HIV-associated dilated cardiomyopathy.

Case Report (Dr R F Miller) The patient was a 39 year old male homosexual book publisher. He first presented to this hospital in December 1988 with a diagnosis of oral hairy leukoplakia and at the time was found to be HIV 1 antibody positive and to be hepatitis B immune. Not long after this he developed a cough, increasing exertional dyspnoea and a reduced exercise tolerance. He was admitted for investigation in January 1989. A chest radiograph showed bilateral infiltrates and he was mildly hypoxaemic. Pneumocystis carinii was seen on Grocott's staining of bronchoalveolar lavage fluid. The patient made a good recovery on treatment with nebulised pentamidine given once daily for 21 days using a Respirgard II nebuliser. He then began treatment with zidovudine and commenced secondary prophylaxis with monthly inhaled pentamidine. He did not attend regularly for his pentamidine prophylaxis. He remained well apart from developing oropharyngeal candidiasis which responded to treatment with oral fluconazole. He was admitted as an emergency in April 1989 with a toxic confusional state. On examination he was markedly dyspnoeic and again mildly hypoxaemic. A sample of sputum induced by inhalation of hypertonic saline revealed Pneumocystis carinii. He was treated with intravenous co-trimoxazole and on this regime his confusional state and blood gases rapidly improved. He developed a diffuse macular rash after