Arikan Y, Burdge D, McLeod WA; International Conference on AIDS.

Int Conf AIDS. 1998; 12: 540 (abstract no. 31224).

University of British of Columbia, Oak Tree Clinic, Vancouver, Canada.

BACKGROUND: Immunosuppressed patients with HIV/AIDS may have atypical presentations of non-AIDS defining infections. There has been no previous published information regarding Q-fever in HIV/AIDS. In normal hosts, disseminated granulomatous skin lesions have never been reported with Q-fever. METHODS: The patients medical records were reviewed. Phase II complement fixation Q-fever serology was performed in a provincial reference laboratory. Skin biopsy specimens were processed routinely in a university hospital pathology laboratory, and also submitted to reference laboratories for mycobacteria, fungal stains and culture, and PCR studies including for mycobacteria and Q-fever. RESULTS: Case Report: A 31-year-old woman with AIDS and CD4 count of 0.001 x 10(9)/L(1) developed maculopapular rash, fever, headache, increased liver enzymes and hepatosplenomegaly. The rash appeared "vasculitic" and involved the extremities including the palms and soles. She had been on treatment for M. avium complex (MAC) infection with rifampin, ethambutol and clarithromycin for one month. Skin biopsy showed granulomas, but no vasculitis. Special studies for mycobacteria, viruses and other pathogens were negative. Q-fever phase II complement fixation serology was reactive (1:64) at time of presentation and convalescent serology showed a four fold decrease in titre (1:16), both highly supportive of a diagnosis of Q-fever. The rash, hepatosplenomegaly, abnormal liver enzymes and fever slowly improved after she started combination antiretroviral therapy, and with ongoing clarithromycin therapy. CONCLUSIONS: Q-fever should be considered in the differential diagnosis of febrile syndromes associated with skin rash in patients with HIV/AIDS. Skin biopsy can help define investigative approaches and lead to diagnosis; in our patient granulomas were demonstrated on biopsy of a "vasculitic" appearing rash that involved the palms and soles.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Exanthema
• Female
• Fever
• HIV Seropositivity
• Humans
• Mycobacterium
• Mycobacterium Infections
• Mycobacterium Infections, Atypical
• Q Fever
• Skin
• organization & administration

Other ID:

• 98396071

UI: 102229614

From Meeting Abstracts