Enterococcus faecalis bacteremia with bone marrow involvement in an HIV patient presenting with bicytopenia

• Published in: Clinical microbiology newsletter 2002-09, Vol.24 (17), p.133-134
• Main Authors: Gutiérrez, Nieves, Bolaños, Margarita, Angel-Moreno, Alfonso, Francés, Adela, Pérez-Arellano, Jose-Luis, Martín-Sánchez, Antonio M.
• Format: Article
• Language: English
• ISSN: 0196-4399; 1873-4391
• DOI: 10.1016/S0196-4399(02)80034-4

A 42-year-old homosexual male presented to a hospital in November 2000 because of subacute loss of strength in his left extremities and cephalgia. A perianal fistula had been surgically repaired 20 years ago, and he was a heavy smoker. HIV infection had been diagnosed in 1989, but he never accepted antiretroviral therapy. His blood pressure and cardiac and respiratory rates were normal, and a left-sided hemiparesis was evident in the neurological exam. The total leukocyte count was 1.4 x 10 super(3)/ mu l (68% neutrophils and 6% lymphocytes), and the platelet count was 64 x 10 super(3)/ mu l. The LDH was 770 U/l, and the GGT was 1070 U/l. A computed tomography scan of the brain showed a low-density area in the right parietal region with irregular contrast enhancement. Sulfadiazine, pyrimethamine, and folic acid were begun empirically with the presumptive diagnosis of toxoplasma encephalitis, along with the antiretroviral drugs stavudine, lamivudine, nelfinavir, and dexamethasone. He was transferred to our hospital because of lack of improvement along with a negative serologic test for Toxoplasma gondii.