Case 28--Recurrent Pneumonia in a Stable AIDS Patient

Dr. Charles Gherman collaborated on this case.

Clinical summary: A 45-year-old retired man with AIDS was admitted in 1/98 for 2-3 weeks of myalgia, arthralgia, night sweats, cough, purulent sputum, and slight hemoptysis, but no fever. The diagnosis of AIDS was based on a positive HIV test and Kaposi's sarcoma. He was compliant with his anti-retroviral medications. He has a history of asthma and allergic rhinitis. There was a past history of acute sinusitis 15 y ago. In 5/95 he had an episode of pneumonia in the right middle and upper lobes, but no pathogens were isolated. He improved with antibiotic therapy. In 11/97 he had cough and sinusitis. He is a non-smoker and does not drink alcohol. 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. He had no reaction to PPD. A CD4 level 4 mo earlier was 482/µl. He was treated with antibiotics and underwent diagnostic bronchoscopy. No pathogens were found, and no tracheobronchial Kaposi's sarcoma was seen. Because he continued to deteriorate, an open lung biopsy was performed. It was interpreted as granulomatous inflammation with a probable infectious etiology. Because of the biopsy findings, he was treated with anti-tuberculous agents until the culture for mycobacteria proved to be negative. One month later, he felt well, and his infiltrates had cleared. In 2/99, because of recurrent pneumonia with cough-induced rib fracture and hemothorax, the biopsy was reviewed. The CD4 level was 308/µl.

What is the differential diagnosis of this man's recurrent pneumonias? Answer

Radiology | Image 1 | Image 2 | Image 3 | Image 4 | Discussion

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Answer: Infection, including opportunistic ones, hypersensitivity pneumonia, aspiration, and obstructing neoplasm can give recurrent pneumonias. In an asthmatic, allergic bronchopulmonary aspergillosis should be considered.

Radiology | Image 1 | Image 2 | Image 3 | Image 4 | Discussion

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