Dr. Kathy Wunderle presented a very interesting case of a middle aged cachetic male with a history of HIV not on HAART without recent CD4 count who presented with a progressive R groin mass, acute non-productive cough, night sweats and weight loss who was found to have non-painful, fixed bulky lymphadenopathy, hypoxia with diffuse crackles and progressive encephalopathy. In addition, the labs that were able to obtained were pertinent for a Na of 114, Cr of 3.3, WBC 30.2, plt 48, elevated LFTs and albumin of 1.3. Eventually, a biopsy of his R groin mass showed MAC and he was also treated for pulmonary TB.
One of the largest take away points from this conference included the management of this gentleman's medical conditions without our conventional resources available to us in the United States. Some examples of resource limitations included:
--once daily labs in a patient at risk for rapid overcorrection of sodium
--inability to obtain a basic chest xray to evaluate his hypoxia
--lack of access to advanced imaging such CT head
Kathy had excellent learning points including:
-- The differential for mass/lymphadenopathy in a patient with HIV is broad, and includes lymphoma, infection, and Kaposi Sarcoma
-- The incidence of TB is higher in HIV infected populations, and they require different prophylaxis than non-TB infected patients (i.e. always given Bactrim ppx)
-- In patients with untreated HIV and TB, start HAART within 2 weeks
- She reviewed a systematic review and meta-analysis published in 2015 in the Annals of Internal Medicine which showed a survival benefit of early ART in HIV-infected adults with newly diagnosed TB for those with CD4 count <50. data-preserve-html-node="true"