ABSTRACT
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 historical and physical exam findings. In particular, duration of illness, symptoms, and 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 would point towards a bacterial parapneumonic process, whereas increasing dyspnea and cough in a patient with cutaneous Kaposi’s sarcoma (KS) could suggest pleuropulmonary KS. As in non-HIVinfected individuals, evaluation of concomitant radiographic abnormalities and sampling of pleural fluid are crucial diagnostic steps.
