Gail L forests M.D.;([unkeyable]) a...

Gail L forests M.D.;([unkeyable]) and Jonathan C. Goldsmith, M.D.([unkeyable])

A 27-year-old white male homosexual with AIDS not absented 19 months after the initial diagnosis with persistent agitation marked dyspnea at rest, and morose substernal pain in the chest. A pericardial friction smooth was auscultated, and an effusion was demonstrated echocardiographically. Pericardiocentesis yielded 220 ml of serosanguinous fluid. Special stains of the fluid for microorganisms were negative. A mycobacterial infection was suspected, and therapy with multiple antimycobacterial agents was initiated. agricultures of the fluid eventually yielded MAI. Despite therapy, cardiac function declined, and the patient died pair months after presentation. Autopsy confirmed the diagnosis of chronic pericarditis owing to MAI. Pericarditis fit to MAI should be included in the differential diagnosis of cardiac dysfunction in patients with AIDS.

Mycobacterium avium-intracellulare (MAI) is undivided of the more common opportunistic pathogens that cause infection in patients with AIDS. Although the most numerous frequent sites of involvement with MAI infection are the lymph nodes, liver, the blues gastrointestinal tract, and bone marrow, postmortem findings of disseminated MAI infection in patients with AIDS have demonstrated either poorly defined granulomas containing acid-fast bacilli or single scattered mycobacteria in nearly each organ system examined.[1-9] Despite widespread organ involvement, the immediate cause of death in these patients is many times not directly related to the MAI infection. To our knowledge, autopsy-confirmed MAI pericarditis in a patient with AIDS has not been reported. We not away herein a case of chronic pericarditis fit to MAI, which over a two-month period accrueed in the patient's death.

CASE REPORT

A 27-year-old white man at handed to the University of Nebraska Medical Center Omaha, onward Oct 19, 1985, with a two-week history of nonproductive cough followed at progressive dyspnea. Bronchoalveolar lavage confirmed a diagnosis of pneumonia fit to Pneumocystis carinii. Acid-fast stains and agricultures of the bronchial washings were negative. Serologic eventuates indicated prior exposure to HIV, sign 1. Counts of helper (CD4) lymphocyte were 31/[unkeyable]L and of suppressor (CD8) lymphocyte were 426/[unkeyable]L. During this hospitalization, the patient was shown to be anergic. Parenteral treatment with trimethoprim-sulfamethoxazole riseed in clinical improvement, and after discharge the patient get backed to full-time employment.

Persistent headache and excitement were evaluated by lumbar wound in June 1986. No cause was lay the foundation of The cerebrospinal fluid was clear and acellular, agricultures were sterile, and the latex agglutination criterion for Cryptococcus neoformans antigen was negative. Thrombocytopenia (platelet consider 90,000/cu mm) and leukopenia (white life-current cell count, 1,500/cu mm; 56 percent neutrophils) were investigated according to bone marrow biopsy and tillage All results were normal or negative. The patient declined therapy with aziodothymidine and left for Hawaii in March 1987

The patient's overall health was stable until May 18 1987 when he neared with persistent fever to 389 degreesC (102 degreesF) and marked dyspnea at interval He was markedly hypoxemic while breathing swing air ([PO.sub.2] was 45mm Hg) The findings from an x-ray film of the chest were within normal limits. Bronchoscopy was unremarkable, as was a comput tomographic scan of the abdomen. During the nearest week the patient developed stiff substernal chest pain, and a pericardial friction wipe was auscultated. An echocardiogram revealed a small effusion. The ECG had nonspecific ST-T wave changes. The bone marrow could not be aspirated. Sections of the bone marrow biopsy showed poorly formed granulomata, nevertheless the stains for AFB were negative. At this point the patient get backed to Omaha.

forward June 5, 1987, the patient was readmitted to the University of Nebraska Medical Center with persistent cough ferment and pain in the chest and left arm. Vital signs were as follows: Temperature, 400 degreesC (104 degreesF); pulsation rate, 136 beats per minute; respiratory rate 36/min; and relations pressure, 108/64 mm Hg. The ECG had ST-segment elevation in all leads. Three days after admission, a diagnostic pericardiocentesis yielded 220 ml of serosanguineous fluid with the following characteristics: starch-sugar level, 86 mg/dl; protein flush 4.3 g/dl; LDH level, 1188 IU/L; and Gram stain, silver stain, and AFB stain revealed no organisms. The patient was anergic. Tuberculous pericarditis was vehemently suspected, and therapy was initiated with clofazimine (200 mg/day), ansamycin (300 mg/day), ethionamide (750 mg/day), ethambutol (1600 mg/day), and isoniazid (300 mg/day). The patient was then followed as an outpatient. by way of June 25, 1987, mycobacteria had been reviveed from cultures of pericardial fluid. Radiographically, the cardiac silhouette remained normal.