ABSTRACT
A 56-year-old man was admitted from the HIV outpatient clinic complaining of fever and shortness of breath. He described shortness of breath on exertion and a new cough productive of yellow sputum with streaks of blood. He felt nauseated and generally weak. His past medical history included a hospital admission 6 weeks earlier where he had been diagnosed with pulmonary tuberculosis and tested positive for HIV at that time. His CD4 count at that point had been 9 (reference range 450–1660 cells/mm3). Anti-tuberculosis treatment was commenced at this stage, followed by anti-retroviral therapy, and co-trimoxazole for Pneumocystis jirovecii pneumonia (PCP) prophylaxis 2 weeks later. He took no other medications. He did not drink alcohol and had never smoked. He worked as a bus driver and lived with his son. He was originally from Nigeria and had lived in the United Kingdom for the past 3 years with annual holidays to Nigeria.
