Refractory hypoxia in an HIV-infected patient-a diagnostic challenge

Siddharth A. Wayangankar, Harsh Golwala, Michael S. Bronze

Research output: Contribution to journalArticlepeer-review


A 39-year-old man with HIV presented to the emergency department for evaluation of dyspnea accompanied by fever, diffuse chest discomfort, dry cough, and fatigue for past 1 week. The patient described his dyspnea as exertional progressing over 1 week to rest dyspnea. He was prescribed antiretroviral therapy but was noncompliant. He had no paroxysmal nocturnal dyspnea, orthopnea, rash, oral thrush, or diarrhea. His last record CD4+ lymphocyte count and HIV viral load were 43 cells/mm3 and 178 0000 copies/mL, respectively. Vital signs included a temperature of 101F, heart rate of 115 beats per minute, respiratory rate of 16 per minute, and pulse oxygenation of 91% on room air. Lung examination revealed decreased breath sounds bilaterally, and the remainder of the examination was unrevealing. Laboratory findings revealed leukocytosis and increased serum lactate dehydrogenase of 577 U/L (90-190 U/L), and chest radiograph showed a right lower lobe infiltrate and perihilar, bilateral interstitial infiltrates (Fig. 1A).

Original languageEnglish (US)
Pages (from-to)1322.e5-1322.e6
JournalAmerican Journal of Emergency Medicine
Issue number7
StatePublished - Sep 2012
Externally publishedYes

ASJC Scopus subject areas

  • Emergency Medicine


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