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What’s your diagnosis? HIV+, CD4 count of 55 per  L, retrosternal pain, without improvement after taking 200 mg of fluconazole per day for 1 week. For.

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Presentation on theme: "What’s your diagnosis? HIV+, CD4 count of 55 per  L, retrosternal pain, without improvement after taking 200 mg of fluconazole per day for 1 week. For."— Presentation transcript:

1 What’s your diagnosis? HIV+, CD4 count of 55 per  L, retrosternal pain, without improvement after taking 200 mg of fluconazole per day for 1 week. For an answer, click here. This is one of over 900 images available on

2 Answer: Longitudinal ulcers in the lower esophagus suggest CMV esophagitis, confirmed by biopsy The prominent eosinophilic nucleolus in the submucosa of the esophagus is evidence for CMV infection This is one of over 900 images available on

3 What’s your diagnosis? CD4 count of 184, fever, and weight loss For an answer, click here. This is one of over 900 images available on Sept 3, 2006November 15, 2006

4 This is one of over 900 images available on Sept 3, 2006November 15, 2006 Answer: A partly calcified mass superior to the right kidney is seen on September 3, with increase in size on November 15. Remarkably high EBV viremia (7.1 * 10 6 per ml). The main differential diagnoses were lymphoma and tuberculosis. Needle biopsy yielded malignant cells which were CD20+, IRF4+, and Bcl-2+, but CD10 and Bcl-6 negative. Final diagnosis: malignant large-cell B type lymphoma

5 For an answer, click here. This is one of over 900 images available on What’s your diagnosis? 26 yo African woman with abdominal pain and suspected extrauterine pregnancy HIV-test was +, CD4 count 18/  L

6 This is one of over 900 images available on Answer Abdominal tuberculosis CT shows extensive lymphadenopathy (arrows) Laparoscopy revealed enlarged lymph nodes with acid-fast bacteria. Culture: M. tuberculosis HIV-test was +, CD4 count 18/  L

7 For an answer, click here. This is one of over 900 images available on What’s your diagnosis? A 35 year-old patient with a CD4 count of 35, never treated for HIV. His wife reports that he forgets things and stumbles. (Left): MRI scan without gadolinium (Right): A T1-weighted image after gadolinium enhancement.

8 This is one of over 900 images available on Answer: Probable AIDS-related dementia, a.k.a. HIV encephalitis, or AIDS dementia complex. (Left): Marked atrophy is evident: enlarged ventricles, prominent sulci (Right): The T1-weighted image after gadolinium enhancement shows diffuse, low-grade uptake of gadolinium in the white matter

9 For an answer, click here. This is one of over 900 images available on What’s your diagnosis? This patient has established Castleman’s disease since October After chemotherapy he entered remission, but in October 2006, he had weight loss, fever, and precordial pain. Shown here is a frame from a 2-dimensional echocardiogram.

10 This is one of over 900 images available on Answer: Pericardial effusion due to body-cavity lymphoma The echocardiogram shows an echo-free space surrounding the heart. Pericardiocentesis yielded an exudate with malignant plasmacytoid cells (see insert) staining for CD38, but negative for CD20

11 For an answer, click here. This is one of over 900 images available on What’s your diagnosis? An extremely immune suppressed patient died after a 7 month illness with malabsorption, loss of weight, fever, and finally liver and kidney failure. Biopsies of liver and duodenum showed massive infiltration by acid-fast bacteria, but cultures remained negative. Shown here: acid-fast stain of duodenum at autopsy.

12 This is one of over 900 images available on Answer: Infection with Mycobacterium genavense, which clinically resembles infection with M. avium, except that conventional cultures remain negative. See N. Engl. J. Med. 323:109-13, and Lancet :76-80

13 For an answer, click here. This is one of over 900 images available on What’s your diagnosis? Lesions gradually increased over several months. The patient is immune suppressed (CD4 count below 100) but otherwise asymptomatic.

14 This is one of over 900 images available on Answer? Molluscum contagiosum. This is a benign viral infection, seen frequently in healthy children. In the presence of immune suppression, lesions may become more abundant.

15 For an answer, click here. This is one of over 900 images available on “Crushed ping-pong balls” – that’s what this is supposed to resemble. What pathogen are we talking about?

16 Answer: There are many ways to color a pneumocyst Giemsa Immunoperoxidase Silver stain (« crushed ping-pong balls ») Fungi-flor ®Grocott stain This is one of over 900 images available on

17 For an answer, click here. This is one of over 900 images available on What’s your diagnosis? An extremely immune suppressed patient presented with fever and heel pain.

18 Answer: Bacillary angiomatosis The diagnosis was established by biopsy (right, Whartin-Starry stain, and electron microscopy). Bartonella hensela shows up black rod-like or coccobacillary elements. Definite diagnosis relies on amplification and sequencing of 16SrDNA, as well as serology. This is one of over 900 images available on

19 For an answer, click here. This is one of over 900 images available on What’s your diagnosis? The symptoms were fever, chest pain, and dyspnea

20 This is one of over 900 images available on Answer: Pneumocystis pneumonia (note interstitial infiltrate of the left lung) with spontaneous pneumothorax. Lung cysts may rupture spontaneously. Although spectacularly evident in the CT scan (right, from another patient), cysts are often difficult to see in conventional Xrays.

21 Lung involvement is often asymptomatic. Cryptococci are occasionally seen in fine needle aspirates of a coin lesion (left) or broncho-alveolar lavage samples (right) For an answer, click here. This is one of over 900 images available on What’s your diagnosis? These micro-organisms were seen in broncho- alveolar lavage fluid. The symptoms were pulmonary infiltrates, fever, and headache.

22 Lung involvement is often asymptomatic. Cryptococci are occasionally seen in fine needle aspirates of a coin lesion (left) or broncho-alveolar lavage samples (right) This is one of over 900 images available on Answer: Cryptococcus neoformans, Papnicalaou stain. More usually, cryptococci are seen in the cerebrospinal fluid (right), using “india ink” staining. Budding forms are typical (arrow)

23 For an answer, click here. This is one of over 900 images available on What’s your diagnosis?

24 This is one of over 900 images available on Answer: Advanced Kaposi’s sarcoma with bilateral leg edema, see detail (right) Photo credit: R. Lüthy


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