Pulmonary findings in HIV patient
40-year-old patient with h/o HIV, most recent CD4 count of 100 ⋃/ ml, presents to the ER complaining of fever, chills, dyspnea and dry cough for the past week. He has been non compliant with his HAART regimen and other prophylactic medications. On exam, his temperature is 102.5‧ F, HR: 120/m, BP: 88/59, RR: 32/m with sPO2: 92% on 4 LPM supplemental O2. Chest X-ray findings were reportedly non-specific. BAL fluid analysis using Methenamine silver stain, as seen under the microscope, is shown below.
What is the most likely diagnosis?
1. Cryptococcus neoformans
2. Pneumocystis jiroveci- Answer
3. Mycobacterium avium complex
4. Cytomegalovirus infection
5. Toxoplasma gondii
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