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Are pseudotumours of bone an additional risk factor for recurrent bacterial infection in HIV‐infected haemophiliacs?

Haemophilic pseudotumours of bone are defined as extraarticular osseous lesions resulting from the spontaneous necrosis of bone secondary to a haematoma under pressure [ 11. The incidence of pseudotumours in haemophiliacs has been estimated to be 2% [2]. Here, we report on an 42-year-old HIV-seropositive haemophiliac with a known pseudotumour in the left psoas, who presented with pyrexia and acute bleeding from his pseudotumour. The pseudotumour had developed after a psoas-bleeding 18 years ago. So far, no AIDSdefining illnesses had occurred. His CD4-count was 18 pL-'. Radiological examination revealed a large pseudotumour in the left pelvis with destruction of the 0 s ilium (Fig. 1). Blood cultures and biopsy of the pseudotumour established the diagnosis of Salmonella typhi infection but faecal cultures were repeatedly negative for Salmonella typhi. Despite prolonged antibiotic treatment with ciprofloxacin and amikacin over 3 weeks fever persisted so that the pseudotumour had to be removed surgically. Following operation body temperature normalized and a life-long secondary prophylaxis with ciprofloxacin (2x750 mg per day) was advised. Under antibiotic prophylaxis the patient was negative for salmonella in repeated blood cultures, while smears from the operation wound demonstrated persisting salmonella HIV-infected haemophiliacs?