[Diabetes insipidus as a manifestation of cerebral toxoplasmosis in an AIDS patient]. / Diabetes insípida como manifestación de toxoplasmosis cerebral en un enfermo con SIDA.

INTRODUCTION: In AIDS patients the endocrine system is often affected. Diabetes insipidus (DI) is uncommon and has been related to drugs and infections of the central nervous system (toxoplasmosis, cryptococcic meningitis, cytomegalovirus encephalitis). In these patients at the time of diagnosis, imaging investigations are often normal. CLINICAL CASE: We report the case of a 40 year old man with infection category HIV C3 (CD4 < 50 mm3 and viral load 301,258 copies/ml), not on antiretroviral treatment at the time of hospital admission. He had polyuria (8-10 litres/day) and polydipsia for the previous 15 days, with no other symptoms. The dehydration test showed central DI (raised osmolarity following subcutaneous desmopresin). On MNR there were bilateral periventricular nodular images, also present in both caudate nuclei, with ring increased uptake following administration of paramagnetic contrast. On the clinical suspicion of cerebral toxoplasmosis empirical treatment was started with sulphadiazine and pyrimethamine together with nasal DDAVP, obtaining a good clinical response. CONCLUSIONS: In patients with HIV infection, DI, although uncommon, may be the first sign of cerebral toxoplasmosis. Imaging studies may be pathological and assist diagnosis.

[Nocardiosis in patients with human immunodeficiency virus infection in Spain]. / Nocardiosis en enfermos con infección por virus de la inmunodeficiencia humana en España.

BACKGROUND: Nocardia usually infects immunosuppressed patients, particularly with cellular immunity deficiency. Nevertheless, despite severe immunosuppression in patients infected with HIV, nocardiosis is rare among these patients. We report here two cases of nocardiosis in patients with HIV infection and review spanish literature up to 1993, with an analysis of the characteristics of this infection in our country. METHODS AND RESULTS: The two patients consumed drugs parenterally and Nocardia organism were recovered in blood cultures after 48 hours of inoculation in standard culture media. The source of the infection was cutaneous in one patient, over an area of venipuncture, and pulmonary in the other patient. Previously, eleven cases of nocardiosis had been reported in the spanish literature in patients infected with HIV. Eighty-four percent were males, and all of them consumed drugs parenterally and displayed a severe cellular immunodepression; the total CD4 lymphocyte count was lower than 100/mm3 in patients when this finding was available (6/13). At diagnosis only one patient received prophylaxis against other type of infection with antibiotics theoretically effective against Nocardia at diagnosis. The Nocardia species recovered more frequently was asteroides (77%) and the most common location was the skin (54%). Treatments more frequently employed were sulfametoxazole-trimethoprim (45%) and sulfadiazine (36%), with a good response except in those with cerebral involvement. CONCLUSIONS: Nocardiosis in patients with HIV infection is rare in Spain. In contrast with other geographical areas skin involvement was the more common form of infection. Prophylaxis with sulfametoxazole-trimethoprim against other infections could be responsible for a lower than expected incidence among this type of patients.