A woman in her 60s.

HIV infection for about 2 years, on ART (Acriptega 50/300/30 mg), no medication from April to
end of November 2022.
In spring 2022 pain in legs and arms started, more descriptive of neuropathic nature. On
21.10.2022 the patient was admitted to the NMPD "North Kurzeme Regional Hospital" in Ventspils with
complaints of pain in the joints of the left foot, oedema in the ankle regions of both feet, local petechial
rash. In hospital, the patient consulted a neurologist, who diagnosed foot paresis of uncertain genesis,
mixed polyneuropathy of the feet with movement disorders. CT scan of the lungs indicated pleurisy,
Covid19 infection on 23.10. Further and more in-depth examination by a rheumatologist was
recommended to clarify the diagnosis at the "North Kurzeme Regional Hospital" in Ventspils. She
received Sol. Medrol at an unknown dose, sol. Dexamethasone. Prescribed with Medrol 32mg, used for
3 weeks.
She was treated in the PICU from 07.12.22. to 23.12.22. due to altered immunological tests to
clarify the diagnosis. Urinalysis showed active sediment with erythrocytes, protein, cylinders, renal
biopsy ordered, performed 12.12.22. Neurologist consulted, neurography performed - sensory
polyneuropathy in hands, motor sensory, axonal demyelinating, asymmetric deep polyneuropathy in
legs. No evidence of myogenic damage. Therapeutic exercise under physiotherapist supervision,
rehabilitation counselling, recommendations. In therapy from 07.12.22 Medrol 16mg p/o. Blood tests
ANA 1:640, hypocomplementemia, dsDNA 206 IU/ml, positive tripple antiphospholipid antibodies,
pANCA without PR3 and MPO titres. CD3 and CD4 cells normal. CTA of abdominal/leg arteries
performed at presentation - no evidence of occlusive changes but liver changes visualised. On renal
biopsy the patient has crescentic glomerulonephritis.
08.12.22
CT angiography of abdominal aorta, iliac and leg arteries with i/v bolus k/v
DESCRIPTION
Aorta of normal configuration, its main visceral branches without haemodynamically significant
stenotic changes.
A. iliaca communis dxt et sin preserved with initial atherosclerotic pangas.
A. iliaca externa dxt et sin normal course.
A. femoralis communis dxt et sin preserved.
A. femoralis superficialis dxt et sin normal course.
A. femoralis profunda dxt et sin unaltered.
The crural arteries in both legs preserved.
More prominent veins in the left lower leg, medially in the v. saphena magna basin.
Lungs unevenly pneumatised in their basal parts, local infiltrative changes with a focal
structure in the basal part of the right lung in segment S10 1,6 x 2 cm, formed of interpenetrating focal
structures, probably local infiltrate or susp. other process changes.

Spleen with markedly inhomogeneous contrast, according to phase. To be evaluated in the

context of other examinations.
The liver is markedly lobulated, small in volume, with several scar-like indentations as in
cirrhosis and fibrosis, against which a hypervascular focus in segment S2 up to 8 mm D is marked.
Multiple calcified concrements in the gallbladder. No intra- or extrahepatic biliary dilatation.
V. porta normal width up to 1,2 cm D.
Superciliary vessels bilaterally normal in size, smoothly contoured.
Both kidneys slightly wavy in outline, parapelvic cysts bilaterally, more pronounced on the left
side.
Urinary bladder thin-walled, smoothly contoured.
No abnormalities in the uterus and ovaries.
No distinct pericellular changes in the bones. Mild degenerative changes in the intervertebral
disc of the lumbar spine, more pronounced at L5-S1 level.

Summary
Chronic changes in the liver with hepatic fibrosis, cirrhosis. Susp. foci not seen. Isolated
degenerative, dysplastic nodules, more in the left lobe.
 No data on portal hypertension at present.
Gallbladder with multiple concrements in the lumen.
Parapelvic cysts in the kidney.
CTA shows no haemodynamically significant changes in the aorta, iliac arteries and leg
arteries along their entire length, traceable to the periphery.
Varicose veins with chronic venous insufficiency in the vena saphena magna sin vascular
basin.
Local focal structure in the basal part of the right lung in segment S10. Findings to be
evaluated by additional CT thoracis.
20.12.22
US for abdominal organs and retroperitoneal space
DESCRIPTION
No known history of liver disease.
The liver is of normal size, uneven, inhomogeneous, with no focal defects. Flow v. portae
hepatopetal , about 22 cm/sec. 6 valid measurements, median elastance 12,8 kPa at IQR 2,2.
The lumen of the gallbladder is occupied by concrements, the bile ducts are not dilated.
Pancreatic visualisation is limited.
Spleen not enlarged, about 10 cm long, about 4 cm thick.
Kidneys with thin, rough parenchyma, without visible structural defects. No abnormal fluid
collections around the kidneys.
No free fluid in the abdomen.
Summary
Picture of cirrhosis. Liver elastography values correspond to F4 on the METAVIR scale (not
knowing primary liver disease F3 - F4).
15.12.22
Chest CT without i/v administration
DESCRIPTION
Lungs well pneumatised. Bronchovascular pattern of the lungs on both sides mildly
accentuated by fibrous peribronchial changes. No differentiation of pathological content in the tracheal
and bronchial lumens. S2 and S3 basally in the right upper lung and fibrous fibrosis in the basal part of
the left lung lingula, subpleural local heterogeneous infiltration in S10 basally in the right lower lung,
which has regressed in volume when compared dynamically with a previous CT scan performed on
07.12.2022.
No increased fluid content in the pleural and pericardial cavities.
No axillary evidence of lymphadenopathy is observed in the lung roots and mediastinum, as
well as in the neck and on both sides.
A small thyroid gland is seen in the neck, and a hypodense nodule is seen in the right lobe.
USG is recommended to evaluate this.
Heart and aortic shadow of normal size and configuration. Blood in the cardiac cavities has a
lower radioiodensity than the myocardium - signs of anaemia. Small calcifications along the coronary
vasculature - CX course.
Bone window examination indicates degenerative features in the vertebral column and
shoulder girdle joints.

Summary
Initial bronchial wall deformity consistent with deforming bronchitis, currently without signs of
exacerbation.
Local subpleural patchy infiltration in S10 dxt, which has regressed in volume when compared
dynamically with a previous CT scan performed on 07.12.2022.