Document 3124
 DOCN  M94A3124
 TI    Toxoplasmic myocarditis in an AIDS patient: diagnosis with an
       endomyocardial biopsy.
 DT    9412
 AU    Zucman D; Lebras P; Bicetre Hospital, France.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):148 (abstract no. PB0017). Unique
       Identifier : AIDSLINE ICA10/94369451
 AB    INTRODUCTION: Cardiac involvement is frequent although rarely
       symptomatic in AIDS patients. There are multiple causes of heart failure
       in this setting and when cardiac signs appear isolated it represents a
       difficult diagnostic problem. CASE RECORD: a 37-year-old homosexual man,
       diagnosed with HIV infection in 1986, is hospitalized in september 1992
       for cardiogenic shock. AIDS had declared 6 month ago (Pneumocistis
       pneumonia) and the patient had been treated with zidovidine since two
       years, replaced by ddI four month ago because of neutropenia. The last
       CD4+ count was 50/mm3 and toxoplasmosis serology was positive (IgG). The
       patient described an increasing exertional breathlessness and
       intermitent fever during the past three weeks. At admission, physical
       examination showed signs of severe acute heart failure. Neurological
       examination was normal and temperature 37 degrees 5 C. Chest X rays
       showed an important cardiomegaly and bilateral pleural effusion. An
       echocardiogram showed a four chamber dilatation with a marked global
       hypokinesis and a circomferantial non compressive pericarditis. The
       cerebral CT scan was normal. The endomyocardial biopsy revealed a severe
       toxoplasmic myocarditis with extensive myocyte necrosis and evidence of
       toxoplasma pseudocysts and trophozoites. A treatment with pyrimethamine
       and clindamycine was immediately begun and the clinical pattern of the
       patient subsequently improved. DISCUSSION AND CONCLUSION: Cardiovascular
       dysfunction is an important complication of AIDS that is reported with
       increasing frequency. Myocarditis can be related to opportunistic
       infections, especially toxoplasmosis. However, other causes are
       possible, among them, non specific myocarditis possibly due to HIV, and
       drugs toxicity such as ddI. In the case of isolated congestive heart
       failure, an endomyocardial must be performed in order to find a curable
       cause, in this case a toxoplasmic myocarditis.
 DE    Acquired Immunodeficiency Syndrome/DRUG THERAPY  Adult  AIDS-Related
       Opportunistic Infections/*PATHOLOGY  Biopsy  Case Report
       Clindamycin/THERAPEUTIC USE  Didanosine/THERAPEUTIC USE
       Heart/*PARASITOLOGY  Human  Male  Myocarditis/COMPLICATIONS/*PATHOLOGY
       Myocardium/*PATHOLOGY  Pyrimethamine/THERAPEUTIC USE
       Toxoplasmosis/COMPLICATIONS/DRUG THERAPY/*PATHOLOGY
       Zidovudine/THERAPEUTIC USE  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).