Pneumonia in AIDS patient…

October 14, 2013

Chest XR, Devices, Non-Trauma, Respiratory, XR

This patient has a history of AIDS with very low CD4 count and came in with respiratory distress:


This Xray shows a diffuse pulmonary infiltrates, bilateral pleural effusions.  There is an endotracheal tube near the carina, it could come back a couple centimeters.  He also has a nasogastric tube coursing below the diaphragm. 

What is the differential diagnosis of a multilobar pneumonia such as this in an AIDS patient?  Comments appreciated!

Author:  Russell Jones, M.D.

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2 Comments on “Pneumonia in AIDS patient…”

  1. Carlos Rivas (@losrivasmd) Says:

    PCP, TB, Influenza, CA-MRSA PNA, Strep PNA, CAP, HCAP, Cryptococus or other fungal PNA… Regardless of the bug, this guy looks like ARDS, needs to be on ARDSnet protocol, EGDT in the first 1-6 hrs, very broad spectrum coverage until the cultures come back: Vanc, Zosyn, TMP-SMX, fluconazole, probably start coverage for mycobact: INH, Rifampin, Levoflox, Amikacin…. poor prognosis, poor guy.


    • emrems411 Says:

      Great differential! I agree, this looks like ARDS and he was treated with ARDS protocol vent settings and empiric coverage. Stay tuned for another post in a couple days with a further differential dx…Thanks for commenting.


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