A 26 Year-Old Woman with AIDS and Pneumonia

WHAT IS YOUR DIAGNOSIS? A 26 year-old woman was referred to our hospital with longer than four months history of fever, non-productive cough, progressive dyspnea and chest pain. The patient had been diagnosed with interstitial lung disease in another hospital three weeks earlier and prescribed prednisolone at a dose of 30 mg once daily along with salmeterol and ipratropium bromide inhalation with no improvement in her status. On admission, patient’s body temperature was 38.3?C, blood pressure was 110/70 mmHg, pulse rate was 88 beats/min, respiratory rate was 24/min and percutaneous oxygen saturation was 91% in room air. The patient had diffuse scattered rhonchi on her lung exam. Physical examination otherwise was normal. The patient’s white blood cell count was 4,100 cells/mm3 (lymophocytes = 42% and neutrophils =58%) and the HIV ELISA test turned out to be positive and was confirmed by Western Blot assay. Laboratory investigations also revealed a low CD4+ cell count (17 cells/ ?l), normal liver function, negative blood culture and three negative AFB sputum smear results. Her chest CT-scan is shown in Figure 1. Fiberoptic bronchoscopy was normal. Transbronchial biopsy is shown in Figure 2.