Diagnosis- PNEUMOCYSTIC CARNII ? PNEUMONIA TYPE 1 RESPIRATORY FAILURE PLHA ORAL CANDIDIASIS Medical History & Presenting Complaints A 30 year old male patient, presented to Emergency department on 04/08/2022 with complaints of fever, productive cough and shortness of breath for 10 days, mucoid sputum (½ cup/day, non-offensive smell, without hemoptysis). No associated chest pain / hemoptysis / palpitation / diaphoresis / PND/ orthopnoea. Associated low appetite for 7 months, weight loss of 2 kg over last 2 months. Patient is not sensitive to dust, fumes, cold environment or seasonal variation. Cattle as pet at home, old smoker and alcoholic. No history of hypertension, diabetes, thyroid disorder, pulmonary koch's, CAD, CKD or rheumatic disease. History of tubercular pleural effusion in 2010-ATT completed. His recent HRCT thorax done outside revealed bilateral basal GGO susceptive of infective etiology. Physical & Systemic Examination- No clubbing / cyanosis / pallor / icterus / pedal edema / lymphadenopathy No neck swelling, no neck vein distended Conscious, oriented, Co-operative. Afebrile BP-116/74 mmHg PR- 110/min RR-20/min SP02- 94% on 3 lit/min oxygen RBS- 189 mg/dl GCS-E4V5M6 Pupils- bilateral 3 mm reactive ENT- oral candidiasis CVS- S1 S2 + Chest- Bilateral air entry + PA- Soft, non-tender ABG at the time of admission: pH- 7.510, pC02- 25, pOz-67.2, HC03-19.5, Lactate 0.93. Course in Hospital- Patient was admitted with similar complaints in medical ward. Routine investigations were advised. Sputum test and Bronchoscopy with BAL study was done. Reports arrived showing- Hb 10.1 Raised TLC 13.29, N 92.1% Platelet 3.19 Raised GOT 302, SGPT 263, GGT 332, ALP 482 NT pro-BNP 108 Urea 27, Creatinine 0.74, Sodium 138, Potassium 4,3 Calcium Raised LDH 510 Procalcitonin 0.59 Raised ESR 140 Raised CRP 125 Sputum for AFB, Gram staining- negative Sputum for P.Carnii (IFA)- negative Bronchoscopy (09/08/2022) - No intraluminal abnormality seen upto subsegmental bronchus. Z.N.STAIN (BAL FLUID)- No acid fast bacilli seen. Rest BAL reports awaited. HIV I & II Antibody- Positive. Anti HCV and HbsAg- Negative. CD4 count - 11 USG whole abdomen- Mild hepatomegaly with hepatic steatosis changes. Patient was managed conservatively on antibiotics, steroid, PPI, anti-fungal, moist oxygen therapy and other supportive measures. Patient is being discharged in stable condition. ART has been started.




? Pneumocystis carnii. P HO pleural effusion. HIV positive start ART Needs further investigation and EVALUATION to conclude..

Good case of pneumocystic carnii Past p/m/h of pleural effusion Recent ix suggest pt is Hiv positive hence ART GGO in lower zones in HRCT also need to exclude COVID and aspergillus

Thanx dr Ashok Leel

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