Difficult case 2
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Difficult Case 2. Sanjay Bhagani RFH/UCL London. 43 year old Ugandan lady UK for 10yrs, one stable partner 4 months of fever, weight loss, night sweats, intermittent diarrhoea and abdominal pain and more recently (4 weeks) cough and shortness of breath

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Difficult Case 2

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Difficult Case 2

Sanjay Bhagani

RFH/UCL

London


  • 43 year old Ugandan lady

  • UK for 10yrs, one stable partner

  • 4 months of fever, weight loss, night sweats, intermittent diarrhoea and abdominal pain and more recently (4 weeks) cough and shortness of breath

  • New diagnosis of HIV, CD4 122 viral load 28000 c/ml

  • HBV/HCV/Syphilis negative

  • Serum CrAg negative


  • Fig 1 CXR


  • Broncho-alveolar lavage performed

  • PJP confirmed

  • ZN stain and TB-PCR negative

  • Multiple stool specimens – negative microscopy

  • Started on high-dose co-trimoxazole and steroids

  • Transferred to our unit


Summary on transfer…

  • Advanced HIV disease – CD4 ~120

  • Non-specific - but weight loss, abdominal and respiratory symptoms

  • Diagnosis of PCP confirmed

  • Do we want to do anything else?


What else is now in the differential diagnosis and what other tests?


So do we have two diagnoses?

  • PCP

  • Histoplasmosis


Histoplasma vs. Pneumocysitis


Occam’s Razor

  • one should not increase, beyond what is necessary, the number of entities required to explain anything


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