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

Difficult Case 2

Sanjay Bhagani

RFH/UCL

London


Difficult case 2

  • 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


Difficult case 2

  • Fig 1 CXR


Difficult case 2

  • 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

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

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


So do we have two diagnoses

So do we have two diagnoses?

  • PCP

  • Histoplasmosis


Histoplasma vs pneumocysitis

Histoplasma vs. Pneumocysitis


Occam s razor

Occam’s Razor

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


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