a full workup was done to look for infectious source.
sputums: AFB negative x 3, fungal negative. PCP negative (no PCR, no bacteria
CSF - negative for infection.
What kinds of things could be causing these findings and what would you do?
Wednesday, December 19, 2007
41 year old with HIV and fever
This is a 41 year old man with AIDS, CD4 below 10, who presented with shortness of breath and fever. He was admitted to a general ward but trasnferred to the unit a few days later for tachypnea. On the general floor, his vitals were normal except for some tachycardia. He was 97% on 2 l NC. CXR:
a full workup was done to look for infectious source.
sputums: AFB negative x 3, fungal negative. PCP negative (no PCR, no bacteria
CSF - negative for infection.
What kinds of things could be causing these findings and what would you do?
a full workup was done to look for infectious source.
sputums: AFB negative x 3, fungal negative. PCP negative (no PCR, no bacteria
CSF - negative for infection.
What kinds of things could be causing these findings and what would you do?
Subscribe to:
Post Comments (Atom)
8 comments - CLICK HERE to read & add your own!:
Could this be pulmonary hemorrhage, disseminated Herpes Zoster, or pulmonary alveolar microlithiasis? The density of the alveolar infiltrate is impressive for someone only on two liters.
3 negative AFB smears in an HIV positive patient is only 60% sensitive. Milliary TB needs to be ruled out by nuclic acid method in this case. Did patient recive any blood transfusion recently/ TRALI?
Any leucocytosis or LFT abnormalities? Did patien get a ct?
Milliary TB is a good thought, and we also considered this diagnosis, but the nodules are too big to be consistent with this. In fact, radiology felt that the size essentially rules it out.
i would wonder about disseminated histoplasmosis as well. How about a urine histo antigen? Any skin lesions?
Sub got it right. Histo was in the blood and grew out of the BAL and out of a colon biopsy. I do not think there were any skin lesions.
tttttttttt
Still theres some hope if you use some Medicine no Prescription right now.
CD 4 < 10 need to r/o CMV as a cause of pneumonitis in addition to MAC . He needs to have FOB with BAL and send for CMV-PCR + get CMV serology . If + start with gancicloviur or foscarnet. On admission need to cover for PCP till r/o but seems O2 is ok no need for steroids.
Post a Commenttest post a comment