Pandemi Döneminde COVID-19 Kliniği ile Başvuran ve Tesadüfen Tespit Edilen AIDS Olgusu

Pneumocystis pnömonisi (PCP), Pneumocystis jirovecii mantarının neden olduğu ciddi bir fırsatçı enfeksiyondur.Bununla birlikte, 31 Aralık 2019’da Çin’in Wuhan eyaletinde etiyolojisi bilinmeyen pnömoni vakalarının tanınmasınıtakiben, hastalarda şiddetli akut solunum sendromu koronavirüs 2019’un (SARS-CoV-2) saptanması, yeni birkoronavirüs türünü ortaya çıkarmıştır. Bu virüsün neden olduğu hastalık daha sonra Dünya Sağlık Örgütü tarafındanCOVID-19 (Coronavirus hastalığı 2019) olarak adlandırılmıştır. Klinik pratikte, her iki enfeksiyonda (PCP ve COVID-19)da ateş, nefes darlığı ve bilateral akciğer parankiminde pnömonik infiltrasyonla uyumlu radyolojik bulgularlakarşılaşmaktayız. 11 Mayıs 2020 itibariyle, COVID-19 salgını beş kıtada 198 ülkeyi ve yaklaşık 4.239.167 kişiyietkilemiştir. Dünya Sağlık Örgütü 20 Mart 2020 tarihinde pandemi ilan etmiştir.Pandemi döneminde ateş ve solunum sıkıntısı ile gelen her hastada öncelikle COVID-19 düşünülmeli ve daha ileritetkikler yapılmalıdır. 22 yaşında erkek hasta bu dönemde 2 gündür olan ateş ve solunum sıkıntısı şikayeti ile başvurdu.Fizik muayenesinde ateşi 38,3oC idi ve akciğer oskültasyonunda ince bilateral ralleri vardı. Laboratuvar testlerinde isekan glukoz seviyesi 100 mg/dl, serum kreatinin seviyesi 0,59 mg/dl, AST 46 U/L, ALT 17 U/L, LDH 1102 U/L, CRP 62mg/L, D-dimer 954 mg/L, lökosit sayısı 12.410 /mm3 (%87,6 nötrofil; %6,8 lenfosit), hemoglobin 11.9 g/dl ve trombositsayısı 258000 /mm3 idi. Toraks bilgisayarlı tomografisinde (BT) her iki akciğerde, daha belirgin olarak sol tarafta ve altloblarda yamalı buzlu cam dansiteli alanlar izlendi. Hasta COVID-19 ön tanısı ile interne edildi ve sonrasında Anti-HIVtesti pozitif çıktı. Klinik, laboratuvar ve radyolojik incelemelere dayanarak hem COVID-19 h em d e P CP t edavileriniolgumuza uyguladık. Sonunda iyileştikten sonra taburcu edildi. Pandemi sırasında sadece SARS-COV-2 değil, aynızamanda akciğer enfeksiyonlarına neden olabilecek diğer infeksiyöz etkenler de göz ardı edilmemeli ve ayırıcı tanıdahepsi düşünülmelidir.

An Incıdentally Detected Case of AIDS Admitted with the Clinical Presentation of COVID-19 During the Pandemic

Pneumocystis pneumonia (PCP) is a serious opportunistic infection caused by the fungus Pneumocystis jirovecii. However, the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the patients, following the recognition of pneumonia cases of unknown etiology on December 31, 2019, in Wuhan, China revealed a new type of coronavirus. The disease caused by that virus has subsequently been named COVID-19 (Coronavirus disease 2019) by the World Health Organization. In clinical practice, we encounter fever, shortness of breath, and radiological findings compatible with pneumonic infiltration in the bilateral lung parenchyma in both infections (PCP and COVID-19). As of May 11, 2020, the COVID-19 outbreak affected 198 countries and about 4.239.167 people on five continents. The World Health Organization declared it a pandemic on March 20, 2020. During the pandemic, COVID-19 should be considered first in every patient presented with fever and respiratory distress, and further examinations should be carried out. A 22-year-old male patient admitted with the complaints of fever and respiratory distress for two days during this period.On physical examination, his fever was 38,3°C with fine bilateral rales at lung auscultation. Results of the laboratorytesting were as follows: the blood glucose level 100 mg/dl, serum creatinine level 0,59 mg/dL, AST 46 U/L, ALT 17 U/L,LDH 1102 U/L, CRP 62 mg/l, D-dimer 954 mg/L, leucocytes 12.410 /mm3 (87,6% neutrophils; 6,8% lymphocytes),hemoglobin 11.9 g/dL and platelet count 258000 /mm3. Thorax computed tomography (CT) demonstrated patched areaswith frosted glass density in both lungs, more prominently on the left side, and in the lower lobes. The patient wasadmitted with a preliminary diagnosis of COVID-19, and then the Anti-HIV test was positive. Based on clinical, laboratory,and radiological examinations, we administered both COVID-19 and PCP treatments to our case. He was finallydischarged after recovery. During the pandemic, not only SARS-COV-2, but also other infectious agents that may causelung infections should not be ignored, and they all should be considered in the differential diagnosis.

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