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A 5-year-old HIV-infected boy with rash and abdominal pain (page 3/3)
Prepared by...
Virat Sirisanthana, M.D. *
* Department of Pediatrics, Chiang Mai University

> He was diagnosed as having chickenpox with bacterial pneumonia.
> Acyclovir (1500 mg/m2/d) 300 mg q 8 hr and cloxaxillin (100 MKD) 400 mg q 6 hr were administered
   
Progression: Day 1-2 of admission
Further management and course in the hospital:
> Despite parenteral cloxacillin and O2 mask, his respiratory condition deteriorated. RR=60/min, BG at O2 mask 6 LPM, pH 7.48, PaO2 87, PaCO2 29, HCO3 21, O2sat = 97%.
> Body temperature was 39.5C
> CXR: repeated later on day 1 of admission (figure 2) showed progression of the infiltration at rt.middle and rt. lower lobes
> CXR: on day 2 of admission (figure 3) showed more progression of the infiltration at rt.middle and rt. lower lobes
> Ceftazidime was added for fear of gram negative bacilli infection.
> He was intubated.
Figure 2 Chest X-ray later on day 1
Figure 3 Chest X-ray day 2 of admission
 
Figure 4 Chest X-ray day 3 of admission
Figure 5 Chest X-ray day 6 of admission
   
With respiratory support, he gradually recovered and was extubated on day 7 of admission.
He was well at the time of the follow up a month later.
 
Further tests for the etiologic agents showed:
> Intubated suctioned specimen: no significant organism found (no AFB, no significant bacteria, no Pneumocystis jirovecii)
> Blood culture: NG
Suggested further reading:
1. ѵ ѹ. Immune Reconstitution Inflammatory Syndrome 㹼ͪշҵҹ. ⪵ԾԷع, ѧ ԴҳԪ, ѧ Ţ (óҸԡ). Update on Pediatric Infectious Diseases 2004. ا෾ : ѷ Żþ ӡѴ 2547.p 287-93. (review article in Thai) Full text

2. Hirsch HH, Kaufmann G, Sendi P, Battegay M. Immune Reconstitution in HIV-Infected
    Patients. CID 2004:38:1159-66. (review article)

   
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