A Case of Severe Colitis in an HIV-Positive Patient With CD4 Count >200cells/μL

Abstract Objectives A 42-year-old African American man with a history of HIV infection on highly active antiretroviral therapy (HARRT) presented with excessive thirst, polydipsia, polyuria, weight loss, and abnormal kidney function tests. Physical examination was normal. Methods The patient workup results were as follows: calcium 13.8 mg/dL (8.4-10.3 mg/dL), ACE 88 U/L (8-52 U/L), PTH 7.34 pg/mL (14-72 pg/mL), 1,25 (OH)2 vitamin D 125 pg/mL (19.9-79.3 pg/mL), BUN 38 mg/dL (6-20 mg/dL), Cr 2.42 mg/dL (0.4-1.2 mg/dL), glucose 87 mg/dL (70-99 mg/dL), CD4 count 303/μL (544-1,894/μL). Chest CT scan showed diffuse pulmonary nodules with mediastinal and bilateral hilar lymphadenopathy. A transbronchial biopsy was performed. Results Biopsy revealed noncaseating granuloma and Schaumann bodies. AFB and GMS stains were negative for micro-organisms. These findings were compatible with sarcoidosis. The patient received prednisone and showed significant improvement in his renal function (creatinine: 1.23 mg/dL) and calcium level (9.12 mg/dL). Conclusion CD4+ T lymphocytes have a crucial role in the formation of sarcoid granulomas. However, HIV infection is characterized by a profound loss of the CD4+ T-lymphocytes. Therefore, sarcoidosis in HIV-positive patients is rare. The development of sarcoidosis usually occurs when a significant increase in CD4+ T-cell count induced by HAART has taken place. Pulmonary involvement and symptoms are responsible for the majority of the morbidity and mortality in sarcoidosis. Renal involvement is significantly less common than respiratory symptoms. This patient was one out of two HI- positive cases of sarcoidosis among 200 patients who were diagnosed with sarcoidosis in our three major affiliated hospitals from 2000 to 2019. This case is unique and rare both in terms of unusual presentation of renal failure and hypercalcemia and also the co-occurrence of sarcoidosis in an HIV-positive patient while the CD4 count is lower than the normal limit.

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Case report of cytomegalovirus retinitis in an HIV-positive patient with a CD4-count nadir of 254 cells per μl

Eye ◽

10.1038/eye.2012.105 ◽

2012 ◽

Vol 26 (8) ◽

pp. 1153-1154 ◽

Cited By ~ 2

Author(s):

B C Ang ◽

S C Teoh

Keyword(s):

Case Report ◽

Cytomegalovirus Retinitis ◽

Cd4 Count ◽

Positive Patient ◽

Hiv Positive ◽

Count Nadir

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Prospective study of tubercular co-infection in HIV infected patients in VIMSAR, Burla, Sambalpur, Odisha, India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20181979 ◽

2018 ◽

Vol 5 (3) ◽

pp. 530

Author(s):

P. K. Bariha ◽

U. P. Pujari ◽

B. K. Kullu ◽

A. Thakur

Keyword(s):

Prospective Study ◽

Cd4 Count ◽

Positive Patient ◽

Hiv Positive ◽

Mortality And Morbidity ◽

Cd4 Cell Count ◽

Pulmonary Tb ◽

Common Opportunistic Infection ◽

Extra Pulmonary ◽

A Prospective Study

Background: Tuberculosis is the most common opportunistic infection in HIV positive patient. This is a major challenge faced by HIV positive patient. Methods: This study was carried out at Medicine Department and ART Centre, VIMSAR, Burla to know the epidemiology and clinical profile of HIV and TB co-infection. This is a prospective study in which all adult patients attending to our hospital for period of one year with HIV-TB co infection are enrolled. There were 269 patients. The clinical parameters are studied after all detailed history and clinical examination. The diagnosis of Tuberculosis was made by relevant investigation like Sputum AFB, Chest X-ray, CSF Study, CT Scan, Pleural Fluid Study, Ascitic fluid study etc.Results: The results indicate majority of the patients out of 211 patients 74 (82.52%), were male 34(16.35%)were female and TGTS were-3(1.42%). Age group mostly affected were 26-35 years (38.1%) and 36-45 years (38.1 %). Extra-pulmonary TB constituted 56.28% and Pulmonary TB-43.72%. 41.99% completed anti-TB treatment and mortality was 12.99%. Mean CD4 count at the time of diagnosis-218iu/l; and patients with low CD4 cell count at the time of diagnosis had high mortality.Conclusions: Extra-pulmonary TB is predominant among HIV TB co-infection and the working-class population affected more than the rest TB Meningitis and Disseminated TB are associated with a bad prognosis when compare to other forms of TB. A low CD4 count at the time of Tuberculosis diagnosis is associated with a higher mortality and early suspicion diagnosis of tuberculosis and early initiation of ATT in HIV patients reduces mortality and morbidity significantly.

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