Author: Thomas Mac Mahon / Editor: Sarah Edwards / Codes: IC6, IP1, OncP1, SLO1 / Published: 27/01/2023
A 42-year-old man attends your Emergency Department (ED) with a three-week history of weight loss (10kg), worsening crampy abdominal pain, night sweats and fevers (up to 38.5°C). He has no cough, sore throat, vomiting or diarrhoea.
He was diagnosed with HIV two years ago and takes his combination antiretroviral therapy as prescribed. He has no other medical problems, and none of his household contacts are unwell.
On examination he is alert and orientated but looks thin and unwell. He has a mild tachycardia (105bpm), but the remainder of his vital signs are within normal limits. His oropharynx and mucus membranes appear normal. He has no rash or meningeal signs. His chest is clear, with periumbilical abdominal tenderness but no guarding. You palpate some non-tender pea-sized axillary lymph nodes.
His full blood count shows a haemoglobin of 7.4g/dL (normal range 13.6-17.7g/dL), white cell count of 1.8×109/L (normal range 4.5-11×109/L) and platelets of 53×109/L (normal range 150-450×109/L). His CRP is elevated at 110mg/L (normal 0-5mg/L). His blood glucose, renal and liver function are normal. His monospot test is negative. His chest x-ray is grossly normal.
His most recent CD4 T-cell count was 245 cells/μL with an undetectable viral load.