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Case of the Month - February 2014

Frans Radebe, NICD/NHLS

Krishnee Moodley, Chetna Govind and Nelesh P. Govender Adapted from a published case report (open-access publication under a creative commons license): Moodley K, et al. S Afr J HIV Med 2013;14:138-140.

Case History

A 46-year-old HIV-infected man on antiretroviral treatment was admitted to hospital with a history of fever and malaise. The patient had an undetectable HIV-1 viral load on admission with a CD4+ T-lymphocyte count of 435 cells/µl. He was also on haemodialysis for chronic renal disease (secondary to hypertension and diabetes mellitus), and had a central venous catheter (CVC) in situ. On examination, he was febrile and had evidence of severe mitral valve regurgitation with bilateral basal crackles. His admission total leucocyte count was elevated, i.e. 11.4 x 109 cells/l (reference range: 4.0 – 10.0 x 109 cells/l).

Question 1: What is your differential diagnosis and what investigations would you perform?

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