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severe pain due to fluid around lung/pneumonia
Nov 22, 2001

I am writing in regards to my lover who is HIV poz and has recently been diagnosed with pneumonia about three weeks ago. The doctors ran evey kind of test possible, x-rays, cat scan, a bronchial scope to retrieve a speciman of the infection, ekg, etc. Everything came back negative except a finding of pnuemonia with associated pluerisy. However there was a massive amount of fluid build up around the left lung which was drained using a needle through the back. Levaquin was prescribed after an 11 day hospital stay at which time he was on Zithromax and Zosyn which had no effect on the pneumonia. After being home for 5 days, he again was rushed to the emergency room in severe pain and admitted to the hospital again. X rays showed again a massive fluid build up aroud the the outside of the left lung which we were told is pushing the lung upward thus causing the intense stabbing pain in his upper back between the shoulder blades. Another draining of the fluid will be performed tomorrow. The antibiotic Levaquin is now being administered by IV. Prior to the first hospital stay he was givin a flu and pneumonia shot. He was checked fo cancer, tb, pcp, congestive heart failure, etc by tests, by blood and fluid and the lung speciman cultures all of which were negative. He has not had a fever whatsoever during all this time either and is not coughing up sputum but has a very slight dry cough. My question ultmately is: Is there potentially anything else that was not checked,and does this sound like normal pneumonia. We were not told which type pneumonia it is. Any help would be greatly appreciated. He is being seen by his family doctor and three lung specialist but is not any better then before. His T & C cell count are 362 and 562 respectfully. His viral load was 27,000 before starting the prescription drug Trizivir for the HIV. This was about 4 months ago when tested poz for HIV. Again, any help will be greatly appreciated. Thank You.

Response from Dr. Feinberg

Fluid can collect in the lung cavity when people have pneumonia-- it can be a PARAPNEUMONIC EFFUSION, which is not infected itself and either gets reabsorbed gradually or has to be drained if it's large, or it can be an EMPYEMA, which is infected (has bacteria in it), and must be drained to avoid/minimize scar tissue and to allow antibiotic treatment to be effective. Fluid i n the chest can also be due to non-infectious causes, such as tumors. Between CT scaaaaaans and adequate specimens of the fluid for cultures, chemistry tests and cytopathology to look for cancerous cells, it should be possible to make a diagnosis of what's going on.

However, it sounds like your partner has plenty of specialists involved in his care that know these things, and sometimes a diagnosis can be elusive. They may have tto repeat various tests until he either gets better on his own aaaaor they figure out what's going on, so please try to be supportive and patient. In the meantime, it is appropriate to remove fluid in order to make him comfortable.


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