An HIV-infected girl with an abscess at her left arm (Page 1/2)

Prepared by...Aurmporn Oberdorfer, MD, PhD
Virat Sirisanthana, MD
Department of Pediatrics, Chiang Mai University, Thailand

An 8-year-old girl. Address: Chiang Mai, Thailand
Chief compliant:
3 weeks ago she developed an abscess at her left arm. Her mother noticed that the abscess located at the same area of the BCG scar which she was vaccinated at 6 years of age. The abscess started as a small nodule at the BCG scar, slowly increased in size. The abscess turned from red to dark brown, mild warm and slightly tender. She did not respond to an oral antibiotic.
1 weeks ago,she developed moderate fever, and cough. Her mother gave her some medicines and she got better.
> Today she came to the hospital for her antiretroviral therapy (ART) appointment.
Present illness:
> She is a perinatally HIV-infected child who presented to us with Pneumocystis carinii pneumonia (PCP) at the aged of 8 years. Now she is on cotrimoxazole for the secondary PCP prophylaxis.


She was started on ART (AZT, 3TC, EFV) 13 weeks ago. Her original CD4 was of 1% (7cells/ccmm), and viral load was greater than 1,046,492 copies/mL. At 8 weeks of ART, her CD4 rose up to 7% (135 cells/ccmm), and her viral load declined to 341 copies/mL. She has been taken ART regularly.
Past history:
> Body weight at birth: 3,500 gm, breast feeding until 3 months of age.


Vaccination: got BCG at birth (Rt. Arm) and BCG booster at 6 years old (Lt. arm) as routine Thai schedule.(Lately this booster dose was no longer in the Thai Expanded Programme on Immunization guidelines)
Physical examination:
Body weight: 16.5 kg (< 3rd percentile), Height: 109 cm (<3rd percentile)
Vital signs: BT:37.0 degree celsius, pulse rate: 90/mins, respiratory rate:26/min
General appearance: A girl looks well, active, not pale, no jaundice
Heart: regular, Lungs: clear
Abdomen liver: 1 cm lower than right costal margin, no splenomegaly
Neurological examination: normal
Lymph nodes: left axillary lymphnode enlagement of 1.5 cm, not tender
Extermities: An abscess at left upper arm sized of 2.5 cm diameter, fluctuated. (Figure1)
Figure 1: An abscess at her left upper arm
What are differential Diagnosis? Next to Page 2

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