chest radiograph Copyright © 2007 Dr.Syrian / hakeem

Transcription

Pneumocystis carinii pneumonia chest radiograph
Chest radiograph of a two-year-old
boy with HIV infection and
Pneumocystis carinii pneumonia. Note
the presence of bilateral interstitial
lung disease, pneumomediastinum,
and subcutaneous emphysema.
Copyright © 2007 Dr.Syrian / hakeem
Pneumocystis carinii pneumonia lung biopsy
Lung biopsy specimen from a child
with HIV infection and pneumonia.
Gomori-methenamine silver stain
shows numerous dark-staining
cysts of Pneumocystis carinii
(courtesy of Dr. Claire Langston,
Baylor College of Medicine,
Houston, Texas).
Lymphoid interstitial
pneumonitis/pulmonary lymphoid
hyperplasia (LIP/PLH) - chest
radiograph
Chest radiograph showing bilateral
reticulonodular interstitial
infiltrates in a two-year-old boy
with HIV infection and lymphoid
interstitial pneumonitis / pulmonary
lymphoid hyperplasia (LIP/PLH).
Presumptive diagnosis of LIP/PLH
is based on persistence for two
months or more of characteristic
radiographic features.
LIP/PLH - lung biopsy
Lung biopsy specimen showing
mononuclear interstitial infiltration
in a child with HIV infection and
lymphoid interstitial pneumonitis /
pulmonary lymphoid hyperplasia
(LIP/PLH). The pathogenesis of
LIP/PLH is poorly understood, but
Epstein-Barr virus has been
implicated as a co-factor in its
development (courtesy of Dr. Claire
Langston, Baylor College of
Medicine, Houston, Texas).
LIP/PLH - lung biopsy
Biopsy specimen showing a
nodular aggregate of mononuclear
cells in the lung of a child with HIV
infection and lymphoid interstitial
pneumonitis / pulmonary lymphoid
hyperplasia (LIP/PLH).
LIP/PLH - digital clubbing
Digital clubbing in a child with HIV
infection and lymphoid interstitial
hyperplasia (LIP/PLH). Marked
lymphadenopathy,
hepatosplenomegaly, and salivary
gland enlargement also are
observed in many children with
LIP/PLH. The clinical course of
LIP/PLH is variable. Exacerbation
of respiratory distress and
hypoxemia can occur in
association with intercurrent viral
respiratory illnesses. Spontaneous
clinical remission sometimes is
observed.
LIP/PLH - parotid gland
enlargement
Bilateral parotid gland
enlargement in an HIV-infected boy
with lymphoid interstitial
hyperplasia (LIP/PLH). Note the
presence also of multiple lesions of
molluscum contagiosum.
2
Granulocytopenia and
Staphylococcus aureus
An HIV-infected girl with
granulocytopenia and
Staphylococcus aureus
bacteremia. Note the presence of
multiple necrotic skin lesions. The
left thigh is held in a position of
flexion, abduction, and external
rotation, indicating the presence of
septic arthritis of the hip. The left
calf is erythematous, swollen, and
indurated secondary to cellulitis
and myositis. Minor and serious
bacterial infections, including
bacteremia, are observed
commonly among HIV-infected
children. Streptococcus
pneumoniae is the pathogen
isolated most frequently, but S.
aureus also must be considered,
particularly if there is a skin or soft
tissue focus of infection.
Suppurative parotitis
Suppurative parotitis in an
HIV-infected girl. Note the marked
swelling and redness overlying the
left parotid gland. On palpation of
the gland, pus could be seen
exuding from Stensen’s duct.
3
Severe encephalopathy
A five-year-old girl with HIV
infection and severe, progressive
HIV encephalopathy. The girl is
non-communicative and spastic.
Note the presence of cortical
thumbs.
Generalized brain atrophy computed tomography (CT) scan
Computed tomography (CT) scan of
the brain of an eight-year-old boy
with HIV infection and generalized
brain atrophy. Cerebral atrophy is
observed commonly among
children with HIV-associated
encephalopathy, but it also may be
observed among children who are
normal neurologically and
developmentally.
Bilateral calcifications of the basal
ganglia - CT scan
Computed tomography (CT) scan of
the brain of a nine-month-old girl
with HIV infection and bilateral
calcifications of the basal ganglia.
This finding in an infant or young
child strongly suggests HIV
infection.
4
Cardiomegaly - chest radiograph
Chest radiograph showing
cardiomegaly in a five-year-old girl
with HIV infection,
cardiomyopathy, and congestive
heart failure. Many HIV-infected
children with congestive heart
failure respond well to medical
management.
Severe HIV wasting
Severe HIV wasting
Abdominal lymphoma
An HIV-infected boy with an
abdominal lymphoma. The most
common cancer of HIV-infected
children is Burkitt’s or
immunoblastic, non-Hodgkin’s
lymphoma. Clinical manifestations
include fever, weight loss, and
evidence of "extranodal" disease
(hepatomegaly, jaundice,
abdominal distention, and
pancytopenia). Children with
central nervous system lymphoma
may experience cranial nerve
palsies or seizures.
5
Scabies
Exaggerated scabies, with a
generalized, papular, pruritic
eruption, in an HIV-infected infant.
Microscopic examination of skin
scrapings to rule out scabies is
recommended for any HIV-infected
child with a generalized skin
eruption.
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Norwegian (crusted) scabies
Norwegian (crusted) scabies in an
HIV-infected boy. Generalized
scaling and hyperkeratotic, crusted
plaques are present.
Severe tinea corporis
Severe tinea corporis in an
HIV-infected boy.
6
Herpes simplex virus
Herpes simplex virus infection in
an HIV-infected girl. Chronic or
progressive herpetic skin lesions
are observed occasionally in
HIV-infected children.
Herpes zoster (shingles)
Herpes zoster (shingles) in an
HIV-infected boy. Such cases can
be complicated by chronicity or
dissemination.
7
Cytomegalovirus retinitis fundoscopic examination
Funduscopic examination of a
16-year-old girl with HIV infection
and cytomegalovirus retinitis.
There are extensive areas of
hemorrhage, with white retinal
exudates. Children with
cytomegalovirus retinitis usually
present with painless visual
impairment (courtesy of Dr. David
Coats, Houston, Texas).
Human papillomavirus
Severe cutaneous warts (human
papillomavirus infection) in a boy
with HIV infection.
Molluscum contagiosum
Severe molluscum contagiosum in
an HIV-infected boy. Some
HIV-infected children develop
molluscum contagiosum lesions
that are unusually large or
widespread.
8
Pseudomembranous candidiasis
Pseudomembranous candidiasis.
Erythematous (atrophic) candidiasis
Erythematous (atrophic) candidiasis.
Oral hairy leukoplakia
Oral hairy leukoplakia in an
HIV-infected girl. Hairy leukoplakia
is typified by the presence of white
or gray lesions along the lateral
tongue. Lesions often have vertical
corrugations and are not
removable with a tongue blade.
This is an Epstein-Barr
virus-associated lesion.
Non-nucleoside reverse
transcriptase inhibitor associated
rash
Non-nucleoside reverse
transcriptase inhibitor associated
rash on a 12-year old girl who had
begun antiretroviral therapy with
efavirenz (Sustiva) one week
previous. Rash is one of the most
common side effects observed with
NNRTIs.
9
Cutaneous cryptococcus
neoformans infection
A nine year-old HIV-infected girl
with cutaneous cryptococcus
neoformans infection. Skin lesions
can be single or multiple, and may
appear as small papules, pustules,
nodules, or ulcers with a base of
granulation tissue.
Tuberculous lymphadenitis
(scrofula)
An 8 year old HIV-infected boy with
tuberculous lymphadenitis
(scrofula). Copious amounts of pus
spontaneously drained from this
lesion. In an immunocompromised
child other causes of lymphadenitis
include infections with
gram-positive bacteria, atypical
mycobacterium and Bartonella
henselae (cat scratch disease);
malignancies such as lymphoma;
masses such as branchial cleft
cysts or cystic hygromas
masquerading as lymph nodes;
and adenitis due to HIV itself.
Antiretroviral associated
lipodystrophy syndrome
Antiretroviral associated
lipodystrophy syndrome in a
17-year old HIV-infected girl.
Although the pathogenesis of the
condition is debated, many studies
suggest an association with highly
active antiretroviral therapy
(HAART). The condition presents
with both physical and metabolic
abnormalities.
10
Kaposi's sarcoma lesion
A seven-year-old HIV-infected girl
with a Kaposi sarcoma lesion. This
tumor is rarely diagnosed among
U.S. children, with the occasional
exception of Haitian children with
vertical HIV infection or older
adolescents. Kaposi sarcoma is
observed more commonly among
HIV-infected children in some other
geographic locales, including parts
of Africa (e.g., Zambia and Uganda)
and Romania. Kaposi sarcoma has
been linked to infection with a
novel herpesvirus, now known as
human herpesvirus 8 (HHV-8) or
Kaposi sarcoma-associated virus
(KSV).
Cryptococcal Meningitis
Head CT from a child with HIV
infection and cryptococcal
meningitis. Bilateral lentiform
nuclear calcifications are present.
Oral candidiasis and herpes
simplex
Oral candidiasis and herpes
simplex
Progressive multifocal
leukoencephalopathy
To learn more about this
manifestation of HIV, refer to the
www.hakeem-sy.org
11
Cutaneous candidiasis
www.hakeem-sy.org
Acanthamoeba infection
www,hakeem-sy.org
12

chest radiograph Copyright © 2007 Dr.Syrian / hakeem

Transcription

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