History of Present Illness: The patient is a 29-year-old woman who was admitted from the office with a history and symptoms highly suspicious for AIDS. She relates that she first noted a general feeling of malaise with stomach cramps and diarrhea approximately two weeks following extraction of two wisdom teeth in the dentist's office. She states that she took a 10-day course of Amoxicillin after her dental surgery, and that she thought maybe the medication was making her sick, as she relates that she had diarrhea from antibiotics approximately seven years ago. She continued to feel miserable with GI symptoms, spiking fevers up to 101 degrees, and some night sweats. She thinks she lost about 8 pounds. She is anorexic and states that her mouth is sore. She has had swollen glands on both sides of her neck for about 5 days. She denies cough, chest pain, shortness of breath, palpitations. There have been no urinary symptoms, and no blood per rectum. Her husband is in the navy and has been overseas for three months. She has not been sexually active since his departure, however she states that her husband has admitted to prior extramarital sexual activities within the past two years. She denies drug use at this time, however admits to a brief period of time approximately 5 years ago when she used IV cocaine. She underwent detox at that time and has remained drug-free since then.

Pertinent findings on physical exam include positive anterior and posterior neck nodes, and bilateral axillary lymphadenopathy. Oral cavity reveals mild thrush.

Laboratory Data: Chest x-ray reveals patchy infiltrate in the left mid lung field to the periphery as well as in the right lower lung, findings suspicious for Pneumocystis carinii. UA negative. CBC: Hgb. 9.2, hct. 28.6, MCV 82, WBC 4.8, 9 lymphs, 4 monos, platelets 201,000. Na 132, K+ 3.2, Cl 11, CO2 10, BUN 38, creatinine 3.9, glucose 90, calcium 6.9. Sputum showed no growth, blood and urine cultures negative. Serology positive for HIV.

Hospital Course: The patient was admitted with presumed acute HIV infection. Because of the suspicion for PCP on CXR, she underwent diagnostic bronchoscopy on day 2 of her hospitalization. Washings returned positive for changes consistent with PCP. The patient was treated with a 2-week course of intravenous Septra with no improvement in her clinical status. She continued with fever, malaise, neutropenia and lymphopenia. Consult was obtained from Infectious Diseases and Pentamidine treatment was initiated. On this regimen the patient became afebrile.

CBC revealed normochromic normocytic anemia for which the patient received 2 units of packed cells.

The patient’s oral thrush resolved with Orabase with .1% triamcinalone q.i.d.

Workup failed to reveal the exact etiology for her renal failure. A percutaneous renal biopsy revealed acute interstitial nephritis. Her renal function remained stable with elevated BUN and creatinine throughout her hospital course. Bicitra was begun to correct the patient’s metabolic acidosis felt secondary to her failure.

At the time of discharge the patient’s acidosis had improved. She was afebrile with stable vital signs, feeling stronger, eating a regular diet. Chest radiograph revealed resolution of the patchy infiltrate. Her hemoglobin on the morning of discharge was 11.9 with a hematocrit of 32. Diarrhea had resolved.

The patient is discharged home in stable condition. She will follow up with Infectious Disease Clinic as an outpatient in two days. She understands the nature of her illness and that initiation of immediate anti-HIV treatment is critical for her.