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CASE 3

CASE 3 . 52 yo man HIV positive 1999 CD4 nadir 50 Smoker 35 pack yrs …quit 2005 COPD…chronic bronchitis Diabetic, Hypertensive, Hyperlipidemic. CASE 3 . 2006 Abacavir /3TC/RTV/ Atazanavir Trial of steroid inhaler for COPD

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CASE 3

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  1. CASE 3 • 52 yo man • HIV positive 1999 • CD4 nadir 50 • Smoker 35 pack yrs…quit 2005 • COPD…chronic bronchitis • Diabetic, Hypertensive, Hyperlipidemic

  2. CASE 3 2006 Abacavir/3TC/RTV/Atazanavir • Trial of steroid inhaler for COPD • Worsening of hypertension, diabetes and lipids along with a change in body habitus with increased centripetal obesity and a dorsocervical fat pad

  3. CASE 3 2010 • Development of rapidly growing right sided inguinal mass • No constitutional symptoms • On examination…rock hard, immobile, 6 cm right inguinal mass

  4. CASE 3 2010 • In retrospect has ignored very minor painless intermittent painless rectal bleeding over past 4 months • CD4 890 HIV viral load<50

  5. CASE 3 2010 • On further examination….rectal ulceration approx. 3 cm with heaped up edges DIAGNOSIS?

  6. CASE 3 2010 • CT Scans of chest/abdo/pelvis/revealed inguinal mass and nothing more HOW WOULD YOU FURTHER INVESTIGATE?

  7. CASE 3 2010 • Ultrasound guided core biopsy revealed…squamous cell ca • Biopsy of rectal ulceration…anal squamous cell ca!

  8. CASE 3 2010/2011 • Chemotherapy, radiation and surgery to remove residual groin mass • Thus far free of disease…will need very close f/u over time both clinically and radiographically

  9. HIV CASE PRESENTATIONS Mike Silverman MD FRCPC David Fletcher MD FRCPC

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