Abstract
Background: A 38-year-old man, without significant medical history, was referred to the hospital with weight loss, fatigue, night sweat, non-productive coughing and aphthae in the mouth. Physical examination displayed a cachectic man with small lymph nodes palpable in the supraclavicular region. Auscultation of heart, lungs and abdomen displayed no abnormalities. Blood examination revealed Hb of 5.4 mmol/l, erythrocyte sedimentation rate of 107 mm/h and leukocyte count of 6.0 x 109/l. Additional blood examination showed a IgA of 4.2 g/l and revealed that the patient was HIV-1 positive, but seronegative for hepatitis B, hepatitis C, lues and tuberculosis.
Highlights
A 38-year-old man, without significant medical history, was referred to the hospital with weight loss, fatigue, night sweat, non-productive coughing and aphthae in the mouth
The precise pathogenesis of the abnormalities is unknown but they may be due to tissue necrosis, check-valve obstruction, endobronchial invasion of Pneumocystis carinii pneumonia (PCP) or result from the cytotoxic effect of HIV on the lungs
One has to be aware of the fact that in patients with coughing or dyspnea, with normal lung auscultation and normal chest radiograph, it may be necessary to make a chest CT scan to visualize the presence of abnormalities that will point out a diagnosis, so that treatment can be started
Summary
A 38-year-old man, without significant medical history, was referred to the hospital with weight loss, fatigue, night sweat, non-productive coughing and aphthae in the mouth. Physical examination displayed a cachectic man with small lymph nodes palpable in the supraclavicular region. Auscultation of heart, lungs and abdomen displayed no abnormalities. Blood examination revealed Hb of 5.4 mmol/l, erythrocyte sedimentation rate of 107 mm/h and leukocyte count of 6.0 x 109/l. Additional blood examination showed a IgA of 4.2 g/l and revealed that the patient was HIV-1 positive, but seronegative for hepatitis B, hepatitis C, lues and tuberculosis. CT scan of the thorax (Fig. 2) includes a section at the level of the top of the lungs (A) on which bilaterally cavitating lesions with septation are visible. Section at hilar level (B) demonstrates little round opacities with central cavitation and areas with interstitial infiltration in both lungs
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