CASE 3 52 yo man HIV positive 1999 CD4 nadir 50 Smoker 35 pack yrs…quit 2005 COPD…chronic bronchitis Diabetic, Hypertensive, Hyperlipidemic.

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Presentation transcript:

CASE 3 52 yo man HIV positive 1999 CD4 nadir 50 Smoker 35 pack yrs…quit 2005 COPD…chronic bronchitis Diabetic, Hypertensive, Hyperlipidemic

CASE Abacavir/3TC/RTV/Atazanavir Trial of steroid inhaler for COPD Worsening of hypertension, diabetes and lipids along with a change in body habitus with increased centripetal obesity and a dorsocervical fat pad

CASE Development of rapidly growing right sided inguinal mass No constitutional symptoms On examination…rock hard, immobile, 6 cm right inguinal mass

CASE In retrospect has ignored very minor painless intermittent painless rectal bleeding over past 4 months CD4 890 HIV viral load<50

CASE On further examination….rectal ulceration approx. 3 cm with heaped up edges DIAGNOSIS?

CASE CT Scans of chest/abdo/pelvis/revealed inguinal mass and nothing more HOW WOULD YOU FURTHER INVESTIGATE?

CASE Ultrasound guided core biopsy revealed…squamous cell ca Biopsy of rectal ulceration…anal squamous cell ca!

CASE /2011 Chemotherapy, radiation and surgery to remove residual groin mass Thus far free of disease…will need very close f/u over time both clinically and radiographically

HIV CASE PRESENTATIONS Mike Silverman MD FRCPC David Fletcher MD FRCPC