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An HIV-infected patient with bilateral pneumonia.

Article Excerpt
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A 43-year-old homeless woman presented with a 2-week history of fever, chills, sweats, generalized pain, and cough that was productive of purulent green-yellow sputum mixed with blood. She reported a 15-lb weight loss over the past 6 weeks.

The patient had had HIV infection for 7 years and had a history of Pneumocystis jiroveci (formerly Pneumocystis carinii) pneumonia (PJP). She had not taken any medications for several months. The patient had smoked 1 pack of cigarettes per day for 30 years and had extensively used intravenous heroin for several years. She also used cocaine and occasionally consumed alcohol.

On physical examination, her vital signs were as follows: temperature, 39.1[degrees]C (102.4[degrees]F); respiration rate, 20 breaths per minute; pulse, 120 beats per minute; blood pressure, 99/61 mm Hg; and oxygen saturation (pulse oximetry), 97% on room air. Her arterial blood gas values on room air were pH, 7.44; PC[O.sub.2], 39 mm Hg; P[O.sub.2], 75 mm Hg; and oxygen saturation, 96%. Additional laboratory test results included a hemoglobin level of 8.1 g/[micro]L; white blood cell count of 5200/[micro]L, with 71% segmented neutrophils, 8% lymphocytes, 15% monocytes, and 6% bands; lactate dehydrogenase level of 128 U/L (normal, 100 to 190 U/L); [CD4.sup.+] cell count of 12/[micro]L; and HIV RNA quantitative level of 123,160 copies/mL.

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The patient's chest radiograph revealed left lower lobe, lingular, and right upper lobe infiltrates (Figure 1). A CT scan of the chest revealed 2.8-cm right hilar adenopathy and 2.0-cm left hilar adenopathy with patchy areas of consolidation in the right upper, right middle, left lower, and...

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