RESUMO
Human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus that is endemic in certain regions of the world, and may account for significant morbidity and mortality among hospitalised patients. Sixty six HTLV-1 seropositive patients admitted to hospital with HTLV-1 associated diseases from 1995-99 were studied. HTLV-1 screening was done with ELISA and confirmed on western blot testing. There were 32 females (48.5%) and 34 males (51.5%). The mean age was 56 years and the age range was 9-89 years. The main associated diseases were tropical spastic paraparesis or HTLV-1 associated myelopathy in 18.2% of cases, acute form of adult T-cell leukaemia/lymphoma 7.6%, lymphomas 15.2%, and ectoparasites/endoparasites in 40.9%. HTLV-1 is associated with diseases in Dominica and association with severe forms of strongyloidiasis and scabies is particularly noted.
Assuntos
Hospitalização/estatística & dados numéricos , Leucemia-Linfoma de Células T do Adulto/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Dominica/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Soropositividade para HIV , Humanos , Leucemia-Linfoma de Células T do Adulto/complicações , Leucemia-Linfoma de Células T do Adulto/terapia , Masculino , Pessoa de Meia-IdadeRESUMO
We present a case of bone marrow granulomas in a 64-year-old West Indian man who presented with severe leucopenia, anaemia, thrombocytopenia, hepatosplenomegaly, hypercalcaemia, hypercalciuria, elevated angiotensin converting enzyme level and reticulo-nodular shadows on chest X-ray. Bone marrow biopsy revealed numerous non-caseating epithelioid granulomas. A diagnosis of sarcoidosis was made and he was treated with prednisolone 60 mg daily for four weeks and the dose was subsequently reduced to 30 mg daily. Eight months follow-up revealed persistent pancytopenia. Bone marrow granulomas are rare and, when they occur, sarcoidosis is an uncommon aetiology. This case illustrates that severe leucopenia may occur in sarcoidosis and may present therapeutic difficulties.
Assuntos
Doenças da Medula Óssea/diagnóstico , Leucopenia/diagnóstico , Sarcoidose/diagnóstico , Biópsia , Medula Óssea/patologia , Doenças da Medula Óssea/patologia , Granuloma/diagnóstico , Granuloma/patologia , Humanos , Leucopenia/patologia , Masculino , Pessoa de Meia-Idade , Sarcoidose/patologia , Índice de Gravidade de DoençaRESUMO
We present a case of bone marrow granulomas in a 64-year-old West Indian man who presented with severe leucopenia, anaemia, thrombocytopenia, hepatosplenomegaly, hypercalcaemia, hypercalciuria, elevated angiotensin converting enzyme level and reticulo-nodular shadows on chest X-ray. Bone marrow biopsy revealed numerous non-caseating epithelioid granulomas. A diagnosis of sarcoidosis was made and he was treated with prednisolone 60 mg daily for four weeks and the dose was subsequently reduced to 30 mg daily. Eight months follow-up revealed persistent pancytopenia. Bone marrow granulomas are rare and, when they occur, sarcoidosis is an uncommon aetiology. This case illustrates that severe leucopenia may occur in sarcoidosis and may present therapeutic difficulties
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Medula Óssea/diagnóstico , Leucopenia/diagnóstico , Sarcoidose/diagnóstico , Biópsia , Doenças da Medula Óssea/patologia , Granuloma/diagnóstico , Granuloma/patologia , Leucopenia/patologia , Medula Óssea/patologia , Sarcoidose/patologia , Índice de Gravidade de DoençaRESUMO
A case of fatal strongyloidiasis associated with human T-cell lymphotropic virus type 1 (HTLV-1) infection is described in a 45-year-old West Indian man living in an area endemic for both strongyloidiasis and HTLV-1 infection. Clinical presentation was typical with severe diarrhea, vomiting, and progressive weight loss. Stool microscopy revealed Strongyloides stercoralis rhabditiform larvae. Despite treatment with thiabendazole, the patient died. Autopsy findings revealed severe ileocolitis due to Strongyloides larvae, right subdiaphragmatic pyogenic abscess, and severe pleuritis of the right lower lobe of the lung. This case illustrates that despite effective antihelmintic therapy, mortality is still high in patients with the hyperinfective state of S. stercoralis. Thus, in patients in areas endemic for both Strongyloides infection and HTLV-1, or in immigrants from these areas, repeated stool microscopy is indicated in patients positive for HTLV-1.
Assuntos
Infecções por HTLV-I/complicações , Estrongiloidíase/etiologia , Evolução Fatal , Infecções por HTLV-I/imunologia , Humanos , Tolerância Imunológica , Masculino , Pessoa de Meia-IdadeRESUMO
We describe a case of Kaposi's sarcoma in a previously healthy 35-year-old bisexual West Indian man of African descent who was seronegative for the human immunodeficiency virus (HIV) and human T-cell lymphotropic virus-1 (HTLV-1) and who presented with extensive mucocutaneous lesions, weight loss, visceral and generalized lymph node involvement, poor response to combination therapy with vinblastine and interferon alfa-2a, and a short survival of eight months from the onset of illness. This is the first documented case of Kaposi's sarcoma in Dominica. The presentation is unusual in that it is similar to the aggressive and disseminated Kaposi's sarcoma seen only in AIDS and the florid variant of the endemic disease in young men in Equatorial Africa.
Assuntos
Soronegatividade para HIV , Sarcoma de Kaposi/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adulto , Antineoplásicos Fitogênicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Evolução Fatal , Humanos , Interferon alfa-2 , Interferon-alfa/uso terapêutico , Masculino , Proteínas Recombinantes , Sarcoma de Kaposi/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Vimblastina/uso terapêuticoRESUMO
We describe a case of Kaposi's sarcoma in a previously healthy 35-year-old bisexual West Indian man of African descent who was seronegative for the human immunodeficiency virus (HIV) and human T-cell lymphotropic virus-1 (HTLV-1) and who presented with extensive mucocutaneous lesions, weight loss, visceral and generalized lymph node involvement, poor response to combination therapy with vinblastine and interferon alfa-2a, and a short survival of eight months from the onset of illness. This is the first documented case of Kaposi's sarcoma in Dominica. The presentation is unusual in that it is similar to the aggressive and disseminated Kaposi's sarcoma seen only in AIDS and the florid variant of the endemic disease in young men in Equatorial Africa.