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
