Case 88 -- HIV Positive Man Died Following Bleeding from Mouth and Nose

Contributed by Patricia A. Aronica, MD, and Oliver Ndimbie, MD
Published on line in December 1996


The patient was a volunteer in a multicenter study of the natural history of HIV infection in homosexual and bisexual men. He became positive for the virus in April 1986. Medical records are scant as the patient was never hospitalized and reported to his primary care physician infrequently. In 1993, the patient underwent oral surgery with subsequent infected non-healing site. The surgical pathology showed acute and chronic sinusitis with extensive necrosis and branching fungal hyphae consistent with aspergillus and abundant gram positive cocci and rods. His past medical history was significant for hepatitis B exposure, significant ethanol use, and smoking.

His last clinic visit was in July 1995. At that time he weighed 158 pounds with a blood pressure of 112/78 mmHg and a CD4 count of 35 and CD8 of 403. Medications included zidovudine, dapsone, and fluconazol. The last physical exam performed was essentially normal.

The patient became progressively ill over the last few months. During the last week of life he had epistaxis and bleeding from the mouth, but he did not present to the hospital. He subsequently died at home in June 1996.





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