1 / 16

CASE 1

CASE 1. 55 yo man…Baker HIV+ since 1996 Refused bloodwork over the years as was ‘Feeling fine’ Oral hairy leukoplakia noted on oral biopsy in 2001. CASE 1. Fall 2013 Dry cough/ soboe …no fevers Seen by respirology …bronchoscopy negative for pathogens. CASE 1. Fall 2013

gur
Télécharger la présentation

CASE 1

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CASE 1 • 55 yo man…Baker • HIV+ since 1996 • Refused bloodwork over the years as was ‘Feeling fine’ • Oral hairy leukoplakia noted on oral biopsy in 2001

  2. CASE 1 Fall 2013 • Dry cough/soboe…no fevers • Seen by respirology…bronchoscopy negative for pathogens

  3. CASE 1 Fall 2013 Was felt to have extrinsic allergic alveolitis….type of ”Bakers lung” Treated with a few months of prednisone with effect

  4. CASE 1 Winter 2014…still on Prednisone • Intractable nausea and vomitting • Admitted and diagnosed with Cryptococcal meningitis • Multiple cutaneous KS lesions

  5. CASE 1 Winter 2014 • Steroids stopped and IV amphotericin instituted with effect…eventually switched to oral Fluconazole

  6. CASE 1 Winter 2014 • At time of Cryptococcal diagnosis…lungs had significant disseminated nodular infiltrates that were felt to represent Cryptococcal disease as part of a disseminated Cryptococcal syndrome • No bronchoscpy done

  7. CASE 1 FEB-MAR 2014 • Discharged from hospital and ready to consider HIV meds but wants to see bloods first • CD4 110/6% HIV viral load 98,422 • Genotype clear

  8. CASE 1 FEB-MAR 2014 • Clinically still coughing without fever or SOBOE • No headache or fever • Multiple cutaneous KS lesions

  9. CASE 1 MAR 2014 • Still refused to start ARVS but clearly more receptive • Wanted to see CD4 off steroids • CD4 90/5% HIV Viral load 389,878

  10. CASE 1 APR 2014 • Initiated TDF/FTC/Raltegravirnow 4 months from initiation of Cryptococcal therapy…refused PCP prophylaxis but continued on Cryptococcal maintenance therapy with Fluconazole

  11. CASE 1 APR 2014 • Cough worsened a few weeks post initiation of ARVS but no fever or flu like symptoms…otherwise improving clinically

  12. CASE 1 MAY 2014 • CT chest reveals worsening coarse nodular infiltrates in chest • New KS lesions now slowing and older lesions beginning to darken

  13. CASE 1 MAY 2014…1 month post initiaton of ARVS • CD4 110/7% HIV viral load 184 • Worsening respiratory symptoms with increasing soboe…unresponsive to antibacterials • Bronchosocpy/BAL/Transbronchial biopsy performed

  14. CASE 1 MAY 2014 • No KS seen in bronchi…BAL negative for pathogens/biopsy revealed chronic inflammation • Admitted to hospital and high dose steroids initiated

  15. CASE 1 MAY 2014 • Worsening symptoms c/w ARDS/IRIS • Transferred to ICU and treated for bacteria/PCP/fungi • Succumbed to respiratory illness

  16. CASE 1 JUNE 2014 TAKE HOME MESSAGE THIS COULD HAVE ALL BEEN AVERTED WITH EARLY INITIATION OF ARVS TRY NOT TO USE STEROIDS IN HIV

More Related