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Miliary PCP in AIDS [Case Report]

Wasser, L S; Brown, E; Talavera, W
The most frequent radiographic presentation of (PCP) is bilateral interstitial or alveolar infiltrates. Atypical features include lobar distribution, pleural effusions, hilar adenopathy, cyst formation and spontaneous pneumothorax. A diffuse miliary pattern has not been described previously for PCP. A 30-year-old male intravenous drug abuser, with AIDS, presented to our institution complaining of fever and productive cough. Admission chest x-ray film revealed a "classic" miliary pattern. Sputum smears were negative for acid-fast bacilli and both bronchoalveolar lavage and transbronchial biopsy revealed only PCP. Repeat bronchoscopy one month later was unrevealing and marked x-ray resolution occurred after treatment with pentamidine alone. The incidence of atypical roentgenographic features of PCP in AIDS is approximately 10 percent. Given the frequency of this infection in AIDS, knowledge of the unusual presentations is imperative. Based on this report, PCP must be included in the differential diagnosis of a miliary x-ray pattern.
PMID: 2788560
ISSN: 0012-3692
CID: 4823062

Elevated levels of angiotensin-converting enzyme in Pneumocystis carinii pneumonia

Singer, F; Talavera, W; Zumoff, B
Serum angiotensin-converting enzyme (ACE) levels are elevated in sarcoidosis and have been used both to diagnose and to assess response to treatment of this disease. We report significantly (p less than .0005) elevated ACE levels in patients with Pneumocystis carinii pneumonia (PCP) (49 +/- 14 U/L) compared with normal control subjects (32 +/- 11 U/L) tested within 48 hours of hospital admission. Serum ACE levels in smoking control subjects (33 +/- 11 U/L) were not significantly (alpha = .05) different from nonsmoking control subjects (32 +/- 11 U/L), but the levels in PCP patients who smoked (55 +/- 15 U/L) were significantly (p less than .025) higher than in those who did not smoke (42 +/- 10 U/L). In addition to suggesting a possible clinical use for measuring ACE levels in suspected or confirmed PCP, we speculate that elevations in serum ACE levels may reflect macrophage dysfunction in patients with PCP.
PMID: 2538296
ISSN: 0012-3692
CID: 849952

Endobronchial tuberculosis in the acquired immunodeficiency syndrome [Case Report]

Wasser, L S; Shaw, G W; Talavera, W
Although many of the pulmonary manifestations of tuberculosis in the acquired immunodeficiency syndrome (AIDS) are well known, endobronchial involvement has not been previously described. We report the clinical, roentgenographic, and bronchoscopic features of three patients with endobronchial tuberculosis and AIDS. All of the patients had nonspecific symptoms of fever and cough; however, none exhibited the classic findings of dyspnea, wheezing, or hemoptysis. Smears of sputum were nondiagnostic. The chest x-ray film revealed mediastinal adenopathy in two patients and a lower lobe consolidation in the third; all had small ipsilateral pleural effusions. Endobronchial lesions were white or pink exophytic masses obstructing the airways, mimicking bronchogenic carcinoma. Areas of "classic" primary tuberculosis were seen in two of the patients. Despite ongoing clinical and roentgenographic deterioration, all patients responded well to antituberculosis medications. Given the frequency of tuberculosis in patients with AIDS and AIDS-related complex, one should maintain a high index of suspicion for involvement of the tracheobronchial tree, so as to avoid a delay in diagnosis and resultant increased morbidity and mortality.
PMID: 3191766
ISSN: 0012-3692
CID: 4823072

Massive haemoptysis in the acquired immunodeficiency syndrome [Case Report]

Wasser, L; Talavera, W; Villamena, P; Akin, M R; Fox, K
A 32-year-old male intravenous drug abuser was admitted to our institution with constitutional symptoms and sputum smears containing acid-fast bacilli, but no parenchymal disease on chest radiograph. He subsequently developed massive haemoptysis and required an emergency lobectomy. The pathology specimen revealed miliary tuberculosis with extensive caseation, schistosomiasis and cytomegalovirus. This is the first report of massive haemoptysis in the acquired immunodeficiency syndrome. The severe pulmonary haemorrhage was most likely due to miliary tuberculosis.
PMID: 3256354
ISSN: 0007-0971
CID: 4823082

Candida pneumonia secondary to an acquired tracheoesophageal fistula in a patient with AIDS

Klapholz, A; Wasser, L; Stein, S; Talavera, W
PMID: 3380393
ISSN: 0028-7628
CID: 4195232

Pulmonary cryptococcosis in AIDS

Wasser, L; Talavera, W
Cryptococcus neoformans is emerging as an important etiologic agent of disseminated infection in patients with the acquired immunodeficiency syndrome (AIDS). Little attention has been placed on the pulmonary expression of this systemic infection. We report five patients with AIDS and cryptococcosis with primary pulmonary involvement. Patients usually presented with fever, cough, dyspnea, and pleuritic chest pain. Chest x-ray findings varied from localized and diffuse infiltration to lymphadenopathy and pleural effusions. All patients developed disseminated disease despite antifungal therapy. Pulmonary cryptococcosis is a frequent presentation of this infection in patients with AIDS.
PMID: 3308348
ISSN: 0012-3692
CID: 4823092

Pulmonary infections in the acquired immunodeficiency syndrome

Talavera, W; Mildvan, D
PMID: 3317612
ISSN: 0882-0546
CID: 4823102

Management of opportunistic pneumonia in AIDS

Teirstein, A S; Rosen, M J; Mildvan, D; Shane, L B; Chuang, M T; Tow, T W; Talavera, W
PMID: 6335956
ISSN: 0077-8923
CID: 4823112