Notheis G, Wintergerst U, Liese J, Stehr M, Belohradsky BH; International Conference on AIDS.
Int Conf AIDS. 1992 Jul 19-24; 8: 113 (abstract no. PuB 7388).
University of Munich, Children's Hospital, Bavaria, Germany.
OBJECTIVE: We would like to present the first report of recurrent major aphthous ulcers in an HIV-infected infant. CASE REPORT: In a meanwhile 12 months old boy the first oral ulceration appeared at the age of 2 months. These ulcers healed with antibiotics within 2 months. At the same time we started therapy with Zidovudine (ZDV), i.v. immunoglobulins and PcP-prophylaxis with Cotrimoxazol. The infant had symptomatic HIV-infection (anaemia, thrombopenia, hepatomegaly, failure to thrive) and severe, quantitative and qualitative B-and T-cell immunodeficiency since the first weeks of his life, but granulocytic function were always normal. At six months a painful major ulcer with a fistula occurred on the soft palate. He refused oral nutrition. At this time CMV-IgM was positive. No pathogens were detected in a suitable biopsy. There was little improvement with symptomatic therapy (steroids, brushing), six weeks later the ulcer worsened, and new oral and anal ulcerations appeared. Further ulcers in the gastrointestinal tract were excluded endoscopically and radiodiagnostically. In the smears of the oral ulcers CMV-early-antigen (CMV-EA) was demonstrated, but not in the anal ulcers. Urine was repeatedly negative for CMV-EA. There was no evidence for CMV-colitis and CMV-retinitis. With ganciclovir therapy (two weeks 5mg/kg bid; one week 5mg/kg/d) the oral ulcers resolved rapidly, but there was no improvement of the anal ulcers. Therefore we started therapy with thalidomide (30 mg/d for 4 weeks), which led to a distinct improvement of the anal ulcer and healing of a recurrent oral ulcer. DISCUSSION: So far this is the first report on mucocutaneous ulcers in HIV infected children. The exact cause of the ulceration in our infant were not clarified despite appropriate biopsies. However with combined therapy of ganciclovir and thalidomide we achieved a distinct improvement.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Child
- Cytomegalovirus Infections
- Cytomegalovirus Retinitis
- Fissure in Ano
- Ganciclovir
- HIV Infections
- HIV Seropositivity
- Humans
- Infant
- Male
- Oral Ulcer
- Recurrence
- Stomatitis, Aphthous
- Thalidomide
- Zidovudine
Other ID:
UI: 102201154
From Meeting Abstracts