Thread by @TheIDtrivia

🧵1/5 #IDtwitter, this is our weekly #IDtrivia 📚

39y/M with no PMH, presents to the ED for evaluation of fatigue, anorexia, and diarrhea of 3 weeks duration. ROS is positive for weight loss, night sweats and an intermittent maculopapular rash located on his chest

2/5 Patient denies recent travel, sick contacts. He works as a bus driver. Sexually active with cis male partners, no condom use, takes PrEP occasionally. Hx of treated syphilis, last HIV and QuantiFERON-TB 6 months ago negative

3/5 On presentation BP88/68 HR90 RR20, T98.7,lethargic, AOx3. Chest clear to auscultation,normal heart sounds, abdomen tender to palpation of mesogastrium. He also had a diffuse rash (pic)

4/5 Labs WBC 3, Hgb 12, Plt 350, Cr 1.1, BUN 40. Na 129, K5,6, CL 112, Glu60. HIV (+), CD4 50, viral load 113,000. RPR 1:18, CXR normal, O&P negative.

5/5 What pathogen is responsible for this presentation?
#IDboardreview #MedEd

🧵 #IDtwitter this is the answer for the previous question:

C) CMV

Hypotension +hyponatremia+ hyperkalemia +hypoglycemia + HCL metabolic acidosis are pathognomonic of adrenal insufficiency(AI). In a patient with HIV; OI and malignancy are the major causes. 👇

CMV and TB are the principal OI’s reported. Adrenal insufficiency due to M Tuberculosis usually occurs within the first 2 years of TB diagnosis in association with no adherence to treatment. A recent negative quantiFERON ruled out TB in this patient. 👇

Patient with multiple sexual partners, no condom use and not compliance with PrEP put him on risk of contracting HIV and most likely syphilis reinfection, however HIV and Syphilis don’t cause AI. 👇

ncbi.nlm.nih.gov/pmc/articles/P…

First infographic about #CMV in #HIV patients.

#IDtwitter #MedED #HIVtwitter #MedTwitter

Second infographic about infectious causes of adrenal insufficiency.

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