ZyraDoc #52 - September 22, 2026

A 35-year-old male presents with a 3-week history of progressive exertional dyspnea, dry non-productive cough, low-grade fever, weight loss, and oral candidiasis.

On physical examination, he is tachypneic and hypoxic (SpO2 84% on room air), with bilateral diffuse fine inspiratory crackles, while rapid HIV testing is positive and CD4+ T-lymphocyte count is 85 cells/µL.

A chest radiograph shows bilateral diffuse perihilar interstitial infiltrates, and Induced Sputum PCR confirms Pneumocystis jirovecii, establishing a diagnosis of Advanced HIV/AIDS with PJP.

Case Summary

Clinical Focus:

The diagnosis is Advanced HIV/AIDS complicated by Pneumocystis jirovecii Pneumonia (PJP).

Aetiology/Cause:

Infection with Human Immunodeficiency Virus (HIV-1 or HIV-2), leading to progressive depletion of CD4+ T-helper lymphocytes.
Severe cellular immunodeficiency (CD4 count <200 cells/µL) allowing opportunistic fungal infection by Pneumocystis jirovecii.
Lack of antiretroviral therapy (ART) adherence or undiagnosed chronic HIV infection.

Clinical Features:

Subacute onset of progressive dyspnea, non-productive dry cough, and low-grade fevers.
Profound exertional desaturation disproportionate to physical examination findings.
Mucocutaneous indicators of immunodeficiency such as oral thrush (candidiasis), angular cheilitis, or oral hairy leukoplakia.
Tachypnea, tachycardia, and hypoxemia on room air.

Diagnosis and Investigations:

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