trimethoprim--sulfamethoxazole-drug-combination and Chest-Pain

Pneumocystis is typically described in the immunodepressed. We report a case of pneumocystis occurring in a patient without known depression of the immune system. The patient, aged 50, was hospitalised for a diffused infiltration pneumonia which developed sub-acutely, and presented with increasing dyspnoea of effort, thoracic pain and a disturbances of general health. The initial assessment did not reveal any risk factors for HIV infection nor any past history of note. The diagnosis of pneumocystis was confirmed by the presence of Pneumocystis carinii in the bronchoalveolar lavage from two samples. There was a favourable outcome following the prescription of Cotrimoxazole for three months and steroid therapy. HIV serology was negative and the sub-population of lymphocytes was normal. A search for neoplasia or systematic disease remained negative.

Topics: Adrenal Cortex Hormones; Anti-Infective Agents; Bronchoalveolar Lavage Fluid; Chest Pain; Diagnosis, Differential; Dyspnea; Humans; Male; Middle Aged; Pneumocystis; Pneumonia, Pneumocystis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Burkholderia pseudomallei; Chest Pain; Cough; Diagnosis, Differential; Doxycycline; Humans; Lung; Lung Diseases, Fungal; Male; Mediastinal Diseases; Middle Aged; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis

Topics: Acetaminophen; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Infective Agents; Chest Pain; Codeine; Drug Combinations; Echocardiography; Female; Heart Septal Defects, Atrial; Humans; Ibuprofen; Nurse Practitioners; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

PRESENTING FEATURES: A 53-year-old man who had human immunodeficiency virus (HIV) presented to the Johns Hopkins Hospital with a 3-month history of increasing dysphagia, cough, dyspnea, chest pain, and an episode of syncope. His past medical history was notable for oral and presumptive esophageal candidiasis that was treated with fluconazole 6 months prior to presentation. Three months prior to presentation, he discontinued his medications, and his symptoms of dysphagia recurred. During that time he developed intermittent fevers and chills, progressively worsening dyspnea on exertion, and a cough productive of white sputum. He also reported a 40-lb weight loss over the past 3 months. On the day prior to presentation, he had chest pain and shortness of breath followed by weakness, dizziness, and a brief syncopal episode. He denied orthopnea, paroxysmal nocturnal dyspnea, lower extremity edema, jaundice, hemoptysis, hematemesis, melena, hematochezia, or diarrhea. There was no history of alcohol use, and he stopped smoking tobacco approximately 1 month previously. He smoked cocaine but denied injection drug use. The patient had never been on antiretroviral therapy and had never had his CD4 count or viral load measured. On physical examination, the patient was a thin, cachectic man who appeared older than his stated age. His vital signs were notable for blood pressure of 102/69 mm Hg, resting tachycardia of 102 beats per minute, resting oxygen saturation of 92% on room air, normal resting respiratory rate, and a temperature of 38.1 degrees C. His oropharynx was clear, with no signs of thrush or mucosal ulcers. His pulmonary examination was notable for diminished breath sounds in the lower lung fields bilaterally. Cardiac, abdominal, and neurologic examinations were normal. His skin was intact, with no visible petechiae, rashes, nodules, or ulcers. Laboratory studies showed a total white blood cell count of 3.2 x 10(3)/microL, with a total lymphocyte count of 330/microL, hematocrit of 30.2%, a serum sodium level of 129 mEq/L, and a serum lactate dehydrogenase level of 219 IU/L. The patient had an absolute CD4 count of 8 cells/mm3 and a HIV viral load of 86,457 copies/mL. His arterial blood gas on room air had a pH of 7.51, a PCO2 of 33 mm Hg, and a PO2 of 55 mm Hg. Electrocardiogram and serial serum cardiac enzymes were normal. A chest radiograph showed bilateral upper lobe patchy infiltrates with left upper lobe consolidation. Computed tomographic (CT) scan o

Topics: AIDS-Related Opportunistic Infections; Anti-Infective Agents; Anti-Inflammatory Agents; Bronchoalveolar Lavage Fluid; Chest Pain; Cough; Deglutition Disorders; Diagnosis, Differential; Drug Therapy, Combination; Dyspnea; Humans; Lung Diseases, Fungal; Male; Middle Aged; Pneumonia, Pneumocystis; Prednisone; Sporotrichosis; Syncope; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination