Four cases of disseminated Mycobacterium bovis infection following intravesical BCG instillation for treatment of bladder carcinoma.

Intravesical BCG (bacillus Calmette-Guérin) instillation is a first-line treatment for superficial transitional cell carcinoma of the bladder. A rare but severe complication of BCG immunotherapy is the development of disseminated BCG disease, which can result in miliary pneumonitis, granulomatous hepatitis, soft tissue infections, bone marrow involvement, and sepsis. Symptoms can present as early as a few hours or as late as several months following the BCG therapy.

Hantavirus pulmonary syndrome.

We present the first case of Hantavirus pulmonary syndrome in the Dallas/Fort Worth area. The patient was a 50-year-old previously healthy white man, who had adult respiratory distress syndrome (ARDS) and hypotensive shock after 1 week of nonspecific "viral" symptoms. Despite supportive care, the patient died within several hours of presentation.

Intermittent fever and pancytopenia in a young Mexican man.

We report a case of brucellosis in a young Mexican man who had weight loss, fever, and nausea. Physical examination revealed hepatosplenomegaly, and examination of the blood showed pancytopenia. This case illustrates the need for a high index of suspicion when patients living in the southern United States have these symptoms.

Persistent infection with Ehrlichia chaffeensis.

Although persistent infection of animals by members of the genus Ehrlichia is well known and may be associated with subsequent severe or fatal illness, persistent infection of humans with Ehrlichia chaffeensis has not been reported. Herein we report a typical case of serologically documented acute ehrlichiosis; despite therapy with tetracycline and chloramphenicol, the patient's condition progressively worsened and he suffered multiple secondary infections and gastrointestinal hemorrhage. He died 68 days after his initial hospitalization.

Pneumocystis pneumonia in a patient with normal chest roentgenograms and normal arterial blood gas values.

For unknown reasons, manifestations of even heavy opportunistic infection in AIDS patients may be chronic and subtle. We have presented the second fully reported case of an AIDS patient with symptomatic Pneumocystis carinii pneumonia in whom the usual screening tests of blood gases and chest roentgenography were normal to all observers. Diffusing capacity for carbon monoxide can be an early and sensitive indication of PCP.

Fusobacterium necrophorum septicemia following oropharyngeal infection.

Fusobacterium necrophorum septicemia developed in five patients after an oropharyngeal infection. Four patients had sore throat or neck pain, and two had findings of jugular vein septic thrombophlebitis. Metastatic abscesses, including embolic pneumonia, empyema, septic arthritis, and osteomyelitis, also occurred.

Infections of hairy cell leukemia. Clinical evidence of a pronounced defect in cell-mediated immunity.

We compared infection rates in 12 patients with hairy cell leukemia (a malignant neoplasm for which the cell of origin remains controversial) with rates in 15 patients with chronic lymphocytic leukemia (a known B-lymphocyte neoplasm) recently treated at four Dallas hospitals. We found a significantly higher over-all rate of infections in the patients with hairy cell leukemia (P = 0.004 BY Gehan's variation on the generalized Wilcoxon test).

Granulomatous synovitis: the role of atypical mycobacteria.

Clinical data on 25 patients with granulomatous synovitis and bursitis observed from 1970 through 1977 are reviewed. The lesions occurred about the extremities, the wrists and hands being involved most often. With three exceptions, the patients had no significant underlying disease.