Intersecting Pathologies: A Unique Case of Usual Interstitial Pneumonia and Organizing Pneumonia in an HIV Patient
Abstract
Abstract Introduction: Lung related complications are common in HIV patients, there are only two reported cases of usual interstitial pneumonia (UIP) associated with organizing pneumonia in the literature. We present a rare case of such a dual-pathology managed with oxygen therapy and steroids. Clinical summary: A 65-year-old male with a past medical history of coronary artery disease and HIV on darunavir/ cobicistat/ emtricitabine /tenofovir alafenamide (CD4 – 667, viral load – 30) presented with fever, flu-like illness, and shortness of breath for 4 days, with no sick contacts and noncontributory social history. Upon admission, the patient was tachypneic and in respiratory distress and was placed on a high-flow nasal cannula with 50L/40% FiO2. On physical examination, he had clubbing and bilateral inspiratory crackles. Labs revealed normal white count, procalcitonin and troponin, elevated kidney function, inflammatory markers, lactate with negative respiratory pathogen panel, and rapid strep A screen. Imaging studies disclosed extensive ground glass densities within the lungs, representing acute infiltrates with chronic interstitial lung disease at the lung bases. Echocardiography showed normal biventricular ejection and no pulmonary hypertension. Intravenous Levofloxacin was commenced for possible bilateral atypical pneumonia; however, throat, sputum, and blood culture showed no growth. Given persistent infiltrates on repeat imaging and increasing oxygen requirements, the…
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