28216610 Visualization

A 34 Age - year Age - old Age Hispanic Personal_background male Sex without History significant History past History medical History history History presented Clinical_event to our hospital Nonbiological_location with a one Duration month Duration history of cough Sign_symptom ; productive of whitish Color sputum Sign_symptom .
At presentation, he denied fever Sign_symptom , chills Sign_symptom , night Sign_symptom sweats Sign_symptom , chest Biological_structure pain Sign_symptom , hemoptysis Sign_symptom , back Biological_structure pain Sign_symptom , recent Detailed_description travel Clinical_event or sick Detailed_description contacts Clinical_event .
He reported that he had approximately a 15–20 pound Lab_value weight Sign_symptom loss Sign_symptom during the last Duration six Duration months Duration .
He denied History smoking Activity , socially drank Activity alcohol Activity , and had History unprotected Detailed_description sexual Activity intercourse Activity with History multiple Detailed_description partners Detailed_description in the past.
On admission, his temperature Diagnostic_procedure was 97.9°F Lab_value ; heart Diagnostic_procedure rate Diagnostic_procedure was 85 Lab_value beats Lab_value per Lab_value minute Lab_value , respiratory Diagnostic_procedure rate Diagnostic_procedure was 16 Lab_value breaths Lab_value per Lab_value minute Lab_value , blood Diagnostic_procedure pressure Diagnostic_procedure was 107/66 Lab_value mm Lab_value Hg Lab_value , and oxygen Diagnostic_procedure saturation Diagnostic_procedure was 100% Lab_value on room Detailed_description air Detailed_description .
Examination Diagnostic_procedure showed oral Biological_structure thrush Sign_symptom , decreased Lab_value breath Diagnostic_procedure sounds Diagnostic_procedure and crackles Sign_symptom on the right Biological_structure lower Biological_structure lung Biological_structure base Biological_structure .
No cutaneous Biological_structure lesions Sign_symptom were reported and the rest of clinical Diagnostic_procedure examination Diagnostic_procedure was unremarkable Lab_value .
His complete Diagnostic_procedure blood Diagnostic_procedure count Diagnostic_procedure ( CBC Diagnostic_procedure ) showed hemoglobin Diagnostic_procedure of 9.7 Lab_value g/dL Lab_value , WBCs Diagnostic_procedure 2.3×109/L Lab_value , and platelets Diagnostic_procedure of 164×109/L.
His creatinine Diagnostic_procedure was 0.62 Lab_value mg/dL Lab_value , and blood Diagnostic_procedure urea Diagnostic_procedure nitrogen Diagnostic_procedure was 10 Lab_value mg/dL.
Radiograph Diagnostic_procedure of the chest Biological_structure showed extensive Severity right Biological_structure and left Biological_structure perihilar Biological_structure opacity Sign_symptom more Biological_structure on Biological_structure the Biological_structure right Biological_structure side Biological_structure , and computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) scan of the chest Biological_structure showed a right Biological_structure sided Biological_structure large Severity perihilar Biological_structure mass Sign_symptom (Figure 1) with multiple Detailed_description thoracic Biological_structure and lumbar Biological_structure vertebrae Biological_structure , ribs Biological_structure , and sternal Biological_structure tiny Severity lytic Detailed_description lesions Sign_symptom consistent with bony Biological_structure metastasis Disease_disorder (Figure 2).
Blood Biological_structure and sputum Biological_structure cultures Diagnostic_procedure were negative Lab_value .
Tuberculosis Disease_disorder was ruled out by three Detailed_description consecutive Detailed_description negative Lab_value sputum Diagnostic_procedure smears Diagnostic_procedure for acid Detailed_description fast Detailed_description bacilli Detailed_description and a negative Lab_value QUANTIferon Diagnostic_procedure gold Diagnostic_procedure test Diagnostic_procedure .
He tested positive Lab_value for human Diagnostic_procedure immunodeficiency Diagnostic_procedure virus Diagnostic_procedure ( HIV Diagnostic_procedure ) and his CD4 Diagnostic_procedure counts Diagnostic_procedure came back at 7 Lab_value cells/uL.
He was started on prophylaxis Therapeutic_procedure with bactrim Medication 80–160 mg Dosage daily Dosage and azithromycin Medication 1200 Dosage mg Dosage weekly Dosage for opportunistic infections.
Bronchoscopy Diagnostic_procedure with biopsy Diagnostic_procedure was performed but was unrevealing Lab_value and he underwent a video Detailed_description assisted Detailed_description mediastinoscopy Diagnostic_procedure with biopsies Diagnostic_procedure of the right Biological_structure hilar Biological_structure mass Sign_symptom .
Pathology Diagnostic_procedure showed spindle Sign_symptom cells Sign_symptom positive Lab_value for CD34 Diagnostic_procedure , BCL2 Diagnostic_procedure , vimentin Diagnostic_procedure , and HHV-8 with diffuse Detailed_description positivity Lab_value for CD31 Diagnostic_procedure diagnostic of KS Disease_disorder .
He started treatment with HAART Medication in the form of emtricitabine Medication and Medication tenofovir Medication disoproxil Medication fumarate Medication 200/300 Lab_value mg Lab_value and dolutegravir Medication 50 Lab_value mg Lab_value .
The patient was actively Detailed_description involved Detailed_description in decisions Clinical_event regarding management Detailed_description options Detailed_description .
He favored HAART Medication isolated regimen without additional Medication chemotherapy Medication .
His condition showed continuing clinical Sign_symptom improvement Sign_symptom ; a repeat CT Diagnostic_procedure scan of the chest Biological_structure at three Date months Date showed profound regression Sign_symptom of the disease with disappearance of most of the lesions Sign_symptom (Figure 3).