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Differential Diagnosis for 60 y/o HIV Positive Patient with Low Grade Fever

Single Most Likely Diagnosis

  • Disseminated Mycobacterial Infection: Given the patient's HIV status and lack of access to antiretroviral therapy (ART) due to insurance issues, the immune system is likely compromised, making opportunistic infections more probable. Disseminated mycobacterial infections, such as those caused by Mycobacterium avium complex (MAC), are common in advanced HIV disease and can present with low-grade fever among other symptoms.

Other Likely Diagnoses

  • Pneumocystis jirovecii Pneumonia (PCP): Another opportunistic infection that can occur in HIV-positive individuals, especially those not on ART. While it typically presents with respiratory symptoms, it can also cause fever.
  • Toxoplasmosis: This parasitic infection can reactivate in immunocompromised patients, leading to symptoms such as fever, although it more commonly causes neurological symptoms.
  • Bacterial Infections: Such as pneumonia or sepsis, which can present with fever and are more likely in immunocompromised patients due to their reduced ability to fight off infections.

Do Not Miss Diagnoses

  • Lymphoma: Specifically, non-Hodgkin lymphoma, which is more common in HIV-positive individuals and can present with systemic symptoms including fever.
  • Tuberculosis (TB): A critical diagnosis to consider, especially in HIV-positive patients, as TB can be life-threatening if not treated promptly. It can present with fever, among other symptoms.
  • Cryptococcal Meningitis: An opportunistic fungal infection that can cause fever, headache, and neurological symptoms in immunocompromised patients.

Rare Diagnoses

  • Kaposi's Sarcoma: A type of cancer that can occur in HIV-positive individuals, often presenting with skin lesions but can also involve internal organs and cause systemic symptoms like fever.
  • Progressive Multifocal Leukoencephalopathy (PML): A rare and serious demyelinating disease of the central nervous system caused by the JC virus, which can reactivate in immunocompromised patients, though it typically presents with neurological symptoms rather than isolated fever.
  • Histoplasmosis: A fungal infection that can cause fever and respiratory symptoms, more common in certain geographic areas and in immunocompromised individuals.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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