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?

8 comments - CLICK HERE to read & add your own!:

Doug said...

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.

Anonymous said...

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?

Jennings said...

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.

sub said...

i would wonder about disseminated histoplasmosis as well. How about a urine histo antigen? Any skin lesions?

Jennings said...

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.

Anonymous said...

tttttttttt

Leviana said...

Still theres some hope if you use some Medicine no Prescription right now.

Anonymous said...

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.