Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

Complications of Human Immunodeficiency Virus Type 1 379

■AZT myopathy: pain and aching in muscles, usually in thighs and

shoulders. Weakness with difficulty arising from a chair or reacting

above shoulders

tests

Laboratory

■Specific diagnostic tests:

■See summaries on individual pathogens listed elsewhere for details.

Other Tests

Dermatologic

■Bacillary angiomatosis: Biopsy (vascular proliferation with edema

and polymorphonuclear infiltrate); Warthin-Starry stain shows

organism B. henselae or quintara.

■Cryptococcosis: Serum cryptococcal antigen assay usually positive;

Biopsy (Gomori methanamine-silver stain typically shows budding

yeast+positive culture LP to exclude meningitis.

■HSV: Tzanck Prep (multinucleate giant cells and intranuclear inclu-

sions specific for HSV or VZV ). Swab or biopsy for viral culture and/or

FA stain. Biopsy site: edge of ulcer.

■Kaposi’s sarcoma: biospy

■Molluscum contagiosum: Lesions restricted to epidermis; histologic

or electron microscopic exam of scraping or vesicle fluid

■Syphilis: Primary: dark field or DFA stain of exudate+VDRL. Sec-

ondary: VDRL or RPR with confirmation by antitreponemal antibody

(MHATP, FTA-Abs, TPHA)

■Staphylococcus aureus: Swab or aspirate should show gram-positive

cocci in clusters and culture S. Aureus in 4+concentrations

■Other: Eosinophilic folliculitis: Biopsy (intercellular edema of follicu-

lar epithelium w/infiltrate of eosinophils, monocytes, and polymor-

phonuclear neutrophils progressing to eosinophilic abscess; Psori-

asis: Histopathologic features may be similar to seborrhea or drug

reactions; distinguish by history and clinical features; Drug reaction:

rash usually responds at 3-5 days after drug discontinued; Ichthyosis:

Clinical features; Seborrhea: Clinical features

Central Nervous System

■Toxoplasmosis:CT/MRI (Location in basal ganglia. Gray-white jct.

Sites usually multiple. Enhancement: prominent-usually solid, irreg-

ular. Usually edema mass effect)

■Lymphoma: CT/MRI (Location periventricular or anywhere, 2–6

cm. One or many sites. Enhancement: prominent, usually solid,