Posters

Discipline Track

Patient Care

Abstract

Background: Approximately 40% of new HIV infections originate from people who are unaware of their diagnosis. Median time from infection to diagnosis was 3 years in 2015. Cases of newly diagnosed HIV in the geriatric population are rare.

Case Presentation: 71 year old Hispanic man with history of diabetes and anemia presenting to the hospital with generalized weakness, presyncopal episodes, shortness of breath, loose stools, and falls for past two weeks. He is a poor historian so wife contacted to provide detailed history. Patient with 100 pound weight loss in 6 months. Intravenous drug use 30 years ago, and blood transfusion 40 years ago. Reports only sexually active with his wife. Recent endoscopy, done to work up anemia, was limited due to extrinsic compression from suspected mediastinal mass. He is in mild respiratory distress saturating at 88% oxygen level on room air. Diminished breath sounds to the bilateral lung bases. Respiratory viral panel negative including negative SARS-CoV2-PCR. Chest X-ray with scattered ground glass opacities concerning for atypical viral pneumonia. MRI brain negative. HIV type 1 antibody positive. CD4 count is 4. HIV viral load is 396,000. Working diagnosis of sepsis and hypoxia secondary to Pneumocystis jirovecii pneumonia (PJP) in a newly diagnosed AIDS patient. Patient started on Bactrim for PJP, and azithromycin for atypical pneumonia coverage and prophylaxis for Mycobacterium avium complex. Bronchial lavage performed, and cytology and fungal studies negative. Histoplasmosis serology positive, so started on itraconazole. Patient stabilized during hospital course, and will follow up with local HIV clinic to start antiretroviral therapy.

Conclusions: This case highlights the importance of routine screening of HIV in primary care. The USPSTF recommends screening for patients age 15 to 65, and any age person at high risk of infection.

Presentation Type

Poster

Academic Level

Resident

Mentor/PI Department

Family Medicine

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Pneumocystis jirovecii Pneumonia in a Newly Diagnosed AIDS Geriatric Patient

Background: Approximately 40% of new HIV infections originate from people who are unaware of their diagnosis. Median time from infection to diagnosis was 3 years in 2015. Cases of newly diagnosed HIV in the geriatric population are rare.

Case Presentation: 71 year old Hispanic man with history of diabetes and anemia presenting to the hospital with generalized weakness, presyncopal episodes, shortness of breath, loose stools, and falls for past two weeks. He is a poor historian so wife contacted to provide detailed history. Patient with 100 pound weight loss in 6 months. Intravenous drug use 30 years ago, and blood transfusion 40 years ago. Reports only sexually active with his wife. Recent endoscopy, done to work up anemia, was limited due to extrinsic compression from suspected mediastinal mass. He is in mild respiratory distress saturating at 88% oxygen level on room air. Diminished breath sounds to the bilateral lung bases. Respiratory viral panel negative including negative SARS-CoV2-PCR. Chest X-ray with scattered ground glass opacities concerning for atypical viral pneumonia. MRI brain negative. HIV type 1 antibody positive. CD4 count is 4. HIV viral load is 396,000. Working diagnosis of sepsis and hypoxia secondary to Pneumocystis jirovecii pneumonia (PJP) in a newly diagnosed AIDS patient. Patient started on Bactrim for PJP, and azithromycin for atypical pneumonia coverage and prophylaxis for Mycobacterium avium complex. Bronchial lavage performed, and cytology and fungal studies negative. Histoplasmosis serology positive, so started on itraconazole. Patient stabilized during hospital course, and will follow up with local HIV clinic to start antiretroviral therapy.

Conclusions: This case highlights the importance of routine screening of HIV in primary care. The USPSTF recommends screening for patients age 15 to 65, and any age person at high risk of infection.

 

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