Unusual imaging findings of SARS-CoV-2 in HIV-positive patie
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Considering SARS-CoV-2 as a major differential diagnosis of pneumocystis in HIV-positive patients even if the lesions are typical.

A 34-year-old man was known to be HIV positive. He was receiving, with poor compliance, a single fixed-dose combination tablet containing tenofovir/emtricitabine/effavirenz as first-line treatment. He was admitted for a fever, cough, and shortness of breath that had been progressing for a week, associated with digestive symptoms including diarrhea and vomiting.

A noncontrast chest CT scan was done and showed the presence of diffuse and peripheral ground glass opacities, predominantly in posterior lobes, associated with cystic lung lesions, which are more specific to an opportunistic pneumocystis infection given the context of immunosuppression.

An infection with the new coronavirus SARS-CoV-2 was also suspected due to his previous contact with a confirmed case of SARS-CoV-2, an RT-PCR analysis of sputum samples was performed and came back positive; on the other hand, a bronchoalveolar lavage was carried out to check for pneumocystis, and was negative. His ARN viral charge was high at 5.23 log (169 000 copy/mL), and the CD4 count was low at 230/mm3.

The patient was hospitalized; his vital signs showed a saturation of 80% in the ambient air and 88% under oxygen at 2 L/min. The results of the blood tests showed a C-reactive protein concentration of 30 mg/L, leukocytes 7360 with neutrophils 6650, and lymphocytes 260.

During his hospitalization, the patient was closely monitored and treated by the therapeutic protocol adopted by the Ministry of Health in Morocco based on association between the use of hydroxychloroquine for 10 days, Azithromycin for 5 days, with brief corticosteroid therapy (5 days). He also restarted his antiviral tri-therapy. During 20 days of hospitalization, he remained stable with improved respiratory function at 90% saturation in the ambient air. He was discharged after consecutive two respiratory specimens tested negative by two RT-PCR taken at 24 h apart.

Source: https://onlinelibrary.wiley.com/doi/10.1002/ccr3.4004?af=R