Case 5--Acute Lung Injury and Pneumothorax in an AIDS Patient Being Treated for Tuberculosis

Clinical summary provided by Dr. David Morris, Pulmonary Fellow, UCSF

Clinical summary: This 41-year-old, homeless, PPD-positive, African-American man was admitted to the hospital in 8/96 with a 2-month history of progressive dyspnea, culminating in shortness of breath at rest for 2 weeks before admission. He also noted a non-productive cough and sharp, bilateral, upper quadrant, abdominal pain, which was worse with coughing or deep breathing. He denied constitutional symptoms. On initial evaluation, he was noted to have tender cervical and supraclavicular adenopathy on the left. Examination was also significant for a fever (101.7 degrees), moderate cachexia, tachycardia, tachypnea, and mild to moderate hypoxemia (oxygen saturation 90%). Examination of the chest revealed decreased breath sounds and decreased fremitus 1/3 up on the left side. He had moderate hepatosplenomegaly.

His past history was significant for 10-20 pack-years of smoking, occasional alcohol, and occasional marijuana. He denied use of intravenous drugs. He was HIV negative 3 years ago. He was a frequent occupant of homeless shelters.

A chest film was obtained. His WBC was 4.59 k/µl, and he had a moderately severe, normocytic anemia (hgb, 7.6 g/dl; hct, 23.8%). Serum chemistries were remarkable for a protein of 8 g/dl, with normal electrolytes, and normal hepatic and renal parameters. An arterial blood gas determination showed pH 7.42, PCO2 33 mm Hg, and PO2 59 mm Hg. Gram stain and AFB smear of the sputum were negative.

Radiology | Image I | Diagnosis #1 | Radiology 1 | Radiology 2 | Image 2 | Image 3 | Diagnoses #2 & #3 | Radiology 3 | Image 4 | Image 5 | Image 6 | Discussion

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