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CASE 4. 67 yo man HIV+ 1991 Hypertensive CD4 on diagnosis 110/7% AZT initiated soon after diagnosis. CASE 4. Antiviral History. CASE 4. 2011 Referred for 2 distinct episodes (2008, 2011) of 5kg weight loss/profound fatigue and pancytopenia lasting 4-8 weeks each time. CASE 4. CASE 4.

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Case 4
CASE 4

  • 67 yo man

  • HIV+ 1991

  • Hypertensive

  • CD4 on diagnosis 110/7%

  • AZT initiated soon after diagnosis


Case 41
CASE 4

Antiviral History


Case 42
CASE 4

2011

  • Referred for 2 distinct episodes (2008, 2011) of 5kg weight loss/profound fatigue and pancytopenia lasting 4-8 weeks each time



Case 44
CASE 4

2011

CT abdomen

  • normal liver

  • Spleen 16 cm

  • No nodes

  • Spleen size unchanged from 2004 U/S

    CT chest

  • normal


Case 45
CASE 4

2011

Bone MarrowAspirate/Biopsy

  • Normal progenitors for all cell lines with no evidence of malignancy

  • Compatible with peripheral destruction/sequestration


Case 46
CASE 4

2011

  • Noted that both episodes of constitutional symptoms occurred in temporal relationship to the initiation/reinitiation of Eprosarten therapy for hypertension

    • This medication was discontinued without further recurrence of symptoms over the next 2 years


Case 47
CASE 4

2011-13

  • Blood counts recovered though platelets remained lower than previous



Case 49
CASE 4

2012

  • Required a laparoscopic cholecystectomy and intra-operatively liver noted to be “coarse/nodular”


Case 410
CASE 4

No ETOH – significant previous history x 20 yrs HCV RNA/HBV DNA (-)

secondary liver disease workup (-)


Case 411
CASE 4

  • Fibroscan done…. 32.8 kpa!

  • U/S

    • No varices

    • +Ascites

    • Liver 18.7 c.m/nodular contour

    • Spleen 18.9 cm

    • Normal portal/hepatic veins


Case 412
CASE 4

Transjugular liver biopsy performed

  • F2-3 scarring from steatohepatitis

  • Venous/sinusoidal pressures compatible with nodular regenerative hyperplasia or non cirrhotic portal hypertension

  • OGD…no varices

  • Ascites managed with diuretics


Case 413
CASE 4

Take home message…

  • Low platelets, which have a very long differential diagnosis in the context of HIV, can be a clue to occult severe liver disease…ie. cirrhosis with portal hypertension, or far more rarely, non cirrhotic portal hypertension


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