The patient is lost to follow-up for 18 months. He returns by presenting to the emergency room with complaints of dyspnea on exertion over three weeks, a dry cough, daily fevers to 39 o C, sweats and chills. He has lost 15 lb over a three-month interval. Patient states he did not take any of the medications prescribed.
His pertinent exam reveals T=38 5 , BP 110/70, P=120, RR=30. His pharynx reveals friable white material on his soft palate and covering his uvula; pulmonary exam is remarkable for diffuse crackles; cardiac exam reveals no jugular venous distension, S 1 / S 2 are normal, without S 3 , and no murmur. Chest X-ray reveals bilateral interstitial infiltrates in perihilar distribution. CD4 count = 100 / mm 3 , CD8 = 1800 / mm 3 , viral load = 92, 000 copies/ml.