Weiss L, Piketty C, George F, Lavarde V, Kazatchkine MD; International Conference on AIDS.

Int Conf AIDS. 1992 Jul 19-24; 8: 146 (abstract no. PuB 7585).

Unite d'Immunopathologie, Hopital Broussais, Paris, France.

OBJECTIVE: We report a case of invasive aspergillosis (ASP) presenting as renal abscess in a patient with AIDS in the absence of specific risk factors for ASP. ASP appears to be uncommon in patients with AIDS. Risk factors including neutropenia, prolonged steroid therapy or Marijuana inhalation are present in 80% of the reported cases of disseminated Aspergillosis. CASE: A 30 year-old male was first admitted in March 1991 for a severe Pneumocystis carinii pneumonia as the first manifestation of HIV infection. The patient was homosexual with no story of drug addiction. He was treated with anti-pneumocystis drugs and a short course of steroids. He then received Dapsone and Zidovudine. CD4 cell count was 7 x 10(9)/1. The patient was readmitted in December 1991 with fever (39 degrees C) and macroscopic hematuria without lumbar pain. The abdominal CT scan revealed a large abscess involving the entire right kidney. The white blood cell count was 10(9)/1 with 72% neutrophils. A nephrectomy was immediately performed. Direct examination of the pus showed Aspergillus fumigatus as the sole pathogen. The same fungus was isolated in the sputum and urine. There were no signs of pulmonary involvement by conventional X-ray and CT scan. The search for Aspergillus antigen in blood and urine was negative; no antibodies were detected. Neutrophil functions assessed in vitro were normal. The patient was initially treated with Itraconazole (400 mg daily). Serum levels of Itraconazole were found to be under therapeutic ranges and the daily regimen was increased to 1000 mg. Since the patient was also receiving Dapsone, a possible interaction between these two drugs can not be ruled out. The evolution was marked by the persistence of aspergillus infection in the right flank. CONCLUSION: Aspergillus infections may occur more frequently in AIDS patients as a consequence of prolonged survival. Isolated kidney localizations have not been so far reported in the literature.

Publication Types:

• Meeting Abstracts

Keywords:

• Abscess
• Acquired Immunodeficiency Syndrome
• Aspergillosis
• Aspergillus fumigatus
• CD4 Lymphocyte Count
• HIV Infections
• Humans
• In Vitro
• Itraconazole
• Kidney Diseases
• Male
• Nephrectomy
• Pneumonia, Pneumocystis
• Risk Factors
• Sputum
• Zidovudine
• surgery

Other ID:

• 92403652

UI: 102201366

From Meeting Abstracts