PMC5624155_01
Pulmonary CT-scan with evidence of atypical bilateral pneumonia: pulmonary parenchyma with multiple areas of interstitial infiltrates (patchy infiltrates) involving apical and medial areas of both pulmonary fields.
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On day 19 of hospitalization, due to continuous episodes of low oxygen saturation, a chest CT-scan was ordered (Figure 1), showing generalized lung involvement and mediastinal adenopathy (Video 1 in Supplementary Material https://doi.org/10.1155/2017/9314580).
Panel (a): lung biopsy with pulmonary tissue showing young fibroblast proliferation at the interstitial level with lymphocytes, histiocytes, and red blood cells. Panel (b): abundant cytomegalovirus inclusions and alveolar spaces with type II pneumocytes and red blood cells. Ziehl-Neelsen, Grocott, and periodic acid-Schiff stain (PAS) were negative. Panel (c): esophagus biopsy with loss of mucosal continuity and the presence of hemorrhage. Panel (d): important infiltration of polymorphonuclear cells and epithelioid cells with a few fragments of squamous epithelia. Acid fast bacilli stain and fungal stains were negative.
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Later that day, an endoscopy showed chronic reflux esophagitis (Grade D of the Los Angeles Classification System), with ulceration (Figures 2(c) and 2(d)).
Timeline of patients' clinical evolution with diagnostic tests and treatments. HIV human immunodeficiency virus, KS Kaposi's sarcoma, PPD purified protein derivative, CMV cytomegalovirus, ART antiretroviral therapy, CPAP continuous positive airway pressure, and IRIS immune reconstitution inflammatory syndrome.
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Patient was discharged from the hospital after 45 days of treatment (Figure 3).