HIV in Children
Abdominal mass in an HIV infected boy
Ira Shah
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital, Mumbai, India
Incharge, Pediatric HIV and TB Clinic, B J Wadia Hospital for Children, Mumbai, India

An 11 years old boy recently diagnosed to be HIV infected presented with generalized abdominal pain and progressive abdominal distension along with fever for 1 month. Father was HIV infected and on antiretroviral therapy (ART) for 3 years and was also diagnosed to have pulmonary tuberculosis and was on anti TB treatment (ATT) for the past 5 months. Mother was also HIV infected but was not on ART. On examination, child was pale, hypotensive, had poor peripheral pulses. Abdomen was tender and he had guarding with rigidity along with hepatosplenomegaly. Bowel sounds were present. Other systemic examination was normal. He was shifted to the intensive care unit and started on IV antibiotics, IV fluids, and inotropes. Packed cell transfusion was given in view of low hemoglobin. His investigations showed hemoglobin of 7.4 g/dl, white cell count of 4700 cells/cumm (82% neutrophils, 15% lymphocytes), platelets of 1,42,000 cells/cumm with CD4 count of 10 cells/cumm (4%). Liver enzymes were elevated (SGOT 106 IU/L, SGPT 164 IU/L) with albumin of 2.1gm/dl and serum bilirubin of 2.7mg/dl (direct 1.2mg/dl). Renal function tests were normal. Prothrombin time (PT) was 16 sec and partial thromboplastin time (PTT) was 40sec. Blood culture did not grow any organism. X-ray chest showed hilar opacities and ultrasound (USG) abdomen showed moderate ascites, multiple enlarged mesenteric lymphnodes and echogenic mesentery with few dilated small intestine loop with sluggish peristalsis. CT abdomen revealed enlarged partly conglomerate mildly enhancing lymphnodes of varying size in the upper abdomen and retroperitoneum and small bowel mesentery with areas of necrosis within. He underwent explorative laprotomy and was found to have normal bowel with few small mesenteric nodes and a large retroperitoneal lymph node mass measuring 15 X 20 cm.

What is the cause of this large retroperitoneal lymph node mass?
See Previous Teaching Files
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