67 yo man newly diagnosed with HIV/AIDS after admission to t | Figure 1

67 yo man newly diagnosed with HIV/AIDS after admission to the ICU with PCP pneumonia. This is his CD4 count.

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A 23‐year‐old man presented with a 2‐month history of recurrent fever and progressing skin ulcers with eschars on his face, trunk and extremities (a, b). Treponemal serology test was positive and immunohistochemistry of his skin biopsy showed numerous spirochetes (c, arrows). Additional results confirmed that he was infected with HIV, with a decreased CD4+ T‐cell count. A diagnosis of malignant syphilis associated with HIV infection was finally made. Malignant syphilis is an uncommon manifestation of secondary syphilis, characterized by generalized ulcerative skin lesions with prodromal symptoms. Generally, it occurs in immunosuppressed individuals, especially in HIV‐infected patients. Malignant syphilis may be the initial presentation of underlying HIV infection. The patient was treated with doxycycline 100 mg twice daily for 14 days as he was allergic to penicillin. The therapy resulted in rapid regression of the skin lesions (d), and antiretroviral therapy was initiated.



49 off #HAART-(highly-active-antiretroviral-therapy) for 4 years c/o diffuse hyperpigmented and violaceous lesions. They began as pink patches and over the course off a couple weeks (he thinks) darkened and appeared as above. Also being treated for pcp. Cd4 count pending. Biopsy scheduled.

Cochrane Review; 11 studies (2531 people); comparing resistance testing with no resistance testing in HIV‐positive people. Main results Resistance testing probably made little or no difference to the risk of dying (moderate‐certainty evidence) or progression to AIDS (moderate‐certainty evidence). Resistance testing probably increased the chance of successful suppression of HIV replication (low‐certainty evidence) but probably made little or no difference in CD4 cell counts (cells affected by HIV) (moderate‐certainty evidence). Resistance testing made little or no difference in the number of people who experience medication side effects (low‐certainty evidence). No studies examined how many people developed a new opportunistic infection, and no studies examined patient quality of life. Conclusion For people for whom treatment no longer works, the use of resistance tests to select new treatments led to suppression of the HIV virus as measured by a blood test, but probably did not reduce the risk of death or progression to AIDS. Whether or not resistance testing provides any benefit for patients who are starting HIV treatment for the first time remains uncertain because no studies have evaluated this. These conclusions are based on studies conducted up to 12 years ago and included very few participants from low‐ and middle‐income countries.



CD4



A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.



A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.
Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.



A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.



Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?