HIV and bronchiectasis


A 7 years old HIV infected girl presented with cough for 2 months and fever for 2 months. Both parents were on antiretroviral therapy {ART} and father had tuberculosis {TB} 3 years ago and mother had TB 6 years ago. On examination, weight was 15 kg, height was 104 cms. She had clubbing with generalized non-significant lymphadenopathy and bilateral leathery crepts in the posterior scapular region. Chest X-Ray showed right lower zone consolidation. Mantoux test was negative. CT Chest showed several large patchy consolidations in bilateral lung with multiple enlarged mediastinal nodes. She was thus started on antituberculous therapy {ATT} consisting of Isoniazid {H}, Rifampicin {R}, Pyrazinamide {Z} and Ethambutol {E}. Her CD4 count was 321, cumm. However, she continued to have cough and there was no weight gain with chest X-Ray showing bronchiectatic changes after 2 months of therapy. She was then started on ART consisting of Zidovudine {AZT, Lamivudine {3TC} and Efavirenz {EFV}, However she had no response and after 4 months of ART, she underwent bronchoscopy and bronchoalveolar lavage {BAL} was sent for TB culture.
Expert Opinion :
The child was subsequently treated with steroids in view of clinical suscpicion of LIP due to clubbing. She responded to the same, and nodes and consolidation resolved.
Answer Discussion :
Rolando Lezama
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Kim Seng Lee
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