We describe an unusual clinical association of disseminated histoplasmosis with reactive hemophagocytic syndrome. We report the case of a new HIV-positive patient with reconstitution inflammatory syndrome like reactive hemophagocytic syndrome associated with disseminated histoplasmosis. We describe the clinical case, the procedures performed, the treatment provided and the patient's evolution. A figure of liver biopsy Grocott's silver methenamine stain that shows lots of uniform ovoid yeasts in portal spaces' macrophages that supports the diagnosis of disseminated histoplasmosis in our case.

BackgroundGeneric drugs may help to support antiretroviral treatment. We want to assess the efficacy and safety at 24 weeks of the change of coformulated (abacavir + lamivudine + dolutegravir) to (abacavir + lamivudine) coformulated as a generic pharmaceutical specialty + dolutegravir.MethodsBetween February and June 2017, switch from Triumeq® to a generic pharmaceutical specialty co-formulated tablet (abacavir + lamivudine) plus Tivicay® was made. Demographic, viroimmunological characteristics and the Charlson index were collected. Six months after switching, efficacy and safety were evaluated.ResultsSwitch was made in 93 patients, with a mean age of 47 years, after six months there were five patients (5.4%) with viral loads between 50 and 400 copies, no patient had viral loads of greater amount. There were 2 interruptions due to toxicity (2.15%), in relation to symptoms of the central nervous system. There were no differences in the amount of years with HAART, nor in the previous months with the STR regimen based on abacavir + lamivudine + dolutegravir, nor in the Charlson index. The effective saving in 2017 derived from the change in these 93 patients was € 125.512.ConclusionsThe change from a regimen of abacavir + lamivudine + dolutegravir seems to be safe and effective at 24 weeks.

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Background: Generic drugs may help to support antiretroviral treatment. We want to assess the efficacy and safety at 24 weeks of the change of coformulated (abacavir + lamivudine + dolutegravir) to (abacavir + lamivudine) coformulated as a generic pharmaceutical specialty + dolutegravir. Methods: Between February and June 2017, switch from Triumeq® to a generic pharmaceutical specialty co-formulated tablet (abacavir + lamivudine) plus Tivicay® was made. Demographic, viroimmunological characteristics and the Charlson index were collected. Six months after switching, efficacy and safety were evaluated. Results: Switch was made in 93 patients, with a mean age of 47 years, after six months there were five patients (5.4%) with viral loads between 50 and 400 copies, no patient had viral loads of greater amount. There were 2 interruptions due to toxicity (2.15%), in relation to symptoms of the central nervous system. There were no differences in the amount of years with HAART, nor in the previous months with the STR regimen based on abacavir + lamivudine + dolutegravir, nor in the Charlson index. The effective saving in 2017 derived from the change in these 93 patients was € 125.512. Conclusions: The change from a regimen of abacavir + lamivudine + dolutegravir seems to be safe and effective at 24 weeks.

Varón de 52 años que refiere desde hace meses un síndrome constitucional y debilidad en miembros. En sus antecedentes destacaba una ingesta excesiva de alcohol. El electroneuromiograma inicial mostró datos sugerentes de polineuropatía de predominio axonal. El estudio con analítica, TC tórax, ecografía abdominal, endoscopia digestiva alta no detectó datos de neoplasia. Durante el seguimiento, a pesar de abandonar el consumo de alcohol, persistió con debilidad generalizada, amiotrofias progresivas, voz nasal y disfagia, destacando en la exploración una fuerza disminuida de forma generalizada 4/5 y fasciculaciones linguales, con lo que se estableció la sospecha clínica de enfermedad de la motoneurona anterior, que fue confirmada mediante un nuevo estudio electrofisiológico.  Con este caso se demuestra que el diagnóstico de esclerosis lateral amiotrófica requiere una exhaustiva exploración física y una alta sospecha clínica. La presencia de determinados signos exploratorios, casi patognomónicos, facilita el diagnóstico.