An atypical presentation of a typical pulmonary pathogen in an immunosuppressed patient

We describe a case of a 38-year-old, HIV-positive asthmatic man with a history of intravenous methamphetamine substance misuse who presented with worsening dyspnoea, wheeze, productive cough without haemoptysis and deteriorating exercise tolerance. His chest X-ray was clear and subsequent CT scanning demonstrated multilobar, patchy consolidation and ground glass change in the lung parenchyma. His CD4 count was 864 cells/mm(3) (n=500-1500 cells/mm(3)) and viral load 863 IU/mL. Our primary diagnosis was an atypical pneumonia with associated bronchospasm. The differential diagnosis also included a methamphetamine-induced pulmonary haemorrhage, given the multiple small foci of ground glass change. The patient's sputum cultured Haemophilus influenzae, which was somewhat surprising, given his unusual CT findings. He recovered with antibiotic therapy and a follow-up CT scan at 6 weeks revealed complete resolution of the radiological findings.