Slide 45 So, this is the patient who was referred to the Washington D.C. Department of Health Chest Clinic. And she is a 40 year-old woman who won a green card lottery, and immigrated from on October of 2010. She had previously worked as a lawyer she was in , and she her – husband unfortunately passed away two years prior, and she came here to the with her five year-old son. She had no significant past medical history, or any bad habits like alcohol, or tobacco, or drug use. About one month after arriving in the , she was admitted to the hospital over complaints of malaise, abdominal discomfort, shortness of breath and cough, with a reported 18-kilogram weight loss. Although I'm not sure what timeframe that was over. And unfortunately, she was diagnosed with a new diagnosis of HIV infection with AIDS with a CD4 count of 10. And she had a chest x-ray which I'll show you on the on the next slide. Incidentally, we have no record of her having a – PPD or an IGRA done, and we also don't have any information about her immigration work-up prior to arrival. Slide 46 So, this is the CAT scan she had. As you see, I don't really need a pointer, but there’s a large right pleural effusion here. And then over here, in the abdominal slices, you can see, in the spleen, there is a low density lesion as well as some ascites, and some necrotic nodes. So, the radiologist read – formally read her CT scan as consistent with lymphoma. And so, she’s carried around this diagnosis. And as the primary physician who saw her was initially very concerned about malignancy, and sent of numerous tumor markers. Slide 47 So, because of this worry about malignancy, she underwent a retroperitoneal lymph node biopsy, and the pathology showed that there were intracellular acid-fast bacilli, but no caseous necrosis. And the pathologist read this as suggestive of mycobacterium avium-intracellulare.
Slide 45 So, this is the patient who was referred to the Washington D.C. Department of Health Chest Clinic. And she is a 40 year-old woman who won a green card lottery, and immigrated from on October of 2010. She had previously worked as a lawyer she was in , and she – her husband unfortunately passed away two years prior, and she came here to the with her five year-old son. She had no significant past medical history, or any bad habits like alcohol, or tobacco, or drug use. About one month after arriving in the , she was admitted to the hospital over complaints of malaise, abdominal discomfort, shortness of breath and cough, with a reported 18-kilogram weight loss. Although I'm not sure what timeframe that was over. And unfortunately, she was diagnosed with a new diagnosis of HIV infection with AIDS with a CD4 count of 10. And she had a chest x-ray which I'll show you on the – on the next slide. Incidentally, we have no record of her having a PPD or an IGRA done, and we also don't have any information about her immigration work-up prior to arrival. Slide 46 So, this is the CAT scan she had. As you see, I don't really need a pointer, but there’s a large right pleural effusion here. And then over here, in the abdominal slices, you can see, in the spleen, there is a low density lesion as well as some ascites, and some necrotic nodes. So, the radiologist read – formally read her CT scan as consistent with lymphoma. And so, she’s carried around this diagnosis. And as the primary physician who saw her was initially very concerned about malignancy, and sent of numerous tumor markers. Slide 47 So, because of this worry about malignancy, she underwent a retroperitoneal lymph node biopsy, and the pathology showed that there were intracellular acid-fast bacilli, but no caseous necrosis. And the pathologist read this as suggestive of mycobacterium avium-intracellulare.
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