ABSTRACT
I. Introduction The approach to the evaluation of a pleural effusion in a human immunodeficiency virus (HIV)–infected patient begins with a differential diagnosis that includes all of the causes of both exudative and transudative pleural effusions found in non-HIV-infected individuals. As in all patients, helpful details in investigating the etiology of a pleural effusion can be obtained from presenting complaints and physical examination findings. In particular, duration of illness, symptoms, and the presence of other medical problems can provide significant clues as to the underlying process. For example, a pleural effusion in the setting of the acute onset of fever, cough, and purulent sputum points toward a bacterial parapneumonic process, whereas increasing dyspnea and cough in a patient with cutaneous Kaposi’s sarcoma (KS) suggest pleuropulmonary KS. As in non-HIV-infected individuals, evaluation of concomitant radiographic abnormalities and sampling of pleural fluid are crucial diagnostic steps.
