Case 3 :

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.