TB & HIV: An Online Course for Clinicians

Case Study

This exercise walks you through an entire case, based on a real-life patient. At four stages in the case, you will be asked to make diagnostic and treatment decisions.

History
The patient is a 27 year old HIV-1 seropositive man with a CD-4 lymphocyte count of 80 cells/µL who presented with fever to 102°F, night sweats for 2 weeks, and cough. He had lost 10 lbs. over the past month. He denied headaches, rash, back pain, or diarrhea.

Past Medical History

• HIV-1 infection for 5 years
• Pneumocystis carinii pneumonia - 1997
• Tuberculin skin test negative - 1998

Medications

• Septra DS 1 tab qd

Social History

• Born in the U.S.
• Has sex with men
• History of cigarette use, 1 pack per day for 11 years
• History of injection drug use with speed, last 2 months ago
• Lives with partner, no recent travel

Physical Exam

• General Temp 101.5°F, pulse 110/min, BP 115/70 mm Hg, cachectic
• Chest: crackles at bases, left greater than right
• Cardiac: regular rate and rhythm, no murmurs
• Abd: soft, liver edge palpable 3 cm below the right costal margin, spleen mildly enlarged
• Ext: no rashes, 1 cm firm left anterior cervical lymph node

X-ray: Enlarged right paratracheal lymph nodes

Next: Question 1