Male patient, 42 years old, single with a child and merchant, who consulted in March 2009 in the Emergency Department of Hospital Dr. Sotero Del Río right (HSDR) for a cervical mass
She reported a two-month history of progressive painless right cervical volume increase, associated with logical dysphagia and accompanied by general malaise, weight loss, night sweats nighttime temperature and intermittent fever.
In the system review, there were no other symptoms.
Relevant history included previous sexual relations with men without condom use.
Located drug use.
Physical examination at admission revealed a patient in good general condition, affliction, diffuse desquamation of the skin, algorra in the palate and hairy leukoplakia in the tongue.
There was a 10 cms right lateral cervical mass, painless, stony, adhered to deep planes, nodular texture and without inflammatory signs.
The rest of the physical examination was normal.
It was decided to hospitalize for study due to suspicion of neoplasia in the context of immunosuppression.
The main laboratory findings were normocytic normochromic anemia with haematocrit of 31.1%, leukocytes of 5900 cells/mm3, granulocyte-containing protein 6 (PCR) and platelet count 161.000 mg/L.
Creatininemia, coagulation tests, plasma electrolytes, biochemical profile and urine sediment were normal.
The expectoration and uroculture smears were negative.
Chest radiography showed no pathological findings.
ELISA test for HIV was positive and serology for HBV and HCV, both negative.
A CT scan of the brain, neck, abdomen and pelvis was requested, in which a right cervical tumor was reported that seemed to depend on the submandibular gland of size 8.4 x 7 x 6 cm, with neoplasic appearance low probability of lymphoma.
The results of the positive blood culture for multisensitive Salmonella group B (sensitive to cefotaxime, ciprofloxacin, nalidixic acid, chloramphenicol and cotrimoxazole) were received.
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In addition, it was decided to perform a surgical incisional biopsy of the cervical lesion that showed brain tumor tissue with profuse bleeding and great surrounding inflammatory involvement.
Samples were sent to cultures of current tissue and Koch, direct Gram stain and bacilloscopy.
Tissue cultures were positive for multisensitive Salmonella group B on the third day after inoculation.
Both cultures were sent to the Instituto de Salud Pública (ISP) for confirmation and typing, corresponding to Salmonella philosophicalmurium.
Treatment was initiated with ceftriaxone ev 2 g/day for 14 days followed by oral ciprofloxacin 500 mg every 12 hours for 30 days.
Histological examination of the cervical biopsy showed a chronic granulomatous non-necrotizing inflammatory process with suppurative foci.
No malignant cellular elements or microorganisms were observed on microscopic examination.
Koch culture was negative.
The patient presented a favorable evolution with progressive reduction of the cervical mass and resolution of the fever, not requiring new surgical interventions.
She was discharged after 44 days of hospitalization with indication to maintain oral ciprofloxacin for 30 days.
HIV RNA was subsequently controlled in the Infectious Diseases Polyclinic at HSDR and it was found in good conditions, with weight gain and no systemic symptoms; PCR 3 mg/L. Atazanavir was confirmed antiretroviral viral load/HIV RNA positive
The decision to use this scheme, which is not commonly used as first-line therapy, was made by the Infectious Diseases team to improve patient adherence because it is better for patients with advanced immunosuppression.
A new head and neck CT after 18 days of antimicrobial treatment showed no lymphadenopathies that could be biopsied and was discharged by the Head and Neck Surgery team.
A year later, the patient is in good condition, with definitive resolution of the cervical mass and under treatment with the same ART regimen. At 15 months, the patient presented undetectable viral load, with severe bacterial CD4 counts of 181
