India HIV Clinical Case Conference (2015-07-15) - Case 1

A 24 year old woman presented to an emergency department in the United States during the month of February with 2 weeks of a dry cough and 1 week of fevers up to 39 degrees Celsius. She also had scattered flesh-colored papules on her face and trunk that had appeared 1 week prior to presentation. She had no other associated symptoms or significant past medical history; she had never had an HIV test. She had not been around anyone who had been ill. She was unemployed and lived in an apartment with a friend. She occasionally injected heroin and used marijuana, but did not smoke tobacco or drink alcohol. 

Physical Exam

Temperature=39.0  Heart Rate=100  Respiratory Rate=20  Blood Pressure=110/70  Oxygen Saturation= 95%

Initial Labs

Chest X ray

“Nodular/ reticular densities throughout both lung fields” 

Chest CT

Ill-defined nodular/ reticular densities throughout both lung fields

What is your differential diagnosis?