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Fever and Productive Cough in a Patient With AIDS, Clinical Infectious Diseases, Volume 52, Issue 5, 1 March 2011, Pages 646–647, https://doi.org/10.1093/cid/ciq165
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(See Pages 688–689 for the Answer to the Photo Quiz.)
A 27-year-old man who was an illegal immigrant from Vietnam was admitted to the Queen Elizabeth Hospital, Hong Kong, because of fever, productive cough, and weight loss. He had been a farmer in Vietnam and had never traveled outside the country before coming to Hong Kong. He had a known history of AIDS (CD4+ cell count, 2 cells/μL; HIV RNA, 23,140 copies/mL). Physical examination showed cervical lymphadenopathy and hepatosplenomegaly, but there was no skin rash. The patient was found to have pancytopenia and deranged liver function. Peripheral blood examination showed a hemoglobin level of 79 g/L; a platelet count of 44 x 109/L; and a leukocyte count of 1.8 x 109/L with 49% neutrophils, 36% lymphocytes, 13% monocytes, and 2% eosinophils. Abdominal ultrasonography confirmed the hepatosplenomegaly, and mild ascites was also detected. Bone marrow aspiration yielded a dry tap. Trephine biopsy showed a hypercellular marrow with increased normal-looking megakaryocytes, active normoblastic erythropoiesis, and normal granulopoiesis. Reactive histiocytes were markedly increased in density, forming ill-defined granulomas. Occasional multinucleated giant cells were also present. Many small round to oval particles with dotlike inclusions were found within the histiocytes and also extracellularly in vacuolated spaces (Figure 1). What is the diagnosis?
