Case Challenge #18

History of Present Illness

A 68 year old Asian female with HIV who presents with fever and SOB. Patient was in her usual state of health until approximately one month ago when she came to the ER with a three day history of cough and fever. She described a persistent dry cough associated with a burning sensation in her chest and occasional wheezing. In addition, she had SOB with even minimal exertion and felt very lethargic. She felt that her cough and SOB progressively worsened over the past week. Three days prior to admission, she developed watery diarrhea, approximately 5-6 BM a day. She denies N/V, melena, hematochezia.

Physical Exam

  • T 38.8, P 84, BP 108/62, R16, 99% RA
  • Lungs: diffuse expiratory wheezes bilaterally
  • Abd: soft, NT, slightly distended, NABS, no HSM

Labs/Imaging

  • CD4 316 and VL <48
  • CMP normal
  • wbc 21, hgb 8, plt 220
  • 35% Polys, 17% Lymphs, 8%, Monos, 40% Eos
  • CXR: heart size normal, patchy infiltrates in bilateral bases
  • Blood and urine cultures negative
  • Stool O&P shows larval forms

 Question