28th May 2025

A 36 year old man from Indonesia presents with intermittent fevers, night sweats and a 6 kg weight loss, over the course of 2 months.

A 36 year old man from Indonesia presents with intermittent fevers, night sweats and a 6 kg weight loss, over the course of 2 months. He states he was diagnosed with HIV 5 months ago in Indonesia but did not elaborate further. On examination, he is cachexic with a high fever. You note an enlarged palpable liver and a hardened right axillary lymph node. The cardiorespiratory examination is normal, as well as a chest x-ray and ECG.

Of note, his blood tests show:

• Hb 93 (130-180 g/L)
• Neutrophils 1.2 (1.8-7.5 x10⁹/L)
• Platelets 200 (140-400 x10⁹/L)
• ALP 374 (30-130 IU/L)
• ALT 82 (0-45 IU/L)
• Bilirubin 12 (<21 μmol/L)
• Albumin 27 (35–50 g/L)
• Lactate Dehydrogenase 1650 (240–480 U/L)

An ultrasound scan of the liver demonstrates hepatomegaly but no duct dilatation.

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