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CASE 5

CASE 5. 54 yo man HIV positive in 2001 Immune Thrombocytopenia Chronic G1a Hepatitis C Crack use daily Normotensive. CASE 5. April 2013 TDF/FTC/EFAVIRENZ CD4 520 HIV Viral load<50 Platelets 222 Creatinine 81 K 4.2 a/c ratio<2…u/a negative for all. CASE 5. September 2014

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CASE 5

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  1. CASE 5 • 54 yo man • HIV positive in 2001 • Immune Thrombocytopenia • Chronic G1a Hepatitis C • Crack use daily • Normotensive

  2. CASE 5 April 2013 TDF/FTC/EFAVIRENZ CD4 520 HIV Viral load<50 Platelets 222 Creatinine 81 K 4.2 a/c ratio<2…u/a negative for all

  3. CASE 5 September 2014 • Off meds x 1 year • Severe Headaches over the last few months in the absence of fevers/constitutional signs/symptoms • Crack use daily

  4. CASE 5 September 2014 O/E : BP 250/130 x 2 Fundi…blurring of disc margins SOAs to mid calves..no bruits Chest clear Jvp 2 cm

  5. CASE 5 September 2014 • Sent to ER as a hypertensive emergency • Sent back out same day on Hydralazine 25mg qid • BP in my office the next day was still 215/120…No overt CHF

  6. CASE 5 September 2014 • Refused to go back to ER • Stopped crack

  7. CASE 5 September 2014 • Trandolapril 2mg/day added to hydralazine 25mg tid • Bloods done • Agreed to be seen 3x weekly

  8. CASE 5 September 2014 • Bp down to 200/110 Labs • Creatinine197 random urine protein 11.586g/l .. Urine albumin 6.656 g/l • U/A 2+ blood/>3g/l protein • K 4.7 • Albumin 31 • CBC …normal platelets • CD4 380

  9. CASE 5 September 2014 • Furosemide 80mg added\restarted RTV/DRV/RGV • BP 175/80 • No soas • Awaiting nephrology consult re biopsy of kidney

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