Multiple myeloma and HIV infection: report of 3 cases

peer reviewedHIV infection rages at the endemic state in Sub Saharan African and especially in Congo Brazzaville. We report the observation of three female patients infected with HIV and developing multiple myeloma. The three patients were treated at the University hospital of Brazzaville between 2000 and 2002. In two cases multiple myeloma was discovered after the diagnosis of HIV infection. In the other case, the diagnosis of HIV infection was posterior to the occurrence of multiple myeloma. HIV infection was symptomatic in two cases who received consequently antiviral treatment. Multiple myeloma was diagnosed at an advanced stage in the three cases. The paraprotein was an IgG in two cases and an IgA in the other one. The CD4 counts before treatment were around 200/mm3 in two cases and within normal limits in the third case. Viral load was not measured. VMCP and VAMCP regimens were administered without major complications and under anti-infectious prophylaxis. The follow-up is still insufficient to assess the medium-term evolution and to determine the prognosis of multiple myeloma. The description of these three cases confirms the involvement of HIV in B cell lymphoma genesis

African histoplasmosis due to Histoplasma duboisii (Histoplasma capsulatum var. duboisii): fourteen cases observed in Congo during 10 years (1981-1990)

peer reviewedFourteen cases of histoplasmosis due to Histoplasma duboisii seen in Congo from 1981 through 1990, are reported: the average age of the patients was 25 years (the youngest being 1,5 y and the oldest 50y), the M/F ratio was 2,5; most of the patients (10/14) live in a rural area. there was a rather constant frequency of one to three cases per annum from 1981 through 1990. The fisrt congolese AIDS-associated systemic histoplasmosis duboisii case was observed in 1990. Lymph node involvment and mucocutaneous lesions were the most frequent clinical manifestations. In all cases, the disgnosis was established by histological examination. When performed, direct microscopy was always positive (11/11). Isolation of H. duboisii in culture was successful in 7 out of 9 attempts. Two cases of systemic infection were rapidly fatal but a good clinical response was obtained in the other cases wih amphotericin B, which due to intolerance, was replaced by ketoconazole in 2 patients.De 1981 à 1990 nous avons collecté au Congo 14 observations d'histoplasmose à Histoplasma duboisii. Globalement on relève: un sex ratio de 2,5; un âge moyen de 25 ans, avec des extrêmes de 1 an et demi et 50 ans; une majorité de patients (10 sur 14) vivant en milieu rural; une fréquence relativement stable avec de 1 à 3 cas de 1981 à 1990, date à laquelle la première forme diffuse a été observée au cours d'un SIDA. Les atteintes ganglionnaires et cutanéo-muqueuses sont les plus fréquentes. Le diagnsotic a toujours comporté la mise en évidence des levures par l'examen histologique. L'examen direct d'un produit pathologique a été positif dans tous les cas où il a été réalisé (11/11), mais la culture est restée négative à deux reprises. les deux formes disséminées ont été rapidement mortelles. Pour les autres observations l'évolution, à court terme et moyen terme, a toujours été bonne sous amphotéricine B. Dans deux cas, des intolérances ont conduit à prescrire du kétoconazole