CHSU Discovery

Pneumocystis pneumonia (PCP) is caused by Pneumocystis Jirovecii. HIV is an RNA retrovirus that infects CD4 (T-helper) cells, which drop from normal level of 600-1000 cells/mm3 at rate of 50-100 per year in untreated people. CDC defines HIV+ person as having AIDS when CD4 count drops below 200 cells/mm3 or AIDS-defining illness develops, including opportunistic infections, malignancies, or neurological diseases. We present a case of 39 yo female with PMH of GERD and asthma who presented to ED with 2-week history of productive cough, chest pain, and dyspnea. She was feeling sick for 4-5 months and lost 40 pounds weight. On admission, she met sepsis criteria and had respiratory distress. White plaques on the soft palate and oral ulcers. Lungs clear to auscultation, although using accessory muscles. No abd pain or rash. Basic blood and urine testing normal. Respiratory Viral Panel neg. Chest X-ray with bilateral pulmonary infiltrates. HIV 1 RNA PCR revealed 692088 copies/ml and absolute CD4 count was 2!! Quantiferon TB Gold testing was indeterminate. CT scan of the chest showed ground glass opacities in bilateral lungs. Bronchoscopy showed Candida albicans and Beta-D-Glucan testing was positive. Bronchoalveolar Lavage PCR positive for Pneumocystis Jirovecii. Patient diagnosed with AIDS due to HIV complicated by Pneumocystis pneumonia (PCP). ID team was consulted. The patient was started on high-dose TMP-SMX, Fluconazole and Prednisone. HAART was started. Patient discharged in stable condition with HIV specialist appt. HIV remains serious public health issue. Primary Care Physicians play vital role in reducing the spread of HIV by screening routinely, and prescribing PrEP and PEP. HAART can remarkably reduce HIV-associated morbidity and mortality and decrease transmission.