India HIV Clinical Case Discussion (2015-06-17) - Case 2

36 y/o HIV seropositive male with pulmonary koch and CNS tuberculomas admits with c/o abdominal pain, swelling of both LL, fever, decreased urine output, scrotal swelling and pain. H/o night sweats and weight loss. Baseline CD4 175. MRI brain s/o lesion in Lt. occipital region. 

Exams: 

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  Temp= 38.8, pulse= 82/min, BP= 140/90 Rt. arm supine
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  Lymphadenopathy reveals axillary, cervical, inguinal group of lymph nodes palpable 2-3cm, nontender, firm, non-matted. 
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  Bilateral mild pitting edema

Systemic exam reveals distended, dilated tortuous veins seen over infra-umbilical area. Palpation: firm mass 5-7cm, irregular in shape, fixed, tender, liver palpable.

USG absomen reveals multiple enlarged lymph nodes around external iliac vessels, peri-aortic, retro-caval region apprx. 1.5-2.5cm. Bilateral raised renal echogenecity. Liver span 17cm, raised echogenecity. 

Labs:

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  Hb= 10.3, TLC= 5500, PLT= 562
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  Urine-R/M = Alb+
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  LDH= 457, Sr. Creat. = 2.1, SGOT= 102, SGPT= 62

Differential Diagnosis?