Simple # 20 - 48-year-old woman with HIV – Ms.

Hunt

This case begins with Ms. Hunt, a 48-year-old female HIV who presents for routine
check up. Recently she has had fevers, weight loss, abdominal pain, and diarrhea.
Her fever of unknown origin was tricky but eventually mycobacterium avium was
cultured. Throughout this case, hallmark findings of HIV infection were discussed
but the fever of unknown origin was very interesting. I did not know that there were
four categories for this including classic, nosocomial, and immune-
deficient/neutropenia, HIV associated. Within the HIV associated FUO, Castleman
disease is an interesting subset and its vascular proliferation in lymphoid tissues
that can cause fever of unknown origin in HIV-positive individuals. I learned that TB
is the primary cause of FUO in HIV patients. I also learned that labwork for HIV
individuals who present with fever should include PPD, RPR, Toxoplasmosis, and
hepatitis panel. Also HIV has a negative effect on oral health and dental exams are
recommended. Overall a great case to review HIV associated infections.

Simple # 22 - 71-year-old male with cough and fatigue – Mr. Groszek

This case introduces Mr. Groszek, a 71-year-old Polish man, who presents with with
a two-day history of fever, cough, and pleuritic chest pain. He has hypoxia,
tachycardia, and hypothermia. On physical exam, there are signs of consolidation
and chest x-ray shows right lower lobe infiltration. He is eventually diagnosed with
right lower lobe pneumonia. This case was great in reading chest x-rays. The quality
of chest ray is made easier by using RIP method, which stands for rotation,
inspiration, and penetration. Rotation is for measuring the distance of each clavicle
from the spinous processes. Inspiration is for counting nine posterior ribs within the
lung fields. Penetration is the ability to visualize the intervertebral spaces within the
heart boundaries. I also learned the many categories of pneumonia and
consolidation types and the criteria for hospitalization of patients with community-
acquired pneumonia. The pneumonic CRB-65 stands for confusion, respiratory rate,
blood pressure, 65 yo and older. Overall a great case that reviews pneumonias.