CHEST Guidelines-A-32-Year-Old-Man-Affected-by-HIV-With-Fever,-Dysp

A-32-Year-Old-Man-Affected-by-HIV-With-Fever,-Dysp

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A 32-year-old man with a history of HIV, who had refused antiretroviral therapy, was admitted to the hospital with a two-week history of worsening cough, fever, and dyspnea. Initial antibiotics did not improve his condition, and bronchoalveolar lavage showed no signs of bacterial pneumonia, tuberculosis, or sarcoidosis, although samples were not ready for Pneumocystis jirovecii testing. The patient's immune function was severely compromised with very low CD4 levels and high HIV viral load.<br /><br />His condition quickly worsened, leading to severe respiratory insufficiency and multiorgan failure requiring ICU admission. Imaging suggested a pulmonary infection, likely Pneumocystis jirovecii pneumonia (PJP), evidenced by lung ultrasounds displaying cystic patterns, and CT scans showing diffuse ground-glass alveolar patterns. Ultrasound results showed significant lung involvement, interstitial syndrome, liver mottling, pleural effusions, and heart dysfunction—all consistent with severe PJP.<br /><br />Treatment with IV trimethoprim/sulfamethoxazole and corticosteroids was initiated due to strong suspicion of PJP. Antiretroviral therapy was withheld to avoid exacerbating the immune system. Despite these efforts, the patient's condition deteriorated rapidly, and he died after 15 days in the hospital.<br /><br />The case highlights the diagnostic value of lung ultrasound in detecting interstitial syndromes and guiding treatment decisions quickly and accurately, particularly in resource-limited settings. The integration of point-of-care ultrasound with other clinical information can be crucial for managing critically ill, immune-suppressed patients such as those with AIDS-related infections like PJP. The study calls for further exploration of characteristic ultrasonographic patterns for better diagnosis and treatment approaches in similar cases.

Keywords

HIV

Pneumocystis jirovecii pneumonia

lung ultrasound

immune suppression

interstitial syndrome

critical care

antiretroviral therapy

trimethoprim/sulfamethoxazole

diagnostic imaging

AIDS-related infections