Abdominal organs involvement in HIVinfection

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Abdominal organs involvement in HIV-infection

• Case study
• Department of TB in HIV-infected
• City TB Hospital No. 2

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Clinical background

• Patient P. 36 years old, male
• Has been drug addict for last 10 years, no
  remission.
• HIV-infection since 2004
• HCV since 2000
• Has been detained for 2 years

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Clinical findings

• Abrupt onset of disease 2 months prior to
  admission when he has been in detention (term 2
  years)
• Complaints weight loss, fatigue, high
  temperature up to 38,5º, enlarged abdomen,
  jaundice, dyspnea

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Clinical findings

• Physical findings
• Skin pallor, jaundice
• Enlarged abdominal circumference due to ascites
• Muffled and rhythmic heart sounds
• Shin and sole edema

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Clinical findings

• Blood Hb 66 g/l, ESR 72 mm/h, Bilirubine 34,4
  µm/l
• CD4 12-62 cells.
• Abdominal ultrasound enlarged liver and spleen,
  increased density of the liver tissue, ascites,
  increased number of echo-positive signals from
  portal lymph-nodes

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Clinical findings
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Clinical findings
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Questions

• Suggested diagnosis
• Diagnostic approach
• Approaches to treatment

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Differential diagnosis

• De-compensated liver cirrhosis
• Proliferative disease of the lymphoid system
• Sepsis
• TB

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Diagnosis

• TB of intra-thoracic lymph-nodes, infiltrative
  stage, complicated by para-mediastinal pleurisy.
• Abdominal TB TB of the mesenteric lymph-nodes,
  TB-ascites-peritonitis (dissemination across
  peritoneum and diaphragm), TB of the spleen

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