Cases from the Osler Medical Service at Johns Hopkins University. Diagnosis: P. carinii pneumonia and primary pulmonary sporotrichosis

The American Journal of Medicine
Julie-Aurore Losman, Kerri Cavanaugh

Abstract

PRESENTING FEATURES: A 53-year-old man who had human immunodeficiency virus (HIV) presented to the Johns Hopkins Hospital with a 3-month history of increasing dysphagia, cough, dyspnea, chest pain, and an episode of syncope. His past medical history was notable for oral and presumptive esophageal candidiasis that was treated with fluconazole 6 months prior to presentation. Three months prior to presentation, he discontinued his medications, and his symptoms of dysphagia recurred. During that time he developed intermittent fevers and chills, progressively worsening dyspnea on exertion, and a cough productive of white sputum. He also reported a 40-lb weight loss over the past 3 months. On the day prior to presentation, he had chest pain and shortness of breath followed by weakness, dizziness, and a brief syncopal episode. He denied orthopnea, paroxysmal nocturnal dyspnea, lower extremity edema, jaundice, hemoptysis, hematemesis, melena, hematochezia, or diarrhea. There was no history of alcohol use, and he stopped smoking tobacco approximately 1 month previously. He smoked cocaine but denied injection drug use. The patient had never been on antiretroviral therapy and had never had his CD4 count or viral load measured. On physical...Continue Reading

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Citations

Aug 24, 2011·Medical Mycology·Dayvison Francis Saraiva FreitasMaria Clara Gutierrez-Galhardo
Jan 16, 2008·Immunology·Karla Simone S FernandesChristina Barja-Fidalgo
Jan 16, 2019·Journal of Fungi·Flavio Queiroz-TellesGil Benard
Feb 24, 2015·Infection·José A S MoreiraCristiane C Lamas

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