Systemic Dissemination of Pneumocystis Carinii in a Patient with Acquired Immunodeficiency Syndrome

Pneumocystis carinii is usually considered a respiratory tract pathogen; however, there are reported cases of limited and generalized dissemination of the organism from the lungs of immunocompromised patients. We present the autopsy findings of a 29-year-old male with acquired immunodeficiency syndrome (AIDS) and recurrent Pneumocystis carinii pneumonia who developed abnormal liver function tests. The patient had received aerosolized pentamidine because of toxic reactions to other modes of therapy. The postmortem examination revealed Pneumocystis in the lungs, liver, spleen, kidney, myocardium, thymus, pancreas, thyroid gland, bilateral parathyroid and adrenal glands, gastrointestinal mucosa, perihilar and mesenteric lymph nodes, and bone marrow. A high index of suspicion, especially in patients treated with aerosolized pentamidine, may lead to an increased recognition of disseminated pneumocystosis. Dissemination of the infection may be due to failure of the aerosolized drug to achieve adequate blood levels. As AIDS patients survive longer because of the developing therapeutic arsenal, disseminated pneumocystosis may be encountered with increasing frequency in these immunocompromised patients

Multiple Small Bowel Perforations Secondary to Cytomegalovirus in a Patient with Acquired Immunodeficiency Syndrome

Cytomegalovirus gastroenteritis can be a life-threatening infection in patients with the acquired immunodeficiency syndrome. Although gastrointestinal ulcerations from cytomegalovirus have been widely reported, our patient is only the second case reported with actual perforations in the small bowel

T-Lymphocyte Subset Studies to Monitor Patients with AIDS and AIDS-Related Complex

Multiple specimens from 124 patients from our clinic were evaluated for T4/T8 cell ratio over three to 28 months. Twenty-nine of 30 patients with the acquired immunodeficiency syndrome (AIDS), 58 of 71 patients with AIDS-related complex (ARC), and four of 23 patients at risk showed initial T4/T8 cell ratios of less than 0.8. which either remained unchanged or decreased. Seventeen of 23 AIDS patients and two of 20 ARC patients with a consistently low ratio (0.3 or less) died during the follow-up period. This indicated that the severity of disease could be predicted by periodical T4/T8 cell ratio studies. These serial studies appeared to be valuable in monitoring the course of patients with AIDS, ARC, and the human immunodeficiency virus infection and also in evaluating the effects of available drug treatment

Nocardia Asteroides aortitis with perforation of the aorta

A 53-year-old man died of nocardial aortitis eight months after undergoing aortic valve replacement. Autopsy revealed vegetation in the area of a previous aortotomy incision and a small perforation of the aorta enclosed by pericardium immediately above the prosthetic valve ring. Prosthetic valve endocarditis was not present. Multiple splenic infarcts, microabscesses of both kidneys, and myocarditis were identified. Antemortem blood cultures and postmortem cultures of the aortic vegetation grew Nocardia asteroides