In patients with AIDS, oral therapy with trimethoprim-sulfamethoxazole and with trimethoprim-dapsone are equally effective for mild-to-moderate first episodes of P. carinii pneumonia, but with trimethoprim-dapsone there are fewer serious adverse reactions than with trimethoprim-sulfamethoxazole.
All patients with the acquired immunodeficiency syndrome treated for their first episode of Pneumocystis carinii pneumonia at San Francisco General Hospital between 1 April 1985 and 15 July 1985 were evaluated for their response to treatment with dapsone (100 mg/day) by mouth for 21 days. Of 44 patients evaluated, 18 were eligible for the study. Of these 18 patients, the conditions of 7 of them worsened or failed to improve during treatment with dapsone and they were considered treatment failures. These patients were changed to standard therapy after 4 to 8 days of dapsone therapy. The remaining 11 patients (61%) improved within 3 to 10 days after dapsone therapy was started. Side effects of dapsone therapy were noted in 6 of 11 patients (of these 11 patients, 5 had a rash, 1 had a rash and abnormal liver enzymes, and 1 had abnormal liver enzymes), but in none of the patients were these side effects severe enough to require the cessation of medication. Based on comparison with historical controls, oral dapsone therapy alone appeared to be less effective than standard therapy or the combination of dapsone plus trimethoprim for P. carinii pneumonia in patients with acquired immunodeficiency syndrome.
Diagnosis of the cause of death in young people is a challenge to both the clinician and the pathologist. Ehlers-Danlos syndrome (EDS) type IV is an inherited connective tissue disorder. It is characterised by thin translucent skin, abnormal fragility of blood vessels, and a typical facial appearance. The cause of death is usually due to large arterial rupture. We describe an unusual case of a 23-year-old man clinically diagnosed with myocarditis, who suffered from recurrent pulmonary haemorrhage and died of massive myocardial haemorrhage and ischaemia without coronary artery disease. Diagnosis of EDS type IV was made by autopsy. To our knowledge, this is the first such report in the literature. Delay in diagnosing this syndrome is common even when clinical features are typical, and the condition often goes unrecognised until necropsy. The diagnosis of EDS should be considered in young people who seek medical attention because of arterial rupture.
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