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Difficult Case 2

Difficult Case 2. Sanjay Bhagani RFH/UCL London. 43 year old Ugandan lady UK for 10yrs, one stable partner 4 months of fever, weight loss, night sweats, intermittent diarrhoea and abdominal pain and more recently (4 weeks) cough and shortness of breath

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Difficult Case 2

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  1. Difficult Case 2 Sanjay Bhagani RFH/UCL London

  2. 43 year old Ugandan lady • UK for 10yrs, one stable partner • 4 months of fever, weight loss, night sweats, intermittent diarrhoea and abdominal pain and more recently (4 weeks) cough and shortness of breath • New diagnosis of HIV, CD4 122 viral load 28000 c/ml • HBV/HCV/Syphilis negative • Serum CrAg negative

  3. Fig 1 CXR

  4. Broncho-alveolar lavage performed • PJP confirmed • ZN stain and TB-PCR negative • Multiple stool specimens – negative microscopy • Started on high-dose co-trimoxazole and steroids • Transferred to our unit

  5. Summary on transfer… • Advanced HIV disease – CD4 ~120 • Non-specific - but weight loss, abdominal and respiratory symptoms • Diagnosis of PCP confirmed • Do we want to do anything else?

  6. What else is now in the differential diagnosis and what other tests?

  7. So do we have two diagnoses? • PCP • Histoplasmosis

  8. Histoplasma vs. Pneumocysitis

  9. Occam’s Razor • one should not increase, beyond what is necessary, the number of entities required to explain anything

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