Infectious Disease
Case 13: An HIV ‐Infected Patient with Fever
CASE
A 27‐year‐old man was recently found to be HIV positive. He presented with HIV encephalopathy and, following successful rehabilitation, he was discharged home and commenced on anti‐retroviral treatment. His CD4 count at the time was 5 and he had a high viral load. He represented 2 weeks later with malaise, fever and vomiting. He had been adherent with his medication. He denied having diarrhoea.
On examination he had a temperature of 39°C, a heart rate of 100 beats/min and an arterial blood pressure of 110/80 mmHg. His respiratory rate was 18 breaths/min with an oxygen saturation of 98% on air. He had evidence of oral Candida and cervical and inguinal lymphadenopathy. He had a normal heart sound and a clear chest. His abdomen was soft but he had a moderately sized hepatosplenomegaly. Neurological examination was unremarkable and there was no evidence of retinal scarring or papilloedema on fundoscopy. There was no visible rash.
The following results are available to you:
Hb 8 g/dL WCC 2 × 109/L Platelets 90 × 109/L CRP 250 mg/L ESR 90 mm/h Na 138 mmol/L K 5 mmol/L Urea 16 mmol/L Creatinine 140 µmol/L LFTs Normal
Chest radiograph: normal
Blood culture: normal
Lactate dehydrogenase: normal
Cryptococcal antigen: negative
Cytomegalovirus PCR: undetected
QUESTION 1
Your score this session: 0 of 0
Which of the following investigations is least useful?