Author/Authors :
Tabarsi، Payam نويسنده , , Yousefzadeh، Amir نويسنده Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD) , , Dorudinia، Atosa نويسنده , , Marjani، Majid نويسنده , , Moniri، Afshin نويسنده Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD) , , Nadji، Seyed Alireza نويسنده Virology Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, TEHRAN-IRAN. , , Baghaei، Parvaneh نويسنده Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahi , , JABBEDARI، Sayena نويسنده Pediatric Neurology Department, Mofid Children Hospital, Faculty of Medicin, Shahid Beheshti University of Medical Sciences, Tehran, Iran , , Mansouri، Seyed-Davood نويسنده ,
Abstract :
WHAT IS YOUR DIAGNOSIS?
A 60 year-old man was admitted to our hospital with a four-week history of fever, non-productive cough and progressive dyspnea. He had been diagnosed with pneumonia in another hospital and had received broad-spectrum antibiotics including ceftriaxone, azithromycin and vancomycin with no improvement. The patient was referred to our hospital. On admission, the patient’s body temperature was 38.1?C, blood pressure was 95/50 mm Hg, pulse rate was 106 beats/min, respiratory rate was 27/min and percutaneous oxygen saturation was 78% in room air. Pulmonary auscultation revealed fine crackles over the lung bases. Intraoral candidiasis was also seen. Physical examination was otherwise normal. The patient’s white blood count was 2,600 cells/mm3 (Lymphocytes = 26%, neutrophils =70%) and the HIV ELISA test turned out to be positive which was confirmed by western blot assay. Laboratory investigations also revealed a low CD4+ cell count (72 cells/ ?l), normal liver function, negative blood culture and three negative AFB sputum smear results. The PCR test performed on his nasopharyngeal swab was negative for both influenza A and influenza H1N1 virus. His chest radiograph and chest CT are shown in Figures 1 and 2.
Fiberoptic Bronchoscopy was normal. Transbronchial biopsy is shown in Figure 3.
