A 28-Year-Old Man With Diffuse Bilateral Pulmonary Nodules

A 28-year-old man with a history of congenital HIV sought treatment at the ED with a chief symptom of generalized malaise and confusion of 3 days' duration. He had mild dyspnea, but no respiratory distress, and he reported no fever, chest pain, or headache. We were unable to obtain past medical, family, or social history because of encephalopathy and we had no available contact person. Review of the patient's medical record revealed he made an initial clinic visit to the Department of Pediatric Infectious Disease 5 years previously. At the time of that visit, CD4 count was 250 cells/mm³ and no known complications of HIV were documented. He was prescribed Stribild (elvitegravir-cobicistat-emtricitabine-tenofovir disoproxil fumarate) and darunavir; however, pharmacy records revealed he did not fill the prescriptions. He underwent no further clinic follow-up examinations. He grew up in California and moved to upstate New York 5 years previously.