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VIRTUAL MEDZONE. Your Resource for HIV Related Innovative Medical Communication. HIV CASE PRESENTATIONS. Stephen Shafran MD FRCPC Anne Marie Zajdlik MD CCFP David Fletcher MD FRCPC. CASE 1 . 45 yo man HIV+ 1998 CD4 nadir <10 Multiple antiretroviral regimens over 15 yrs. CASE 1 .

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VIRTUAL MEDZONE


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virtual medzone

VIRTUAL MEDZONE

Your Resource for HIV Related Innovative Medical Communication

hiv case presentations

HIV CASE PRESENTATIONS

Stephen Shafran MD FRCPC

Anne Marie Zajdlik MD CCFP

David Fletcher MD FRCPC

case 1
CASE 1
  • 45 yo man
  • HIV+ 1998
  • CD4 nadir <10
  • Multiple antiretroviral regimens over 15 yrs
case 11
CASE 1

Current regimen:

  • ABC/3TC/RTV/DRV/ETV/RGV/ Rosuvastatin/Nadolol
  • CD4 220
  • VL<50 x 8 months
case 12
CASE 1

March 2011

  • Awakens one morning with significant bilateral leg pain/erythema lasting 3 days
  • No fevers/blistering or migration of erythema
case 13
CASE 1

March 2011

  • Described as burning/cramping muscle pain +/- bone pain…not skin/joint pain
  • No joint/leg swelling
case 14
CASE 1

March 2011

  • Pain completely gone at clinic visit
  • Noted during pain that feet were cold and pulses were barely palpable
  • ASA 325 mg prn relieved pain within minutes throughout the day
case 15
CASE 1

March 2011…In the office

  • Examination unremarkable from a neurological, vascular, MSK, and dermatological standpoint

Cause???

case 16
CASE 1

On further detailed history:

  • He had a migraine H/A the evening before and took an OTC migraine pill (in Costa Rica)
    • Ergotamine/caffeine/Dipirone
case 17
CASE 1

ERGOTISM!!!

  • Vascular insufficiency due to spasm
  • Role of RTV/DRV and Nadolol
  • Role of ETV