RESUMEN
A uniquely indolent case of necrobiotic xanthogranuloma with bilateral, periorbital involvement was presented. This patient presented with cutaneous eyelid lesions of 20 years' duration. Although symptomless, the patient underwent testing for hematologic malignancy, which led to a diagnosis of multiple myeloma. A review of the literature revealed that this is the longest interval between the onset of the skin manifestations and the diagnosis of the systemic malignancy in this rare disease.
Asunto(s)
Enfermedades de los Párpados/diagnóstico , Mieloma Múltiple/diagnóstico , Xantogranuloma Necrobiótico/diagnóstico , Anciano , Antígenos CD/metabolismo , Enfermedades de los Párpados/metabolismo , Resultado Fatal , Humanos , Inmunoglobulina G/sangre , Masculino , Mieloma Múltiple/sangre , Xantogranuloma Necrobiótico/metabolismo , Paraproteinemias/diagnósticoRESUMEN
BACKGROUND: To determine the iatrogenic risk factors for cytomegalovirus (CMV) retinitis in patients with the acquired immunodeficiency syndrome (AIDS). METHODS: The case-control study included 120 patients with CMV retinitis and 159 patients without CMV retinitis, all of whom had AIDS and CD4 counts less than 50 cells/microL at the time of diagnosis of retinitis or at the defined corresponding date in the controls. Iatrogenic risk factors studied were corticosteroid use, treatment with chemotherapy, treatment with radiotherapy, and blood transfusions. RESULTS: Among the risk factors studied, only steroid use was predictive of CMV retinitis (odds ratio 6.41, 95% confidence interval 2.35-17.51). Based on this study, the use of steroids systemically elevated the risk of CMV retinitis.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Retinitis por Citomegalovirus/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/etiología , Adulto , Antivirales/uso terapéutico , Transfusión Sanguínea , Recuento de Linfocito CD4 , Estudios de Casos y Controles , Retinitis por Citomegalovirus/diagnóstico , Retinitis por Citomegalovirus/etiología , Femenino , Glucocorticoides/uso terapéutico , Humanos , Enfermedad Iatrogénica , Masculino , Oportunidad Relativa , Ontario/epidemiología , Radioterapia , Factores de RiesgoRESUMEN
PURPOSE: To determine the clinical risk factors for cytomegalovirus (CMV) retinitis in patients with AIDS. DESIGN: A case-control study. PARTICIPANTS: The study included 120 patients in whom CMV retinitis had been diagnosed from 1990 through 1999 (cases) and 159 patients without CMV retinitis from the same period (controls). All individuals had AIDS and CD4 counts less than 50 cells/microl at the time of diagnosis of retinitis in the cases or on the corresponding date for the controls. METHODS: Clinical risk factors were determined by history or physical examination. Confounders controlled for included CD4 count, hospital center, and a series of variables to control for confounding by drug treatment. Statistical analysis was performed by multivariate logistic regression. A systematic model-building strategy was developed from assumption testing to model building to model checking. MAIN VARIABLES MEASURED: Presence of visual symptoms, retinal microinfarctions (cotton-wool spots), history of opportunistic infections, and risk factors for human immunodeficiency virus acquisition were determined and compared in both groups. RESULTS: The following clinical risk factors were significant predictors of CMV retinitis: flashing lights or floaters (odds ratio [OR], 11.42; 95% confidence interval [CI], 3.43 to 38.01), cotton-wool spots (OR, 2.90; 95% CI, 1.01 to 8.29), number of previous opportunistic infections (OR, 1.81; 95% CI, 1.24 to 2.64), previous nonocular CMV infection (OR, 82.99; 95% CI, 6.86 to 1004.58), previous Mycobacterium infection (OR, 3.41; 95% CI, 0.99 to 11.85), and homosexuality (OR, 2.83; 95% CI, 1.13 to 7.12). CONCLUSIONS: Based on this study, clinical variables have been identified that elevate the risk of CMV retinitis. These findings may be useful to clinicians and health policy experts in developing rational guidelines for screening, examination frequency, and targeted prophylaxis for CMV retinitis in patients with AIDS.