NE
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5mo after exposure to a household case of active pulmonary TB,a 27yo HIV+ man presents with fever,chills,rash,weight loss,and nonproductive cough for 2weeks.A CD4 count 3mo ago was 380cells/mm3.A chest xray reveals basilar interestitial infiltrates without cavities,adenopathy or pleural effusion,A PPD test with controls reveals cutaneous anergy.What's the most likely diagnosis?
a:TB
b:toxo
c:CMV
d:P.Carinii
e:strep.pneumoniae
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| Pulvinar
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ans=P carini
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| doyoudig
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DDDD
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| sprint123
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I was confused initially about PCP since the CD4 count was 380---Then realised that it was 3 months ago
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| Justice
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d:P.Carinii
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| doyoudig
Forum Guru
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are we all sure about this answer b/c
1. Immunocompromised Pt esp HIV commonly have no rxn to PPd b/c of reduced Immuned defenses
2. TB is very common w/ a CD count < 380
3. CD count nornally decr by 30-7- per year
4. He had a close contact
5. CXR findings & Signs - Can be TB as well
what do you all think???
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| NE
Forum Guru
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It is TB - he is immunocompromised and he had close contact ; even if PPD is anergic we should suspect Tb. PCP is very rare if CD4>200.
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| sprint123
Forum Guru
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That was a good question!Can we suspect TB with only B/L interstitial infiltrates without cavity/effusion???
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| nadiabarati
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but how about "interstitial" pattern on xray???
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