HIV in Children
GRAND ROUNDS AND TEACHING FILES
Chronic cough with hemoptysis
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

A 4 years old boy HIV infected boy presented with a cough with expectoration and hemoptysis for a month, low-grade evening rise in body temperature for 20 days and breathlessness for 10 days. Grandmother had tuberculosis (TB) 3 years ago and took antituberculous therapy (ATT) for 6 months. The child had white colored sputum (about 2 tablespoons a day) with intermittent blood in sputum. On examination, the child was malnourished, had a respiratory rate of 36/min with intercostal and subcostal retractions. The trachea was shifted to the right and chest movements are decreased on the right side. Apex impulse was parasternal in 4th right intercostal space suggestive of dextrocardia. Vocal resonance was decreased on the right side of the chest and there were florid crepitations on the entire right side with decreased air entry and bronchial breathing on the right infraclavicular area. There was no clubbing. Ultrasound (USG) Abdomen shows situs inversus with dextrocardia. Other systems are normal.

What is the diagnosis?
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