A 24 year old African-American male with a history of AIDS with a recent CD4 count of 57/uL, is admitted to the hospital with substernal chest pain and shortness of breath for the past two weeks. Dyspnea is mostly on exertion, and the patient denied productive cough or hemoptysis, fevers, chills, or night sweats. Three weeks prior to presentation, the patient underwent esophagogastroduodenoscopy, which revealed an esophageal ulcer. Biopsies did not show any specific pathology and cultures were negative. Outpatient medications include prednisone, rabeprazole, fluconazole, clarithromycin, and ethambutol, bactrim.
Vitals on admission were as follows: temperature 97.2, pulse 80/min, and respiration rate 26/min. On physical exam, no crackles or wheezing were found. Computerized tomography scan of the chest revealed multiple bilateral nodules, without pleural effusions or mediastinal/hilar lymphadenopathy. Bronchoscopy was preformed with transbronchial biopsy; cultures obtained were negative. Transbronchial lung biopsy showed an interstitial infiltrate of mononuclear cells, predominantly lymphocytes, consistent with a diagnosis of nonspecific interstitial pneumonitis. The pateint was subsequently referred to infectious disease clinic for highly active antiretroviral therapy.
"Nonspecific Interstitial Pneumonitis in HIV-infected Patients,"
The Medicine Forum:
Vol. 4, Article 5.
Available at: http://jdc.jefferson.edu/tmf/vol4/iss1/5