In the 6-year period 1984-1989, 101 liver biopsies or 'needle necropsies' from human immunodeficiency virus positive patients were examined histologically. Of these, only nine showed no abnormality whatsoever. The commonest histological findings were either fatty change or changes related to co-existent chronic viral hepatitis. Granulomas were seen in 15 cases, four of which were positive for acid-fast bacilli. A range of organisms were recorded: cytomegalovirus (4); Histoplasma capsulatum (1); Pneumocystis carinii (2); Cryptococcus neoformans (1); and Leishmania donovani (1). There were two cases of non-Hodgkin's lymphoma, but no cases of Kaposi's sarcoma. Marked iron deposition, which correlated with multiple blood transfusions was seen in nine biopsies. We were unable to identify any histological feature in the liver as being specific for HIV infection. The high incidence of liver abnormalities reflects: (i) the coincident exposure to hepatotropic viruses; (ii) the presence of opportunistic infections and neoplasms, usually part of a disseminated multi-organ process arising in the setting of profound immune depression; (iii) iatrogenic causes, in particular iron overload related to multiple blood transfusions received for treatment of zidovudine-induced anaemia; and (iv) non-specific changes associated with chronic debilitating disease.
70 year old man with chronic obstructive pulmonary disease and hypertension was admitted to hospital with a two month history of worsening dyspnoea on exertion and ankle swelling. On examination, the patient was in atrial fibrillation with an apical ventricular rate of 136 beats/min. The jugular venous pressure was not visible, but there was bilateral pitting oedema to the knees. Auscultation of the chest revealed polyphonic wheeze and poor air entry but no crepitations. An electrocardiogram (ECG) confirmed atrial fibrillation. Full blood count, urea and creatinine, liver and thyroid function tests, and bone profile were all within normal limits. The plasma magnesium was 0.56 mmol/l. The patient was treated with oral digoxin, intravenous frusemide, and nebulised salbutamol. Within 24 hours of admission, the patient had a cardiac arrest and was successfully resuscitated. Three further cardiac arrests involving a similar rhythm disturbance occurred during the second day.
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