Severe thrombocytopenia and human immunodeficiency virus infection. Report of two cases and reviewThrombocytopenia is a relatively frequent complication in patients infected by human immunodeficiency virus (HIV). Most frequent mechanisms of thrombopenia are destruction of half-filled platelets by immunocomplex and defects in production. We present two cases of severe thrombocytopenia associated to HIV infection. Case 1: A male patient, 45 years old with fever and diarrhea that lasted for 1 month that presented with thrombopenia of 3.000 platelets/mm 3 . After beginning zidovudine and lamivudine therapy, he normalized the platelet count in 5 days. Case 2: A male patient of 30 years old, who suffered during one day migraine, nausea, vomits and then seizures. A criptococccal meningitis was confirmed. Concomitantly he had a platelet count of 59.000/mm 3 . He started antiretroviral therapy with zidovudina and lamivudina, then was changed to didanosine plus stavudine plus nevirapine. After 6 months of severe thrombocytopenia, platelets count was restored to normal values. A literature review is presented.Key words: Thrombocytopenia, platelets, immune-complex. Palabras claves: Trombocitopenia, plaquetas, inmuno-complejo. Hospital de EnfermedadesInfecciosas Dr. Lucio Córdova L. Santiago, Chile. (RPP, LAR).Hospital Barros Luco Trudeau.Santiago, Chile. Servicio de Hematología (JLCG). Recibido: 24 junio 2005Aceptado: 3 agosto 2006Correspondencia a:Se discute acaso existe una relación directa entre el grado de inmunosupresión, la cuantía de la trombocitopenia y una baja sobrevida, con experiencias contradictorias 10 . El estudio regular de la trombocitopenia incluye hemograma completo, con recuento y morfología plaquetaria. La biopsia medular se justifica cuando la etiología es oscura. Otros estudios de utilidad son la complementemia, ELISA anti-VHC, la pesquisa de los agentes infecciosos antes mencionados y la determinación de anticuerpos anti-plaquetarios.Ante la ausencia de publicaciones nacionales relativas a este tema, nos pareció importante comunicar nuestra experiencia en dos casos de asociación entre trombocitopenia e infección por VIH ocurridos el año 2001 y efectuar una revisión de la literatura médica relativa a su tratamiento. Caso 1. Varón de 45 años, portador de infección por VIH, reconocido desde 1996, en profilaxis con isoniacida y cotrimoxazol. Ingresó a nuestro servicio tras un mes de fiebre intermitente, diarrea, compromiso general y una baja de peso no cuantificada. Al examen físico eran destacables su buen estado de conciencia, temIntroducción e ha descrito la trombocitopenia (recuento de plaquetas inferior a 150.000/mm 3 ) como una complicación relativamente frecuente en el síndrome de inmunodeficiencia adquirida (SIDA) en sus diferentes etapas 1,2 . Las causas más importantes de trombocitopenia en esta situación clínica son 1,[3][4][5][6][7][8][9] : de origen periférico, como sucede en la destrucción mediada por inmuno-complejos en un cuadro semejante e indistinguible al púrpura trombocitopénico idiop...
Unusual presentation of bilateral bullous Pneumocystis jiroveci pneumonia complicated with pneumothorax In patients with human immunodeficiency virus infection, pneumothorax overcomes in advanced stages of the illness, associated with infections by Mycobacterium tuberculosis or Pneumocystis jiroveci, in smokers and intravenous drug users. We present a case with this unusual complication: homosexual man, 30 years of age, with a history of one month of cough, progressive dyspnea, weight loss and diarrhea. He was hospitalized with the diagnosis of atypical pneumonia, respiratory failure and a presumptive HIV infection. His clinical course was complicated by the presence of bullae and pneumothorax by day 15 of hospitalization. The existence of Pneumocystis jiroveci in sputum was confirmed by a direct immunofluorescence test. The patient was treated with sulpha-trimethoprim, steroids, oxygen, but he died 21 days after admittance. The strategies recommended for treatment of pneumothorax appeared during P. jiroveci pneumonia in HIV positive patients are summarized.
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