Clinical History:

A 29-year-old woman became increasingly short of breath, with a non-productive cough and low-grade fever. She also had a mild watery diarrhea for the past week. She was also noted to have hypoglycemia and hyponatremia. A chest radiograph showed ill-defined bilateral infiltrates. A stool for ova and parasites was negative. A bronchoalveolar lavage (BAL) with transbronchial biopsy (TBB) was performed. After the results of the BAL and TBB were reported, an HIV test was performed and was positive. A CD4 lymphocyte count was 135 cells/microliter. Further history revealed that her risk factor was a sex partner at risk (a former injection drug user).

Answers:

1. What is the stage of her HIV infection?

She is in Stage C3. Stage C is reached when an opportunistic infection or neoplasm, in this case cytomegalovirus (CMV), diagnostic of AIDS is present. Even if she did not have an opportunistic infection, she would still be diagnosed with AIDS because her CD4 lymphocyte count is <200 cells/microliter.

2. Where else in the body might this infection be found?

CMV infection is often widely disseminated. The severity can be quite variable. CMV can produce a pneumonitis, as in this case. Cytomegalovirus can produce a retinitis with pain and blindness and is the most common cause for visual problems with AIDS. Gastrointestinal infection can occur. CMV meningoencephalitis can occur. The adrenal can be involved to produce endocrine manifestations similar to Addison's disease.