Imaging Findings in Musculoskeletal Complications of AIDS

Abstract

Patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are susceptible to a variety of complications that can affect the musculoskeletal system. These complications can be infectious, inflammatory, or neoplastic or can take some other form. Infection (cellulitis, necrotizing fasciitis, soft-tissue abscess, pyomyositis, osteomyelitis, septic arthritis) is the most common complication. Inflammatory processes include various arthritides as well as polymyositis. Non-Hodgkin lymphoma and Kaposi sarcoma are the two most common neoplasms in this patient population. Miscellaneous disorders include osteonecrosis, osteoporosis, rhabdomyolysis, anemia-related abnormal bone marrow, and hypertrophic osteoarthropathy. The underlying mechanisms leading to these diseases are complex and not fully understood but are thought to be multifactorial. Radiology may play an important role in early diagnosis and treatment planning in this population, in whom clinical and laboratory findings are commonly equivocal and nonspecific. Although biopsy is often necessary for the final diagnosis, it is important for the radiologist to be familiar with the different types of musculoskeletal disease in HIV-positive and AIDS patients so that an appropriate differential diagnosis can be established.

Kaposi sarcoma of the musculoskeletal system

“…49 Scintigraphy with sequential thallium and gallium scanning was helpful, because gallium uptake usually was negative in KS but positive in infections and lymphomas of the bone. 38,49 The differential diagnosis of osseous KS includes BA, mycobacterial spindle cell pseudotumor, pyogenic granuloma, arteriovenous malformation, hemangioendothelioma, and angiosarcoma. In patients who are seropositive for HIV, it is particularly important to distinguish KS from BA, and a Warthin-starry stain or tissue culture may help in this regard.…”

“…37 On occasion, radiographic evaluation of intraosseous KS lesions of the maxilla noted root resorption of involved teeth. 29 The presence of a periosteal reaction was reported infrequently, 14,38 particularly in the patients with African KS, who had large, cutaneous tumors that had eroded into underlying bone. A contiguous soft tissue mass was evident using MRI (and, in 1 patient, a CT scan) in 9 patients (4 with classic KS, 4 with AIDS, and 1 with African KS).…”

Primary pyomyositis caused by Streptococcus intermedius

“…Según Patel y col 4 la PM primaria fue descrita por primera vez en 1885 por Scriba como una enfermedad endémica en los trópicos. Sin embargo, en los últimos años y -probablemente en relación con un aumento de pacientes inmunodeprimidos 5 y con la disponibilidad de mejores pruebas diagnósticas 6 -se ha observado un aumento del número de casos en países de clima templado. En las regiones tropicales la PM es una enfermedad relativamente frecuente en varones sanos, especialmente en los grupos de edad de los 2 a los 5 años y entre los 35 y 40, mientras que en los países de clima templado la mayor parte de los casos ocurren en adultos, que en un 60% están inmunodeprimidos 7 .…”

“…La RM, además, es más sensible que la tomografía computarizada en la detección de los cambios inflamatorios intramusculares de la fase inicial. Es, por tanto, la prueba más indicada para el diagnóstico precoz de PM 6 . Por último, el tratamiento dependerá de la fase en que esté la infección en el momento del diagnóstico.…”

Post-Operative Malignant Hyperthermia Complicated by Rhabdomyolysis: Case Report

“…In the present case, a high signal intensity was present on STIR due to rhabdomyolysis caused by postoperative MH. The sensitivity of MRI of the extremities to detect abnormal muscles is higher than that of CT or ultrasound (100%, 62%, and 42%, respectively) in patients with rhabdomyolysis [11]. Furthermore, for signal abnormalities on MRI might persist for longer compared with the improvement of clinical signs of MH [11].…”