HIV and AIDS Quiz: Ace Your Exams

A 35-year-old man comes to the clinic with a two-week history of fever, night sweats, abdominal pain, and diarrhea. Three years ago, the patient was diagnosed with HIV-AIDS and refused treatment. The patient is sexually active with men and women and uses condoms inconsistently. The patient uses intravenous drugs including heroin and consumes alcohol regularly. He was adopted at the age of five from India and does not have a history of travel outside the United States. Temperature is 36.6°C (98.0°F), pulse is 99/min, respirations are 20/min, and blood pressure is 120/75 mmHg. Physical examination reveals conjunctival pallor, anterior, cervical, inguinal, and axillary lymphadenopathy. Oral examination reveals white, mucosal plaques on the lateral aspect of the tongue that cannot be scraped off. Abdominal examination reveals ascites and hepatosplenomegaly. Laboratory studies are detailed below. CT of the abdomen and pelvis reveals ascites, mesenteric and periaortic lymphadenopathy, and bowel wall thickening. A biopsy specimen of an axillary lymph node is shown below. Which of the following is the most likely diagnosis?
 

Laboratory value	Result
Hemoglobin	9  g/dL
Hematocrit	30%
Leukocyte count	13,100 /mm3
Platelet count	100,000/mm3
Alkaline phosphatase	207 U/L
Lactate dehydrogenase (LDH)	421 U/L
CD4+T cell	42 cell/microL
HIV viral RNA quant	4851 copies/ml
Interferon gamma release    assay (IGRA)	undetectable

^{CDC Public Health Library}