We describe a patient with intravascularpulmonary lymphomawho presented withprogressive dyspnea and hypoxemiawith normal chest radiographicfindings. After anunrevealing noninvasive evaluation,a high-grade B-cellintravascular lymphoma wasdiagnosed by bronchoscopywith transbronchial biopsy.Treatment with a modifiedCHOP regimen resulted in resolutionof the patient’s hypoxemiaand exercise limitation.Although intravascular pulmonarylymphoma rarely presentswith pulmonary symptoms,it should be consideredin the differential diagnosis ofpatients presenting with hypoxemiaand normal chest radiographicfindings.

ABSTRACT: In general, the management of invasive pulmonaryaspergillosis is based on antifungal therapy and reversal of immunosuppression.Voriconazole is the preferred treatment inmost cases. Liposomal preparations of amphotericin B, caspofungin,and posaconazole are alternatives in patients whocannot tolerate voriconazole or have refractory aspergillosis.Prophylaxis in high-risk patients has gained popularity withthe availability of oral extended-spectrum azoles; posaconazoleis approved for prophylaxis in patients with acute leukemia,myelodysplastic syndrome, and graft versus host disease.(J Respir Dis. 2008;29(11):429-434)

A 71-year-old man who had received a diagnosis of emphysema 12 years ago was referred by his primary care physician to the pulmonary clinic. His symptoms were well controlled until a few months ago, when he complained of mild shortness of breath on physical activity. However, the shortness of breath worsened and became a significant limiting factor. He also had a persistent dry cough.

I read with interest the Chest Film Clinic on pneumomediastinum by Weinstock, Boiselle, and Roberts in the August issue (What caused this woman's pneumomediastinum? J Respir Dis. 2008;29:314-317). In the discussion of the differential diagnosis, the authors did not mention the occurrence of mediastinal emphysema in diabetic ketoacidosis, which was described in 4 patients by Beigelman and associates1 in 1969.

Death caused by asthma is not traditionally thought to be especially common, but it is important to note that asthma often plays a contributing and probably unrecognized role even if it is not often listed as the cause of death on a death certificate. Because early response to asthma exacerbations can make a crucial difference, it is important to develop patient action plans in the outpatient setting well before an attack occurs. However, since busy clinicians must prioritize their educational efforts, identifying who is most at risk for death from asthma is all the more important.

That opening tells more about the book than the author may have intended. The decision to read and review this book was triggered by reading a short announcement of its publication, noting that the wife of one of the most prominent evangelical Christian preachers active in the United States today had come to recognize the challenges of HIV and AIDS and to speak out about the issues. This seemed like a “conversion experience” worthy of exploration.

This month’s Managing Managed Care reviews just a few of the many presentations from the International AIDS Conference that have some relevance to patient care today. One of the highlights was a discussion of the current status of HIV eradication.

As the 2008 election draws closer, the questions of candidates and campaign issues occupy more and more space in print media, minutes on radio and television, and bandwidth in the ubiquitous blogs and spam messages that have become the modern equivalent of brochures hung on the doorknob.

Cutaneous manifestations of immune recovery in response to highly active antiretroviral therapy may account for up to 54% to 78% of the clinical presentations of the immune reconstitution syndrome (IRS)

A 14-year-old boy of African origin with HIV infection presented to the emergency department complaining of sore, swollen eyes and a sore throat. His antiretroviral treatment at that time consisted of lopinavir/ ritonavir and abacavir/lamivudine fixed-dose combination.

We report a case of osteomyelitis due to Mycobacterium avium-intracellulare complex (MAC) in an AIDS patient shortly after the initiation of antiretroviral therapy with subsequent immune reconstitution inflammatory syndrome (IRIS).

An assessment of rapid HIV testing offered in emer­-gency department (ED) settings found the OraQuick ADVANCE Rapid HIV-1/2 Antibody Test produced a high rate of false-positives (Reuters. August 5, 2008).

A 42-year-old white woman with AIDS presented to the emergency department (ED) with a 5-day history of persistent, high-grade fever (temperature of 38.3°C to 40.0°C [101°F to 104°F]); generalized weakness; malaise; and mild headache. The previous night she noted the onset of nausea, emesis, and loss of appetite.

The skin is the most common organ to manifest immune reconstitution syndrome (IRS).1-3 While many viral dermatoses are described in the context of antiretroviral-induced immune recovery (eg, herpesvirus infections, molluscum, genital condylomata, verruca vulgaris),4,5 the case report by Iarikov and colleagues6 is the first report of verruca plana in this setting.

It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Patients with sudden flailing movements or unresponsive staring may, in fact, be experiencing psychogenic events. Other types of pathological spells, such as syncope and migraine, can also be mistaken for epileptic seizures.

Levothyroxine is one of the most commonly prescribed medications for the treatment of hypothyroidism as well as the suppression of thyroid neoplasms.1 Most patients with hypothyroidism require lifelong therapy with levothyroxine; therefore, the likelihood of drug interactions is high.

Kaposi sarcoma was diagnosed in a 54-year-old woman who had had a renal transplant. These multiple purple patches, plaques, and nodules abruptly appeared on the patient’s abdomen when she was taking prednisone and azathioprine.

A 74-year-old man who had Parkinson disease dementia presented with constipation and bloating associated with abdominal pain.

Because widespread use of highly active antiretroviral therapyhas made it possible for persons with HIV infection to livelonger, the epidemiology of HIV/AIDS has shifted in severalways. The number of persons 50 years and older living withHIV/AIDS has risen in recent years, and there has been asubstantial increase in common comorbidities associated withaging in this population. These changes place new emphasis onthe important role of primary care in HIV/AIDS management.[Infect Med. 2008;25:477-480]

Community-acquired pneumonia is a frequent cause ofhospital admission in adults. It usually results from infectionwith pathogens such as Streptococcus pneumoniae, Haemophilusinfluenzae, Mycoplasma, and Chlamydia, among others. In a fewcases, pneumonia develops from infection with unusualpathogens, such as Pasteurella multocida, a gram-negativeorganism commonly found in the mouths of cats and dogs.We report a case of P multocida pneumonia associated with skintrauma caused by cat scratches in a woman with a history ofchronic obstructive pulmonary disease. [Infect Med. 2008;25:487-489]