T.H., a 48-year-old man, was an admitted intravenous (IV) drug user and occasionally abused alcohol. Over 4 weeks, he had experienced fever, night sweats, malaise, a cough, and a 10-lb. weight loss. He was also concerned about several discolored lesions that had erupted weeks before on his arms and legs. T.H. made an appointment with a physician assistant (PA) at the neighborhood clinic. On examination, the PA noted bilateral anterior cervical and axillary lymphadenopathy and pyrexia. T.H.'s temperature was 39°C. The PA sent T.H. to the hospital for further studies.
T.H.'s chest radiograph (x-ray image) showed paratracheal adenopathy and bilateral interstitial infiltrates, suspicious of tuberculosis (TB). His blood study results were positive for human immunodeficiency virus (HIV) and showed a low lymphocyte count. Sputum and bronchoscopic lavage (washing) fluid were positive for an acid-fast bacillus (AFB), and a PPD (purified protein derivative) skin test result was also positive. Based on these findings, T.H. was diagnosed with HIV, TB, and Kaposi sarcoma related to past IV drug abuse.
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