Pulmonary Hemorrhage: Results

Pulmonary Hemorrhage: ResultsA liver biopsy specimen disclosed granulomatous hepatitis, without evidence for AFB or fungal disease. However, symptoms and liver function test abnormalities resolved entirely within 3 weeks of receiving empiric isoniazid, rifampin, and ethambutol. Treatment with these drugs was discontinued 3 months PTA on return of abdominal pain, nausea, vomiting, weight loss, malaise, and night sweats. An extensive gastrointestinal evaluation was unre-vealing and the patient was admitted to the hospital for progression of symptoms.
At the time of hospital admission, the patient also complained of dyspnea, and was found to have a new large right pleural effusion with right lower lobe consolidation and atelectasis, in addition to a smaller left pleural effusion. A diagnostic right thoracentesis yielded serosanguineous fluid compatible with an exudate (total protein, 4,000 mg/dL; lactate dehydrogenase [LDH], 441 lU/mL [serum, 451 IU/mL]; glucose, 84 mg/dL [serum glucose not available]; RBC, 3,575/mm; WBC, 170/mm [20% polymorphonuclear leukocytes, 60% lymphocytes, 20% mesothelial cells]); special stains and cultures for routine bacterial, AFB, and fungal pathogens were negative. A pleural biopsy specimen demonstrated abundant invasive fungal elements involving the pleura, with morphologic features consistent with Histoplasma capsula-tum, prompting initiation of intravenous amphotericin В therapy. other

On the seventh hospital day, the patient developed hypotension, melena, hematemesis, and abdominal pain. The patient was successfully resuscitated with intravenous crystalloid, 4 U of packed RBCs, and 6 U of fresh frozen plasma, but he required intubation for progressive respiratory compromise. A chest radiograph demonstrated increased interstitial markings bilaterally, enlarged cardiac silhouette, and bilateral pleural effusions, findings that were interpreted as representing congestive heart failure.

This entry was posted in Respiratory Symptoms and tagged AIDS, alveolar hemorrhage, pulmonary infiltrates.