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[Extract] Case PresentationOn 2nd July 2013, a 29-year-old HIV-positive woman presented herself to the outpatient clinic at the Infectious Diseases Institute in Kampala, Uganda. Her weight had decreased from 46 kg to 42 kg in the past few weeks. In addition, she complained about abdominal pain, diarrhea, vomiting, and evening fevers during the week leading up to her visit (see Table 1 and Fig 1 for patient characteristics). Her CD4 T cell count in June 2013 was 34 cells/μl, and she had documented second-line antiretroviral treatment (tenofovir disoproxil fumarate, emtricitabine, and lopinavir-ritonavir) failure. She admitted to taking her medications irregularly and was on trimethoprim-sulfamethoxazole prophylaxis. Her last HIV-1 RNA viral load in June 2013 was 199,994 copies/ml. Based on her immunosuppression and symptoms, we screened her for tuberculosis (TB). At the time of screening, she could not produce sputum, but an abdominal ultrasound in late June 2013 showed a lymphadenopathy. A chest X-ray was not carried out at baseline, as it would not have changed the clinical decision to treat the presumptive diagnosis of extrapulmonary TB. Her glomerular filtration rate (GFR) was 55 mL/min, the liver enzyme alanine aminotransferase was 33 IU/L (normal range 0–35 IU/L), and her albumin level was slightly decreased (35.5 g/L; normal range 38–47 g/L).

If It Looks Like a Duck, Swims Like a Duck, and Quacks Like a Duck—Does It Have to Be a Duck?