A 45-year-old man was admitted in for 2-3 weeks of myalgia, night sweats, cough,

Question

A 45-year-old man was admitted in for 2-3 weeks of myalgia, night sweats, cough, purulent sputum, and slight hemoptysis, but no fever. On admission in 1/98 heart rate was 88/min, respiratory rate 12/min, peak flow 490 L/min, and oxygen saturation 95% on air. Rhonchi were heard, and he had cough on forced expiration. New bilateral opacities were seen on a radiograph A CD4 level was 342/µl. An open lung biopsy was performed and interpreted as granulomatus inflammation with central zones of caseous necrosis. One year earlier, he had been admitted for an episode of pneumonia in the right middle and upper lobes, but no pathogens were isolated. He improved with antifungal therapy. Two years previous he had a recurrent cough and chronic sinusitis. He is a non-smoker and does not drink alcohol.

Based on the above, you: (Select all that apply)

A. suspect autoimmune disease-prescribe immunosuppressant

B. suspect HIV infection; order HIV antibody test and if positive begin ART

C. suspect TB-confirm and then prescribe appropriate antibiotics

D. suspect candidiasis superinfection-prescribe antibiotics

E. suspect cancer- order CT scan to check for metastasis

F. suspect demyelination-order MRI

G. suspect PCP-prescribe immunosuppressants

Explanation / Answer

The above condition cannot be PCP because of CD4 cells number.

It cannnot be cancer becuase of granulomatus inflammation with central zones of caseous necrosis

It cannot be demyelination also

So the diagnosis suspected may be TB as per the above symptoms . so go for confirmation

It might also be HIV as CD 4 cells count is bit low (342)............ so go for HIV diagnosis just to rule out from TB

Candiadiasis may be present because the pateient has responded to antifungal therapy earlier and HIV is a risk factor for Candidiasis

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