Photo Quiz: HIV-Infected Female with Thigh Pain.

Abstract

A 50-year-old female who was recently diagnosed with HIV was admitted to the emergency department with a 4-week history of cough, weight loss, anorexia, pain, erythema, and an edema on the right lateral thigh. The patient reported an increase in pain and the size of this swelling as well as restrictions to normal movement of the right leg within 1 week of being admitted to our hospital. There was no preceding history of trauma. Six months before admission to the hospital, her CD4+ cell count was 22 cells/mm3, and her HIV RNA level was 104,222 copies/ml. On physical examination, the patient was malnourished, afebrile, had a blood pressure of 110/80 mm Hg, pulse of 93 beats per minute (bpm), respiratory rate of 24 breaths/min, an oxygen saturation of 95% on room air, and her HIV was controlled. Laboratory studies showed the following: nonreactive Mantoux test; hemoglobin, 8.7 g/dl (reference value, 13.0 to 18.0 g/dl); platelet count, 343 × 109/liter (reference value, 140 to 450 × 109/liter); leukocyte count, 9.9 × 109/liter (reference value, 4 to 11 × 109/liter); and normal liver and renal functions. A chest X-ray revealed bilateral micronodular infiltrate (Fig. 1A), and the ultrasound scan revealed an intramuscular abscess in the lateral part of her right thigh. An X-ray did not reveal osteomyelitis. The patient was treated with cephalexin at 500 mg every 6 h (q6h) for 7 days; however, pus was accumulated, and the abscess was drained (Fig. 1B). Microbes were detected by acid-fast staining of primary clinical material (Fig. 1C) and culture growth (Fig. 1D).