Document 0707
 DOCN  M94A0707
 TI    Case presentation: a 35 year old man with cystic pneumocystis pneumonia,
       cerebro-ocular lymphoma and recurrent bacteraemia.
 DT    9412
 AU    Paterson DL; Allworth AM; Hospital Brisbane, Australia.
 SO    Annu Conf Australas Soc HIV Med. 1993 Oct 28-30;5:27 (abstract no.
       TC-3). Unique Identifier : AIDSLINE ASHM5/94348948
 AB    A 35 year old man HIV antibody positive since 1986 presented in February
       1993 with pleuritic chest pain haemoptysis and dyspnoea. His past
       history included syphilis, bacillary angiomatosis, Kaposi's sarcoma and
       CMV retinitis. His CD4 lymphocyte count was 70 x 10(6)/L. He was on
       didanosine and monthly nebulised Pentamidine. Physical examination
       revealed a low-grade fever (37.8 degrees C) and a left pleural rub. CXR
       revealed marked cystic changes in the left lower lobe and a small apical
       pneumothorax. Pneumocystis carinii was isolated from an induced sputum
       sample. In view of a Bactrim allergy, he was treated with intravenous
       Pentamidine for 3 weeks. He made a dramatic improvement with total
       clearing of the cystic changes over a number of weeks. He re-presented
       in May 1993 with dysphasia and poor balance. MRI of his head showed
       multiple low intensity lesions in both cerebral hemispheres. The lesions
       increased in number despite 2 weeks of anti-Toxoplasma treatment
       delivered by a peripherally inserted central catheter (PICC). A
       stereotactic cerebral biopsy was performed revealing a high-grade B cell
       lymphoma. He was treated with radiotherapy (40 Gy in 15 fractions) with
       good clinical response. However the vision in his left eye deteriorated
       due to orbital recurrence of lymphoma. The patient had 2 bacteraemic
       episodes with Gram negative organisms during his illness. These were
       with Serratia marcescens and then Acaligenes denitrificans. Cystic
       pneumonia due to Pneumocystis carinii and the spectrum of bacteraemic
       illnesses seen in HIV-infected people will be reviewed.
 DE    Adult  AIDS-Related Opportunistic Infections/*DIAGNOSIS/DRUG THERAPY
       Bacteremia/*DIAGNOSIS  Brain Neoplasms/*DIAGNOSIS  Case Report
       Cysts/*DIAGNOSIS/DRUG THERAPY  Human  Lung Diseases/*DIAGNOSIS/DRUG
       THERAPY  Lymphoma, AIDS-Related/*DIAGNOSIS  Male  Orbital
       Neoplasms/*DIAGNOSIS  Pentamidine/THERAPEUTIC USE  Pneumonia,
       Pneumocystis carinii/*DIAGNOSIS/DRUG THERAPY  MEETING ABSTRACT

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