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Title : A 52 year-old male w/ general weakness and cough
Date : July 3, 2009
Contributed by

Mi Kyong Joung, M.D., Samsung Medical Center, Seoul, Korea

Patient History
Age/Sex A 52 years old man
Chief complaint General weakness
Present illness

He has lived in Myanmar for his business In Myanmar, he regularly had sexual contact with the street girl twice or three times a month during last 8 years. He had general weakness, intermittent fever, chill and headache 20 days ago.

Past medical history

He was treated with anti-TB medication because of pulmonary tuberculosis.

Physical examination

Initial vital sign 92/60mmHg-88beats/min-18/min-35.7'C He had crackle in left lower lung. Erythematous papules were detected on right abdomen and leg

Initial laboratory findings

CBC : WBC 11840/ul(segment 83.4%, lymphocyte 7.1%), Hb 12.2g/dl, platelet 213000/ul chemistry : AST 187U/l, ALT 149U/l, total bilirubin 1.5mg/dl ESR 103mm/hr CRP 9.54mg/dl

Radiologic findings

Chest X-ray showed consolidation in left lower lobe and multifocal nodules in both lungs. Chest CT scan showed segmental consolidation in left lower lobe and mediastinal hilar lymphadenopathy, and 1-2 cm sized several well- defined nodules in both lungs.

Hospital course

He was diagnosed AIDS. CD4 count was less than 10/uL. Sputum culture and smear was done. Biopsy of right leg was done from erythematous papules.

Figure


 
Question - ID Case of the Week ( July 3, 2009 )
What is your diagnosis in this patient with lung consolidation and skin papules?
 
Correct Answer

Pulmonary tuberculosis with cutaneous CMV infection

 


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