Case studies in
OI management
Module 4 Sub module case
studies OI
Case study 1

24 year-old man with oral thrush, presented with
low grade fever, progressive dyspnea on exertion
and dry cough for 2 weeks

Physical examination showed
T 38.5°C, RR 26/min, O2 saturation was 97% on
room air but decreased to 90% with minimal
exertion.
No cervical lymphadenopathy. Lung clear to
auscultation

CXR as shown
Case study 1
What is the differential Dx?
Case study 1

Differential Dx:
- PCP
- Miliary TB
- Disseminated fungal infection
- CMV infection
- Bacterial e.g. Salmonella
Case study 1

What will you do?
a. Start empirical Rx for PCP
b. Sputum examination and await result
c. Fiberoptic bronchoscopy with BAL (if
available)
Case study 1

BAL result : PCP
Case study 1






Presumptive PCP & Empirical Rx :
correct Rx in 72% ( CDC criteria : HIV+, dyspnea,
nonproductive cough, no previous prophylaxis,
had previous H/O PCP, CXR: diffuse interstitial
disease with moderate hypoxemia )
In severe or atypical cases : Early FOB
In slow or non-responded cases after empirical Rx
for 3-5 days : FOB
FOB: procedure of choice for Dx PCP
Sensitivity of BAL >95% if no Rx
Trans bronchial biopsy is not necessary but may
be helpful for Dx of concomitant infections
Case study 2
28 yr-o female, known HIV positive for 5 yrs,
presents with headache
1 month history of progressive headache
without fever or neurological deficit
No previous opportunistic infection except
herpes zoster 8 moths ago at her left chest
wall
Case study 2: Physical exam
T 37.2oC BP 110/60 P 90/min RR 20/min
Oral thrush
Pruritic papular eruption rash over extremities
Other general exam unremarkable
Neuro exam: fully conscious, cooperative
Cranial nerves: intact
Motor and sensation: intact
Stiff neck positive, mild photophobia
Pupil 3 mm, equal, reactive to light,
Fundus: no papilloedema
What is the most likely diagnosis?
What is the appropriate management?

Serum cryptococcal Ag: positive
>1:100

LP: pressure 40cm Hg (high)
RBC 5 cells/mm3, WBC 50 cells/mm3
Protein 88, sugar 60/98
India ink +ve
What should be the management?