Disseminated lung disease in elderly patient with multimorbidity and HIV infection (clinical case)

Disseminated lung diseases have similar non-specific manifestations in various etiologies, pathogenesis, and morphology. Pulmonary dissemination is the concept of X-ray, there are no pathognomonic symptoms on a radiograph that are inherent in a particular disease with pulmonary dissemination, therefore, in real clinical practice, differential diagnosis in pulmonary dissemination is the prerogative of the physician. Diseases that are manifested by pulmonary dissemination can be classified by dissemination of infectious causes (tuberculosis, HIV-associated dissemination, fungal lesions), malignant pulmonary lesions (carcinomatosis, cancer lymphangitis), cardiogenic dissemination and interstitial lung diseases. In recent years, the incidence of allergic interstitial lung diseases has increased. Infectious lesions of the lungs in patients with HIV infection and reduced immune status in many cases also have a disseminated form and cause difficulties in the differential diagnosis of tuberculosis. The article presents a clinical case of pneumocystis pneumonia in an HIV-infected patient with pulmonary dissemination syndrome on X-ray. The difficulties of the diagnostic search with low compliance of the patient and the physician are shown (a patient registered with HIV for 10 years hid this fact of his history from the attending physician and gave a written refusal to get tested for HIV fibrobronchoscopy). The possibility of introducing compulsory HIV screening for all patients admitted to the hospital with disseminated processes in the lungs has been considered.