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#idboardreview 20 M PLWH CD4 30 VL 500k w/ pulmonary TB at time of HIV diagnosis. Started on RIPE immediately, ART started 2 wks later. 4 wks post ART: headache & weakness. Diagnosis? #meded #idmedEd #idtwitter 
CNS TB #IRIS Immune reconstitution syndrome: Continue ART and RIPE; NSAIDs if mild, steroids if more severe/refractory prednisone 1.5mg/kg/d x2wk f/u 0.75mg/kg/d x2wks
32/M w poorly controlled HIV 2/2 ART nonadherence, p/w 7 d of L eye blurring of vision a/w central scotoma, photopsia & floaters. Denies fever, SOB, cough. Vitals stable. CD4 35 and VL 1 M one month ago. Labs: leucopenia. CMV retinitis suspected. Best way to diagnose? #IDMedEd
1/3) Answer: urgent ophthalmologic exam. Retinitis: most common form of CMV disease in HIV+ w/ CD4 <50. Presence of either photopsia (flashes of light similar to welding sparks) or floater is highly indicative of CMV retinitis and should be asked on history. #IDMedEd #HIVMedEd
2/3) Dx: expert ophtho exam of a dilated pupil (white fluffy spots with hemorrhages, so called "ketchup and cottage cheese" appearance). Negative blood CMV PCR/serology does not R/O CMV disease (only 70% w/ viremia & can have viremia w/o evidence of CMV disease). #IDMedEd
