Cytomegalovirus colitis in a human immunodeficiency virus seropositive individual with moderately severe immunodeficiency

Colitis is the most common extraocular manifestation of cytomegalovirus (CMV) infection in human immunodeficiency virus (HIV) infected patients. CMV disease is usually seen in HIV-infected patients with CD4+ counts less than 50/ mm3 . There are documented reports of CMV gastrointestinal disease in patients with CD4+ count greater than 50 cells/L. A 46-year-old man with HIV1 infection on irregular antiretroviral treatment presented with low grade fever, abdominal pain and vomitings. He is a known alcoholic. Physical examination revealed pallor, evidence of malnutrition and tenderness in the abdomen. Laboratory investigations revealed mild anaemia; CD4+ count was 240 cells/L. Fundus examination of the patient was normal. Contrast enhanced computed tomography (CECT) of the abdomen revealed dilated small bowel loops, thickening of wall of splenic flexure and thickening of caecal and terminal ileal wall with mild narrowing. As anti-CMV antibodies (IgM) and CMV real time-polymerase chain reaction (PCR) tested positive, patient was treated with intravenous ganciclovir for 14 days followed by oral valganciclovir and patient showed remarkable improvement. Our case highlights the fact that CMV colitis can also occur in patients with relatively preserved CD4+ counts especially if co-morbid conditions like alcoholism co-exist

Non-invasive evaluation of arterial stiffness in patients with increased risk of cardiovascular morbidity: A cross-sectional study

Objectives: Cardiovascular disease (CVD) is associated with a generalized atherosclerotic process that begins in the large arteries, representing vascular pathology leading to increased cardiovascular morbidity and mortality. Pulse wave velocity (PWV) is a simple, accurate, reproducible and a good prognostic marker of arterial stiffness. Testing arterial stiffness with non-invasive techniques provides an opportunity to evaluate large patient populations with cardiovascular risk. Therefore, the aim of the present study was to evaluate non-invasively the arterial stiffness (AS) in patients with high cardiovascular risk. Materials and Methods: Totally 3969 subjects [CAD - 845, DM - 973, ESRD - 942, RA - 221 and 988 age-matched healthy controls] were enrolled in the study approved by the IEC, NIMS; and all the subjects gave written informed consent to participate. Pulse wave velocity was determined non-invasively by PeriScope (M/S Genesis Medical Systems, Hyderabad, India). Results: In patients with CAD, DM, ESRD and RA, heart rate (HR), blood pressure (BP) and PP were significantly more than healthy controls. Peripheral and central arteries′ PWVs were higher in these patients′ group. The mean HR was maximum in RA patient, while systolic blood pressure (SBP) was highest in ESRD patient. There was a good correlation between ba PWV and PP in all patients′ group and healthy controls except RA patients. Conclusion: Our study findings emphasize the importance of the PWV in identifying the vascular damage in patients with high CV risk. Increased PWV was found to be a good independent predictor of cardiovascular morbidity

Cytomegalovirus colitis in a human immunodeficiency virus seropositive individual with moderately severe immunodeficiency

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