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patients present with several months of mild cough and dyspnea; chest radiographs show interstitial infiltrates Many patients with this entity undergo transbronchial biopsies in an attempt to diagnose Pneumocystis pneumonia Instead, the tissue shows interstitial inflammation ranging from an intense lymphocytic infiltration (consistent with lymphoid interstitial pneumonitis) to a mild mononuclear inflammation Corticosteroids may be helpful in some cases refractory to antiretroviral therapy d Sinusitis Chronic sinusitis can be a frustrating problem for HIV-infected patients even in those on adequate antiretroviral therapy Symptoms include sinus congestion and discharge, headache, and fever Some patients may have radiographic evidence of sinus disease on sinus CT scan or sinus x-ray in the absence of significant symptoms Nonsmoking patients with purulent drainage should be treated with amoxicillin (500 mg orally three times a day) Patients who smoke should be treated with amoxicillin-potassium clavulanate (500 mg orally three times a day) to cover H influenzae Prolonged treatment (3 6 weeks) with an antibiotic and guaifenesin (600 mg orally twice daily) to decrease sinus congestion may be required For patients not responding to amoxicillin-potassium clavulanate, levofloxacin should be tried (400 mg orally daily) Some patients may require referral to an otolaryngologist for sinus drainage 3 Central nervous system disease Central nervous system disease in HIV-infected patients can be divided into intracerebral space-occupying lesions, encephalopathy, meningitis, and spinal cord processes Many of these complications have declined markedly in prevalence in the era of HAART a Toxoplasmosis Toxoplasmosis is the most common space-occupying lesion in HIV-infected patients Headache, focal neurologic deficits, seizures, or altered mental status may be presenting symptoms The diagnosis is usually made presumptively based on the characteristic appearance of cerebral imaging studies in an individual known to be seropositive for Toxoplasma Typically, toxoplasmosis appears as multiple contrast-enhancing lesions on CT scan Lesions tend to be peripheral, with a predilection for the basal ganglia Single lesions are atypical of toxoplasmosis When a single lesion has been detected by CT scanning, MRI scanning may reveal multiple lesions because of its greater sensitivity If a patient has a single lesion on MRI and is neurologically stable, clinicians may pursue a 2-week empiric trial of toxoplasmosis therapy A repeat scan should be performed at 2 weeks If the lesion has not diminished in size, biopsy of the lesion should be performed Since many HIV-infected patients will have detectable titers, a positive Toxoplasma serologic test does not confirm the diagnosis Conversely, less than 3% of patients with toxoplasmosis have negative titers Therefore, negative Toxoplasma titers in an HIV-infected patient with a spaceoccupying lesion should be a cause for aggressively pursuing an alternative diagnosis b Central nervous system lymphoma Primary nonHodgkin s lymphoma is the second most common spaceoccupying lesion in HIV-infected patients Symptoms are similar to those with toxoplasmosis While imaging tech-.

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We used the goto statement earlier in this chapter as an unconditional branch in a switch statement. The more common use of goto, however, is to create a loop. In fact, the goto statement is the seed from which all other looping statements have been germinated. Unfortunately, it is a semolina seed, producer of spaghetti code (see the Spaghetti Code sidebar) and endless confusion.

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