Chapter 38: The purple spotted geek
A 42-year-old software engineer developed numerous pigmented skin lesions over a period of 6 months. He also noticed a purple lump on his hard palate. He then developed a cough and became short of breath, so he finally went to see his GP who sent him to A&E.
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1. What are the spots?
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2. What blood test would you recommend?
His HIV antibody test was positive and CD4 cell count was 34 /mm3 (7%) with a plasma HIV viral load of 256,000 copies/mL. He had a chest X-ray.
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3. What does the chest X-ray show?
Correct answer:
Reticular-nodular infiltrates more prominent in lower zones due to pulmonary Kaposi’s sarcoma.
He has a thoracic CT scan.
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4. What does the thoracic CT scan show?
Correct answer:
Reticular infiltrates and nodules characteristic of pulmonary Kaposi’s sarcoma.
He has a skin biopsy that confirms the diagnosis of Kaposi’s sarcoma.
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5. What virus causes Kaposi’s sarcoma?
The diagnosis was confirmed as stage T1 I1 S0 AIDS-associated Kaposi’s sarcoma. He was treated with combination antiretroviral therapy, opportunistic infection prophylaxis and systemic liposomal anthracycline chemotherapy.
After 4 months his palate, conjunctiva and lungs were dramatically better and his CD4 count had risen to 58/mm3 and plasma HIV viral load was undetectable (<40 copies/mL).
