VA Morning Report 12.12 – Hypercalcemia, diffuse lymphadenopathy

Case Summary

Thanks to Anne Montgomery for presenting a fascinating case of 30M with HIV/AIDS who presented with AMS and fever found to have hypercalcemia and disseminated MAC.

Top pearls

  1. All lymphocytes, including CD4 cells, are reduced in acute infection. The CD4% is a more accurate measure of the degree of immunosuppression in patients with HIV presenting with an acute infection.
  2. Bacterial infections are the most common cause of infectious syndromes in patients with HIV and therefore, are the focus of the initial diagnosis and treatment.  CrAg, AFB blood culture (moderate sensitivity for disseminated MAC), and B-D-Glucan + LDH (sensitive, but not specific markers of PCP) are also important considerations in the first/second pass work up.
  3.  Both solid and liquid tumors occur with higher frequency in patients with HIV.  Many of these tumors are related to an oncogenic virus: squamous cell carcinoma (HPV), lymphoma (EBV) and kaposi sarcoma (HHV-8). See below for more details.
  4. Break up the causes of hypercalcemia into PTH-related and PTH-independent causes. Remember that a “normal” PTH is ABnormal in a hypercalcemic patient.



Non-infectious complications of HIV

HIV Non-CD 4 count

Hypercalcemia –



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