 years, 75% were male and 83% were men who have sex with men. Median elapsed time from HIV infection to anal cancer diagnosis was 10.5 ± 9.5 years. Anal pain and local large tumors detected by physical examination were the most common clinical manifestations; pain with or without itching was marginally correlated with poor survival. The median of CD4 T-cell countfor the whole study group was 330 cells/µL. At the time ofthe neoplasm diagnosis, CD4 T-cell count was more than 200 cell/µL in 62.5% of the patients. In the descriptive analysis, higher CD4 T-cell count was significantly associated with a prolonged survival. In the overall population, 71% were receiving highly active antiretroviral therapy (HAART) and all of them had undetectable viral load at the time ofneoplasm diagnosis. HAART was correlated with better survival in the overallpopulation. Histopathologic examination showed that 4 cases (50%) had in situ carcinoma and 4 patients (50%) had diagnosis of invasive anal carcinoma. One patient underwent surgical tumorectomy plus HAART, 2 patients received chemotherapy plus HAART and 3 patients were treated with fractionated radiotherapy plus systemic chemotherapy plus HAART. One patient died without the possibility of treatment due to his poor clinical condition and for one patient was no available data. After a follow up of 2 years, overall survival rate was 71%. CONCLUSION: A carefully evaluation of anal infiltrative or tumoral lesions is necessary to achieve an early diagnosis and to improve the survival in this kind of patients.

Primary extranodal non-hodgkin lymphoma of the head and neck in patients with acquired immunodeficiency syndrome: a clinicopathologic study of 24 patients in a single hospital of infectious diseases in Argentina.

Introduction Extranodal non-Hodgkin lymphomas (NHLs) are commonly described in patients with acquired immunodeficiency syndrome (AIDS) and are related with an atypical morphology and aggressive clinical course. AIDS-associated lymphomas are characterized by their rapid progression, frequent extranodal manifestations, and poor outcome. Objective The aim of this article is to remake the clinical features of head and neck (HN) NHL in patients with AIDS to facilitate early diagnosis and treatment. Methods We evaluated the epidemiologic, clinical, immunologic, virologic, and histopathologic characteristics of 24 patients with human immunodeficiency virus (HIV)/AIDS with primary HN NHL treated at a single institution between 2002 and 2012. Histopathologic diagnosis was made according to the criteria of the World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues. Additional immunohistochemical stains were applied in all cases. Results Eighteen patients (75%) were men and the median of age was 39 years. The gingiva and the hard palate were the most common sites of the lesions (15 patients, 62.5%). Lactate dehydrogenase levels were elevated in 16 cases (84%). Bone marrow infiltration was detected only in 4 cases (16.6%). The median CD4 T-cell count was 100 cells/µL. According to the histopathologic evaluation, the most common subtype was diffuse large B-cell lymphoma (12 cases, 50%), followed by plasmablastic lymphoma (9 cases, 37.5%) and Burkitt lymphoma (3 cases, 12.5%). Conclusion HN NHL is a severe complication of advanced HIV/AIDS disease. Early diagnosis followed by chemotherapy plus highly active antiretroviral treatment is necessary to improve the prognosis and the survival of these patients.

Miocardiopatía dilatada aguda asociada con eosinofilia / Eosinophilia-linked acute dilated myocardiopathy

La miocardiopatía dilatada aguda con insuficiencia cardíaca parece constituir una forma de presentación del compromiso miocárdico por eosinofilia periférica incluso en pacientes de avanzada edad (AU)

Miocardiopatía dilatada aguda asociada con eosinofilia / Eosinophilia-linked acute dilated myocardiopathy

La miocardiopatía dilatada aguda con insuficiencia cardíaca parece constituir una forma de presentación del compromiso miocárdico por eosinofilia periférica incluso en pacientes de avanzada edad

Mielitis subaguda como forma de presentación de sífilis en una paciente inmunocompetente / Subacute myelitis as a form of presentation of syphilis in an immunocompetent patient

La neurosífilis se asocia con distintos síndromes clínicos neurológicos, en especial en enfermos con compromiso del sistema inmunitario. No obstante, la afección aislada del canal medular es poco frecuente. Se presenta una paciente inmunocompetente, con antecedentes de un parto reciente eutócico con pareja estable y sin epidemiología evidente para infecciones de transmisión sexual, que se presentó a la consulta con paraparesia asimétrica con hipoestesia agregada. Mediante pruebas complementarias se llegó al diagnóstico de neurosífilis. Se destaca la consideración de esta entidad entre los diagnósticos diferenciales del síndrome mielítico, incluso en sujetos sin alteraciones de la inmunidad.

Neurosyphilis is associated to various clinical neurological syndromes, especially in patients with compromise of the immunological system. Nevertheless, an isolated disease of the medullar channel is rare. We present an immunocompetent patient with a background of a recent eutocic delivery, with a stable partner, and without any epidemiological evidence of sexually transmitted diseases, who consulted due to asymmetric paraparesis with aggregated hypoesthesia. Through complementary tests a diagnosis of neurosyphilis was reached. The consideration of this entity among differential diagnoses for a myelitic syndrome is emphasized, even in subjects with no immunological alterations.

Análisis de la producción de artículos biomédicos en castellano por autores argentinos / Analysis of production of biomedical articles in Spanish by argentine authors

Se enfatiza la necesidad de la publicación de la producción científica argentina en medios locales especializados.(AU)

Análisis de la producción de artículos biomédicos en castellano por autores argentinos / Analysis of production of biomedical articles in Spanish by argentine authors

Se enfatiza la necesidad de la publicación de la producción científica argentina en medios locales especializados.

[Hepatic abscess as first manifestation of pneumococcal invasive disease]. / Absceso hepático como presentación inicial de la enfermedad invasora por Streptococcus pneumoniae.

Pneumococcal invasive disease is an important cause of morbidity and mortality in different population groups. Most cases originate from an airway infection. We describe a patient with diabetes mellitus who presented a liver abscess as first manifestation of pneumococcal invasive disease, without respiratory symptoms. The patient was treated with percutaneous drainage and systemic antibiotics with good results. Streptococcus pneumoniae should be considered among the possible etiologies of hepatic abscess, even in absence of respiratory symptoms.

Absceso hepático como presentación inicial de la enfermedad invasora por Streptococcus pneumoniae / Hepatic abscess as first manifestation of pneumococcal invasive disease

Pneumococcal invasive disease is an important cause of morbidity and mortality in different population groups. Most cases originate from an airway infection. We describe a patient with diabetes mellitus who presented a liver abscess as first manifestation of pneumococcal invasive disease, without respiratory symptoms. The patient was treated with percutaneous drainage and systemic antibiotics with good results. Streptococcus pneumoniae should be considered among the possible etiologies of hepatic abscess, even in absence of respiratory symptoms.

La enfermedad invasora por Streptococcus pneumoniae es una causa importante de morbi-mortalidad en diferentes grupos poblacionales. La mayor parte de los casos se origina a partir de un foco infeccioso primario de origen respiratorio. Se describe el caso de un paciente diabético en el cual esta grave enfermedad se presentó de manera inicial como un absceso hepático sin manifestaciones respiratorias asociadas. El enfermo respondió de manera apropiada al tratamiento quirúrgico percutáneo y a la administración de antimicrobianos sistémicos. Se propone la consideración de S. pneumoniae entre las etiologías posibles de los abscesos hepáticos en sujetos con factores de riesgo para enfermedad invasora por este microorganismo, aún en ausencia de síntomas respiratorios.

Refractory recurrent bleeding as a late mortal complication of chest wall irradiation.

Radiation therapy is used to treat breast malignancies. Old external radiotherapy protocols included high-dose schedules and were associated with late complications. We describe the case of a 72-year-old woman who was admitted with recurrent bleeding from chest wall. Arteriovenous fistulae were diagnosed. Embolization therapy was initially successful, even though the bleeding episodes became recurrent. Arteriovenous fistulae should be included among differential diagnosis of thoracic bleeding in patients with history of local radiation therapy. The prognosis is poor and endovascular treatment may be considered a first-line treatment.