Introduction. Heart failure and dilated cardiomyopathy (DCM) in adults are rarely caused by hypoparathyroidism induced hypocalcemia. Case report. Female patient, 40 years old, diabetic, with previous history of thyroidectomy for Graves' disease, was hospitalized for syncope and symptoms of heart failure. ECG revealed sinus tachycardia, long QT, negative T from V1 up to V4. Chest X-ray, cardiac ultrasound and contrast cardiac MRI confirmed dilated left chambers, severe systolic dysfunction of the left ventricle (left ventricle ejection fraction=15%) due to diffuse hypokinesia and restrictive type of diastolic dysfunction. Patient status insignificantly improved with specific heart failure depletion treatment but important signs of hypocalcemia occurred. Low levels of total and ionic serum calcium were detected (total serum calcium 3.6 mg/dL, ionic calcium=2.2 mg/dL) along with low serum levels of parathormone (10 pg/mL) and high level of phosphatemia (6.4 mg/dL). After one month of parenteral treatment with calcium and oral vitamin D, hypocalcemic signs disappeared and heart failure significantly improved. Conclusion. This rare adult condition is refractory to heart failure conventional therapy but promptly responds to restoration of normocalcemia. It is important to be aware of this pathophysiological setting, in order to treat it correctly.

Human papillomavirus (HPV) is the most common cause of cervical cancer worldwide, and Romania has the highest rate of cervical cancer in Europe. Sixty-five young Romanian women infected with HIV during early childhood and 25 control subjects were evaluated for the presence of cervical HPV infection and for cytologic abnormalities. HPV infection was evaluated longitudinally in 42 HIV-infected individuals. Overall 28/65 (43.1%) of HIV-infected and 8/25 (32.0%) of uninfected subjects were infected with HPV, and 21/65 (32.3%) and 6/25 (24%) had high-risk subtypes, respectively. In HIV-infected women, those maintaining or acquiring a new subtype in follow-up were more likely to have a lower nadir ( p = 0.04) and current ( p = 0.01) CD4 cell counts. The incidence rate for HPV acquisition events was 0.69 per subject per year, and 0.52 for high-risk subtypes. In the HIV-infected group, 9/13 (69.2%) individuals with abnormal cytology progressed at follow-up. Although HPV prevalence was similar to controls, the rate of Pap smear abnormalities was much higher, possibly due to the decreased ability to mount new immune responses. Given the high rate of incident detection of vaccine preventable strains and cytologic progression in this cohort, HPV vaccination may be beneficial at any age in co-infected women.

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Introduction. Pulmonary infiltrate and eosinophilia represent a heterogenous group of diseases causes by extrinsic or intrinsic factors. Extrinsic factors represented by medication or infectious agents (parasites, fungi, mycobacteria) may trigger an eosinophilic immune response. We report the case of a 53 years old male patient with pulmonary infiltrate and eosinophilia secondary to Toxocariasis infection who was diagnosed with deep vein thrombosis and pulmonary embolism one month later from the diagnosis of pneumonia. Further investigations demonstrated a hypercoagulable state. Case presentation. On March 2015 a 53 years old male came to my office because of a very intense pain on the left posterior thorax which increased by deeply breathing. Physical exam was in normal range, but chest computer tomography without contrast done in emergency showed pulmonary infiltrate at the base of the left lung with pleuritic reaction. Blood tests showed white blood cells at the upper range with eosinophilia (21.75%, 2,050/mc) and inflammatory syndrome. Investigations for eosinophilia showed a positive Western blot test for Toxocara canis so the patient began the treatment with Albendazolum 800 mg/day for three weeks with positive response. One month later the patient visited us for a pain on the right calf. The ultrasound Doppler vein confirmed the diagnosis of deep vein thrombosis and the chest Computer Tomography with contrast substance described mild right pulmonary embolism. The patient started the anticoagulant treatment. Thrombophilia tests were done, MTHFR A1298C gene and PAI1 675 were positive. Discussions. Helminthic infections are associated with eosinophilia. Helminths who migrate to the viscera as like as Toxocara canis could produce high eosinophilic response. Our questions was if eosinophilia was responsible for the patient thrombosis or was it only the trigger factor? As two genetic tests for thrombophilia (MTHFR A1298C gene and PAI1 675) were positive we considered deep vein thrombosis and pulmonary embolism in the context of hypercoagulable states. Conclusion. This case highlights the implication of eosinophilia as trigger factor for vein thrombosis and pulmonary embolism.