Histopathological Changes of the Thyroid and Parathyroid Glands in HIV-Infected Patients

Cherqaoui, Rabia; Shakir, K.M. Mohamed; Shokrani, Babak; Madduri, Sujay; Farhat, Faria; Mody, Vinod

doi:10.1155/2014/364146

Cited by 11 publications

(6 citation statements)

References 34 publications

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“…However, this is in line with previous reports showing that cryptococcal infection engaging the thyroid gland is rare, and only sporadically documented in HIV-negative subjects, as reviewed by Avram et al [10]. A retrospective autopsy study on HIV-positive cases reported that cryptococci were found in the thyroid in no more than one out of the total of 102 individuals [11].…”

Section: Discussionsupporting

confidence: 91%

Sarcoidosis with cryptococcal infection apparently engaging only immune-privileged body compartments: a case report

2020

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Background: Infection with the Cryptococcus neoformans yeast fungus is largely restricted to patients with HIV, sarcoidosis or immunosuppressive therapies. In sarcoidosis, there is intense local immune response in granuloma lesions, coupled with a paradoxical systemic anergy. An analysis of cryptococcal infection in sarcoidosis may therefore shed light on whether opportunistic pathogens preferentially engage immune-privileged tissues. Case presentation: A 54-year-old man was admitted to our hospital after 2 months with palpitations and activityrelated presyncope. A chest X-ray was normal, electrocardiography showed type-II atrioventricular-block, and there was a tentative diagnosis of myocarditis. Computed tomography reported minor hilar lymph glands and multiple nodular lesions in the lungs. Magnetic resonance imaging showed oedema and nodular structures in the heart, and fibrosis and granulomas were found in endomyocardial biopsies. The diagnosis was revised to cardiac sarcoidosis, and prednisone was initiated. In parallel, positron-emission tomography had revealed a marked uptake in the right thyroid lobe, a thyroid lobectomy was then performed, and the pathology showed a BRAF-positive papillary thyroid carcinoma. Four days postoperatively the patient developed symptoms suggestive of meningoencephalitis. Cerebrospinal fluid and blood cultures yielded growth of C. neoformans. Fungal staining of the thyroid specimen revealed cryptococcal elements in the carcinoma and in granulomas close to the tumour. Notably, there was no evidence of cryptococci in the heart sarcoid sections or in the normal thyroid parenchyma. The patient was successfully treated with antifungal agents and at the 2-year follow-up there was no evidence of thyroid cancer relapse. Conclusion: This sarcoidosis patient had a remarkable clinic with evidence of cryptococcal infection only in body compartments commonly regarded to be immune-privileged. The findings suggest that an opportunistic and environmentally abundant pathogen, when infecting an immunocompromised host, primarily engages immunodeficient locations such as the brain, a tumour microenvironment and some forms of granuloma.

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Section: Discussionsupporting

confidence: 91%

Sarcoidosis with cryptococcal infection apparently engaging only immune-privileged body compartments: a case report

2020

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“…It is the same for those who were treated with the combination AZT-3TC-NVP having CD4+ T cell count between 349 and 200 cell / mm 3 . It should be noted that a decrease in the serum level of PTH has already been reported in HIV-infected patients [40]. The mechanism could be related to antibodies against parathyroid cells.…”

Section: Discussionmentioning

confidence: 74%

Metabolic Disorders of Vitamin D and Parathyroid Hormone in Patients Living with Human Immunodeficiency Virus Type 1 Taking Antiretroviral Treatment in Côte d’Ivoire

Aké¹,

Boyvin²,

Séri³

et al. 2018

ISRR

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Background:A number of studies have highlighted the phosphocalcic balance disorder and posed the problem of the correlation between 25-hydroxyvitamin D 3 and parathyroid hormone in people living with HIV (PLHIV). However, few studies have been conducted on the link between antiretroviral therapy and the level of 25 (OH) D 3 during HIV infection. The objective of this study was to evaluate 25 (OH) D 3 and the parathyroid status in HIV-infected people taking antiretroviral treatment in Côte d'Ivoire.

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“…Increased prevalence of hypocalcemia has been reported in HIV positive individuals, but it was mostly related to vitamin D deficiency [ 4 ]. A retrospective review reported greater frequency of parathyroid hyperplasia in autopsy specimens of HIV infected African American patients, which could be result of high prevalence of vitamin D deficiency in HIV infected patients [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Severe Symptomatic Hypocalcemia from HIV Related Hypoparathyroidism

Sandhu¹,

Desai

Batra

et al. 2018

Case Reports in Endocrinology

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We report the case of a 54-year-old Caucasian female who presented with a two-year history of persistent hypocalcemia requiring multiple hospitalizations. Her medical history was significant for HIV diagnosed four years ago. She denied any history of prior neck surgery or radiation. Her vital signs were stable with an unremarkable physical exam. Pertinent medications included calcium carbonate, vitamin D3, calcitriol, efavirenz, emtricitabine, tenofovir disoproxil, hydrochlorothiazide, and inhaled budesonide/formoterol. Laboratory testing showed total calcium of 5.7 mg/dL (normal range: 8.4-10.2 mg/dL), ionized calcium of 2.7 mg/dL (normal range: 4.5-5.5 mg/dL), serum phosphate of 6.3 mg/dL (normal range: 2.7-4.5 mg/dL), and intact PTH of 7.6 pg/mL (normal range: 15-65 pg/mL). She was diagnosed with primary hypoparathyroidism. Anti-calcium-sensing receptor antibodies and NALP5 antibodies were tested and found to be negative. During subsequent clinic visits, doses of calcium supplements and calcitriol were titrated. Last corrected serum calcium level was 9.18 mg/dL. She was subsequently lost to follow-up. This case gives insight into severe symptomatic hypocalcemia from primary hypoparathyroidism attributed to HIV infection. We suggest that calcium levels should be closely monitored in patients with HIV infection.

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Histopathological Changes of the Thyroid and Parathyroid Glands in HIV-Infected Patients

Cited by 11 publications

References 34 publications

Sarcoidosis with cryptococcal infection apparently engaging only immune-privileged body compartments: a case report

Sarcoidosis with cryptococcal infection apparently engaging only immune-privileged body compartments: a case report

Metabolic Disorders of Vitamin D and Parathyroid Hormone in Patients Living with Human Immunodeficiency Virus Type 1 Taking Antiretroviral Treatment in Côte d’Ivoire

Severe Symptomatic Hypocalcemia from HIV Related Hypoparathyroidism

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