Differential Diagnosis
- Single most likely diagnosis
- C) Immune reconstitution inflammatory syndrome (IRIS): This condition occurs in HIV patients who have recently started antiretroviral therapy (ART) and have a significant increase in CD4+ T-lymphocyte count, as seen in this patient (from 51/mm^3 to 185/mm^3). The symptoms of daily high fever, lymphadenopathy, and the absence of other infectious symptoms are consistent with IRIS.
- Other Likely diagnoses
- B) Drug-related fever: The patient has been taking fluconazole and antiretroviral therapy, which could potentially cause a drug-related fever. However, the presence of lymphadenopathy and the significant increase in CD4+ T-lymphocyte count make IRIS a more likely diagnosis.
- E) Non-Hodgkin lymphoma: Although less likely, Non-Hodgkin lymphoma is a possible diagnosis in HIV patients with persistent fever and lymphadenopathy. However, the recent increase in CD4+ T-lymphocyte count and the absence of other symptoms such as weight loss or night sweats make this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- A) Cryptococcal meningitis: Although the patient does not have symptoms such as headache or altered mental status, Cryptococcal meningitis can present with non-specific symptoms such as fever and should be considered in HIV patients with low CD4+ T-lymphocyte counts.
- D) Kaposi sarcoma: Kaposi sarcoma can cause fever, lymphadenopathy, and skin lesions, but the absence of skin lesions and the recent increase in CD4+ T-lymphocyte count make this diagnosis less likely.
- Rare diagnoses
- Other opportunistic infections such as Pneumocystis jirovecii pneumonia or Toxoplasmosis could be considered, but the absence of respiratory symptoms and the normal chest x-ray make these diagnoses less likely.
- Lymphoma caused by other viruses such as Epstein-Barr virus could be considered, but the recent increase in CD4+ T-lymphocyte count and the absence of other symptoms make this diagnosis less likely.