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Case of the Month - July 2014

Dr John Black

A 39-year old lady presented to the Emergency department at the end of November 2013. She had a 3 week history of progressive dyspnea, non-productive cough and fever. In the 3 weeks prior to admission, she had been reviewed by her primary care facility and was found to be HIV-infected with a CD4 count of 143 cells/mm3. She was screened for TB with a Gene Xpert (GXP), which was negative, and treated with Amoxicillin. Her illness had progressed despite this, which prompted her presentation to hospital. Her past medical history was unremarkable, being employed as a domestic worker. She had never smoked, was not on any medication and had no significant exposure history.

She was acutely ill, temperature 39°C, BP 135/85, Pulse 157 and oxygen saturation of 82% on room air. She had no palpable lymphadenopathy, oral or cutaneous lesions, but bilateral crepitations were noted on chest auscultation. Her WCC was 8.82 x 109/L, HB 12.6 g/dL and Plt 501 x 109/L. The CRP was 57 and the CEU was normal. A repeat GXP was negative.

Question 1: What is the differential diagnosis?

Continue to Answer 1