Newly diagnosed human immunodeficiency virus infection in an octogenarian with acute respiratory failure

Abstract

A previously healthy 83-year-old man presented to our emergency department with 3-day history of fever and dyspnea. Physical examination findings were as follows: oral temperature of 38.2°C, pulse rate of 119 beats/min, respiratory rate of 32 breaths/min, blood pressure of 108/67 mmHg and diffuse crackles over bilateral lungs. Clinical laboratory findings were as follows: white blood cell count of 10.8 × 103/μl with 95% neutrophils, 3.2% lymphocytes, 1.7% monocytes, hemoglobin of 9.0 g/dl and platelets of 216 × 103/μl. Chest radiography revealed increased interstitial marking and ground-glass opacities of both lungs (Figure 1A). The patient received oral endotracheal intubation on account of persistent dyspnea and hypoxiemia. Figure 1 ( A ) Chest radiograph revealed increased interstitial marking, ground-glass opacities and patchy infiltration of the both lungs (obtained at our emergency department). ( B ) Chest radiograph revealed resolutions of these increased interstitial marking and ground-glass opacities of the both lungs (obtained 3 months after admission). On admission, a high-resolution computed tomography scan of the chest revealed diffuse ground-glass opacities with thickening of interlobular septa of both lungs (Figure 2). Sputum bacterial cultures were negative. Other tests for pulmonary pathogens were performed, including a tuberculosis culture, acid-fast stain, polymerase chain reaction (PCR) for Pneumocystis jiroveci , cytomegalovirus (CMV) and HERPES simplex virus, and blood tests for CMV and Cryptococcus antigens. Figure 2 Computed tomography of the chest revealed diffuse ground-glass-opacities with thickening of interlobular septa of both lungs …