trimethoprim--sulfamethoxazole-drug-combination and Sporotrichosis

The so-called exotic pulmonary mycoses are imported diseases in France. They are infrequent or exceptional and for this reason can be underdiagnosed or recognized with delay. Nevertheless, they are easily treatable infections with available antifungal agents. As a rule, the site of primary infection is the lung with ensuing clearance or chronic local infection and/or dissemination. Immunocompromised hosts are more prone to develop severe forms or reactivation of the disease.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Infective Agents; Antifungal Agents; Blastomycosis; Coccidioidomycosis; Diagnosis, Differential; Histoplasmosis; Humans; Itraconazole; Ketoconazole; Lung Diseases, Fungal; Paracoccidioidomycosis; Penicillium; Sporotrichosis; Sulfadiazine; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

PRESENTING FEATURES: A 53-year-old man who had human immunodeficiency virus (HIV) presented to the Johns Hopkins Hospital with a 3-month history of increasing dysphagia, cough, dyspnea, chest pain, and an episode of syncope. His past medical history was notable for oral and presumptive esophageal candidiasis that was treated with fluconazole 6 months prior to presentation. Three months prior to presentation, he discontinued his medications, and his symptoms of dysphagia recurred. During that time he developed intermittent fevers and chills, progressively worsening dyspnea on exertion, and a cough productive of white sputum. He also reported a 40-lb weight loss over the past 3 months. On the day prior to presentation, he had chest pain and shortness of breath followed by weakness, dizziness, and a brief syncopal episode. He denied orthopnea, paroxysmal nocturnal dyspnea, lower extremity edema, jaundice, hemoptysis, hematemesis, melena, hematochezia, or diarrhea. There was no history of alcohol use, and he stopped smoking tobacco approximately 1 month previously. He smoked cocaine but denied injection drug use. The patient had never been on antiretroviral therapy and had never had his CD4 count or viral load measured. On physical examination, the patient was a thin, cachectic man who appeared older than his stated age. His vital signs were notable for blood pressure of 102/69 mm Hg, resting tachycardia of 102 beats per minute, resting oxygen saturation of 92% on room air, normal resting respiratory rate, and a temperature of 38.1 degrees C. His oropharynx was clear, with no signs of thrush or mucosal ulcers. His pulmonary examination was notable for diminished breath sounds in the lower lung fields bilaterally. Cardiac, abdominal, and neurologic examinations were normal. His skin was intact, with no visible petechiae, rashes, nodules, or ulcers. Laboratory studies showed a total white blood cell count of 3.2 x 10(3)/microL, with a total lymphocyte count of 330/microL, hematocrit of 30.2%, a serum sodium level of 129 mEq/L, and a serum lactate dehydrogenase level of 219 IU/L. The patient had an absolute CD4 count of 8 cells/mm3 and a HIV viral load of 86,457 copies/mL. His arterial blood gas on room air had a pH of 7.51, a PCO2 of 33 mm Hg, and a PO2 of 55 mm Hg. Electrocardiogram and serial serum cardiac enzymes were normal. A chest radiograph showed bilateral upper lobe patchy infiltrates with left upper lobe consolidation. Computed tomographic (CT) scan o

Topics: AIDS-Related Opportunistic Infections; Anti-Infective Agents; Anti-Inflammatory Agents; Bronchoalveolar Lavage Fluid; Chest Pain; Cough; Deglutition Disorders; Diagnosis, Differential; Drug Therapy, Combination; Dyspnea; Humans; Lung Diseases, Fungal; Male; Middle Aged; Pneumonia, Pneumocystis; Prednisone; Sporotrichosis; Syncope; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

A case of bilateral, symmetric, sporothricoid granulomas involving the dorsa of fingers and wrists is reported. The culture-proved Mycobacterium marinum skin infection was acquired by a fish-fancier while clearing his aquarium with bare hands. The patient suffered from chronic hand eczema. Treatment with co-trimoxazole was successful.

Topics: Adult; Hand Dermatoses; Humans; Male; Mycobacterium Infections, Nontuberculous; Sporotrichosis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Diagnosis, Differential; Drug Combinations; Humans; Lymphoma, Non-Hodgkin; Male; Nocardia asteroides; Nocardia Infections; Skin Diseases, Infectious; Sporotrichosis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Diagnosis, Differential; Diagnostic Errors; Drug Combinations; Humans; Male; Potassium Iodide; Sporotrichosis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Cutaneous