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Extrapulmonary tuberculosis masking disseminated histoplasmosis in AIDS
  1. L Greene1,
  2. B Peters2,
  3. S B Lucas2,
  4. A L Pozniak1
  1. 1Department of Genitourinary Medicine, King's College Hospital NHS Trust, London SE5 9RS
  2. 2Departments of Genitourinary Medicine and Histopathology, UMDS, St Thomas's Hospital, London SE1 7EH
  1. Dr A L Pozniak, St Stephen's Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9TH

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Case presentation (Dr L Greene and Dr A L Pozniak)

A 32 year old black African man was admitted from our emergency clinic complaining of right sided abdominal pain which was dull in nature with colicky exacerbations that had been present for 6 weeks. The pain had increased in severity over the preceding 3 days. The patient also reported watery diarrhoea and weight loss of 7 kg over the same period.

He had been found to be HIV antibody positive 1 month previously following an episode of shingles. He reported no risk factors for HIV infection other than unprotected vaginal intercourse in Africa up to 7 years previously. He had no other significant medical history and had not travelled outside of Europe since leaving west Africa in 1990. His CD4 count at diagnosis was less than 20 cells ×106/l. His only medication at presentation was co-trimoxazole 960 mg three times weekly as primary prophylaxis against Pneumocysitis carinii pneumonia and co-proxamol for pain relief.

On examination he was thin and mildly pyrexial at 37.5°C. Scarring from his recent attack of shingles was present on the left anterior thigh in the distribution of the L2 dermatome. The oral cavity was clear. Bilaterally, shotty, non-tender lymph nodes were present in the cervical, axillary, and inguinal regions. There were no cardiovascular or respiratory abnormalities. In the abdomen he had a large, tender, irregular non-mobile right iliac fossa mass that was dull to percussion which extended from the pelvis to below the level of the umbilicus. No other masses were palpable. Neurological examination was unremarkable.

Baseline investigations showed the haemoglobin was 10.7 g/dl, total white cell count was 3.2 × 109/l, and platelet count was 122 × 109/l. The mean cell volume was low at 75 fl with a ferritin level within normal limits. The aspartate aminotransferase (AST) and …

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