The Red Scourge: Pneumocystis carinii
Pneumocystis carinii pneumonitis is a well-known pulmonary infection associated with AIDS. Its symptoms include dyspnea, fever, cough, chills, sweats, and hemoptysis. Interestingly, normal findings on chest x-ray film have been reported. In such instances, transbronchial biopsies and a touch preparation of lung tissue yield a high rate of positive results. It is not unusual to find other opportunistic infections concomitantly with Pneumocystis carinii such as cytomegalic virus, Histoplasma capsulatum, Mycobacterium avi-vum-intercellulare, and Cryptococcus neoformans in immunocompromised patients.
This homosexual patient was admitted for evaluation of fever, dyspnea, nonproductive cough and persistent headaches. Skin biopsy of the nodule on his right antecubital fossa was consistent with Kaposi’s sarcoma. Although his chest x-ray findings were normal, a gallium scan was markedly positive (Fig 3). A transbronchial biopsy of his lung revealed numerous cysts characteristic of Pneumocystis carinii (Fig 4). His persistent headaches were caused by Cryptococcus neoformans which was seen in his cerebral spinal fluid and was cultured as well. The patient ultimately expired secondary to opportunistic infections. Click Here
Bacterial endocarditis is characterized by the triad of fever, new murmur, and skin lesions. The cutaneous signs include splinter hemorrhages of nails, conjunctival and palatal petechiae, Osier’s nodes, Janeway lesions, and purpura.
Systemic lupus erythematosus may involve one or many organ systems. Associated findings may include fever, pleuritic pain, and skin lesions which were also seen in this case. However the cutaneous lesions are usually scaly erythematous atrophic plaques, urticarial, or occasionally blistering lesions. Familial Mediterranean fever is transmitted in an autosomal recessive manner. It is characterized by fever, abdominal pain, arthritis, pleuritis, and erysipelas-like or urticarial skin lesions.