GRAND ROUNDS AND TEACHING FILES
A 6 years old HIV infected girl presented with cough for 15 days, breathlessness and fever for 3 days. She was treated with cough syrup but had no relief. She was only on TMP-SMX prophylaxis as her CD4 count was 980 cells/cumm. She was treated for Primary Tuberculosis Complex a year ago with Antituberculosis Therapy (ATT) for 6 months in view of positive Mantoux test (10 x 10 mm) and Chest X-Ray that was suggestive of right parahilar haziness. She had no other illnesses. On examination, she was febrile, had a respiratory rate of 36/min with bilateral decreased air entry in both infraxillary area and bilateral inframammary crepitations. Other systems were normal. Chest X-Ray showed bilateral pleural effusion. Hemogram showed lymphocytosis. ESR was 32 mm at end of 1 hour.