Maaliki Naji, Ali Aleem Azal, Isache Carmen Liliana, Aung Win
Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA.
BMJ Case Rep. 2021 Mar 23;14(3):e240849. doi: 10.1136/bcr-2020-240849.
A 36-year-old African American man with no medical history presented with a recent history of cough and dyspnoea. Initial chest imaging revealed diffuse bilateral lung infiltrates. A subsequent HIV test resulted positive, and he was presumptively diagnosed with AIDS, later confirmed by a CD4 of 88 cells/mm Empiric therapy with trimethoprim-sulfamethoxazole was initiated for presumed pneumonia. The patient's clinical status deteriorated despite treatment. Further workup with chest CT, bronchoscopy and skin biopsy led to a diagnosis of Kaposi sarcoma with pulmonary involvement. Highly active antiretroviral therapy therapy was initiated, along with plans to start chemotherapy. However, the patient's clinical status rapidly declined, leading to respiratory failure and eventual death. This case underlines the importance of maintaining a broad differential in immunocompromised patients presenting with respiratory symptoms.
一名36岁无病史的非裔美国男性，近期出现咳嗽和呼吸困难。初始胸部影像学检查显示双侧肺部弥漫性浸润。随后的HIV检测呈阳性，他被初步诊断为艾滋病，后来通过CD4细胞计数为88个/立方毫米得到确诊。针对疑似肺炎开始使用甲氧苄啶-磺胺甲恶唑进行经验性治疗。尽管进行了治疗，患者的临床状况仍恶化。通过胸部CT、支气管镜检查和皮肤活检进一步检查后，诊断为卡波西肉瘤伴肺部受累。开始进行高效抗逆转录病毒治疗，并计划开始化疗。然而，患者的临床状况迅速恶化，导致呼吸衰竭并最终死亡。该病例强调了对出现呼吸道症状的免疫功能低下患者保持广泛鉴别诊断的重要性。
