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Symptoms and Signs – Differential Diagnosis of Hypercalcemia
• Vitamin D intoxication, milk-alkali syndrome: increased GI absorption
• Thiazides: increased renal absorption
• Solid tumors: breast, lung, pancreas, kidneys, ovary
• Parathyroid hyperplasia, adenoma
• Paget’s disease: increased bone resorption, seen only during periods of immobilization
• Other causes: familial hypocalciuric hypercalcemia, thyrotoxicosis, adrenal insufficiency, prolonged immobilization, vitamin A intoxication, recovery from acute renal failure, lithium administration, pheochromocytoma, disseminated systemic lupus erythematosus (SLE)
• Malignant disease: increased bone resorption via osteoclast activating factors, secretion of parathyroid hormone (PTH)–like substances, prostaglandin E2, direct erosion by tumor cells, transforming growth factors, colony-stimulating activity
• Hyperparathyroidism: increased bone resorption, GI absorption, and renal absorption; etiology:
• Hyperparathyroidism or renal failure with secondary hyperparathyroidism
• Hypercalcemia is common in the following neoplasms:
• Hematologic cancers: myeloma, lymphosarcoma, adult T-cell lymphoma, Burkitt’s lymphoma
• Granulomatous disorders: increased GI absorption (e.g., Sarcoidosis)
• Vitamin D intoxication, milk-alkali syndrome: increased GI absorption
• Thiazides: increased renal absorption
• Solid tumors: breast, lung, pancreas, kidneys, ovary
• Parathyroid hyperplasia, adenoma
• Paget’s disease: increased bone resorption, seen only during periods of immobilization
• Other causes: familial hypocalciuric hypercalcemia, thyrotoxicosis, adrenal insufficiency, prolonged immobilization, vitamin A intoxication, recovery from acute renal failure, lithium administration, pheochromocytoma, disseminated systemic lupus erythematosus (SLE)
• Malignant disease: increased bone resorption via osteoclast activating factors, secretion of parathyroid hormone (PTH)–like substances, prostaglandin E2, direct erosion by tumor cells, transforming growth factors, colony-stimulating activity
• Hyperparathyroidism: increased bone resorption, GI absorption, and renal absorption; etiology:
• Hyperparathyroidism or renal failure with secondary hyperparathyroidism
• Hypercalcemia is common in the following neoplasms:
• Hematologic cancers: myeloma, lymphosarcoma, adult T-cell lymphoma, Burkitt’s lymphoma
• Granulomatous disorders: increased GI absorption (e.g., Sarcoidosis)
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Symptoms and Signs – Differential Diagnosis of Malignancy Induced Hypercalcemia
• Multiple myeloma: 33% frequency, 10% of hypercalcemic cases
• Lymphoma: 4% of hypercalcemic cases
• Lung carcinoma: 6% frequency, 35% of hypercalcemic cases
• Genitourinary cancer: 6% of hypercalcemic cases
• Breast carcinoma: 10% frequency, 25% of hypercalcemic cases
• Multiple myeloma: 33% frequency, 10% of hypercalcemic cases
• Lymphoma: 4% of hypercalcemic cases
• Lung carcinoma: 6% frequency, 35% of hypercalcemic cases
• Genitourinary cancer: 6% of hypercalcemic cases
• Breast carcinoma: 10% frequency, 25% of hypercalcemic cases
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Symptoms and Signs – Differential Diagnosis of Persistent Hypercapnia
• Hypercapnia with normal lungs: CNS disturbances (cerebrovascular accident [CVA], parkinsonism, encephalitis), metabolic alkalosis, myxedema, primary alveolar hypoventilation, spinal cord lesions
• Diseases of the chest wall (e.g., kyphoscoliosis, ankylosing spondylitis)
• Neuromuscular disorders (e.g., myasthenia gravis, Guillain-Barré syndrome, amyotrophic lateral sclerosis [ALS], muscular dystrophy, poliomyelitis)
• Chronic obstructive pulmonary disease (COPD)
• Hypercapnia with normal lungs: CNS disturbances (cerebrovascular accident [CVA], parkinsonism, encephalitis), metabolic alkalosis, myxedema, primary alveolar hypoventilation, spinal cord lesions
• Diseases of the chest wall (e.g., kyphoscoliosis, ankylosing spondylitis)
• Neuromuscular disorders (e.g., myasthenia gravis, Guillain-Barré syndrome, amyotrophic lateral sclerosis [ALS], muscular dystrophy, poliomyelitis)
• Chronic obstructive pulmonary disease (COPD)
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Symptoms and Signs – Differential Diagnosis of Hyperchloremia
• Ureterosigmoidostomy
• Sodium loss > chloride loss
• Respiratory alkalosis
• Renal tubular disease
• Prolonged diarrhea
• Metabolic acidosis
• Hyperparathyroidism
• Excessive infusion of normal saline solution
• Diabetes insipidus (DI)
• Dehydration
• Cystic fibrosis (CF)
• Acetazolamide administration
• Ureterosigmoidostomy
• Sodium loss > chloride loss
• Respiratory alkalosis
• Renal tubular disease
• Prolonged diarrhea
• Metabolic acidosis
• Hyperparathyroidism
• Excessive infusion of normal saline solution
• Diabetes insipidus (DI)
• Dehydration
• Cystic fibrosis (CF)
• Acetazolamide administration
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Symptoms and Signs – Differential Diagnosis of Hypercholesterolemia
• Uncontrolled diabetes mellitus
• Third trimester of pregnancy
• Primary hypercholesterolemia
• Primary biliary cirrhosis
• Nephrotic syndrome
• Hypothyroidism
• Drugs (steroids, phenothiazines, oral contraceptives)
• Diet high in cholesterol and saturated fat
• Biliary obstruction
• Uncontrolled diabetes mellitus
• Third trimester of pregnancy
• Primary hypercholesterolemia
• Primary biliary cirrhosis
• Nephrotic syndrome
• Hypothyroidism
• Drugs (steroids, phenothiazines, oral contraceptives)
• Diet high in cholesterol and saturated fat
• Biliary obstruction
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Symptoms and Signs – Differential Diagnosis of HIV Infection, Cognitive Impairment
EARLY TO MIDSTAGE HIV DISEASE
• Depression
• Alcohol and substance abuse
• Medication-induced cognitive impairment
• Metabolic encephalopathies
• HIV-related cognitive impairment
ADVANCED HIV DISEASE (CD4+ < 100/MM3)
• Opportunistic infection of CNS
• Neurosyphilis
• CNS lymphoma
• Progressive multifocal leukoencephalopathy
• Depression
• Metabolic encephalopathies
• Medication-induced cognitive impairment
• Stroke
• HIV dementia
EARLY TO MIDSTAGE HIV DISEASE
• Depression
• Alcohol and substance abuse
• Medication-induced cognitive impairment
• Metabolic encephalopathies
• HIV-related cognitive impairment
ADVANCED HIV DISEASE (CD4+ < 100/MM3)
• Opportunistic infection of CNS
• Neurosyphilis
• CNS lymphoma
• Progressive multifocal leukoencephalopathy
• Depression
• Metabolic encephalopathies
• Medication-induced cognitive impairment
• Stroke
• HIV dementia
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Symptoms and Signs – Differential Diagnosis of HIV Infection, Cutaneous Manifestations
BACTERIAL INFECTION
• Bacillary angiomatosis: numerous angiomatous nodules associated with fever, chills, weight loss
• Staphylococcus aureus: folliculitis, ecthyma, impetigo, bullous impetigo, furuncles, carbuncles
• Syphilis: may occur in different forms (primary, secondary, tertiary); chancre may become painful because of secondary infection
FUNGAL INFECTION
• Candidiasis: mucous membranes (oral, vulvovaginal), less commonly Candida intertrigo or paronychia
• Cryptococcoses: papules or nodules that strongly resemble molluscum contagiosum; other forms include pustules, purpuric papules, and vegetating plaques
• Seborrheic dermatitis: scaling and erythema in the hair-bearing areas (eyebrows, scalp, chest, and pubic area)
ARTHROPOD INFESTATIONS
• Scabies: pruritus with or without rash, usually generalized but can be limited to a single digit
VIRAL INFECTION
• Herpes simplex: vesicular lesion in clusters; perianal, genital, orofacial, or digital; can be disseminated
• Herpes zoster: painful dermatomal vesicles that may ulcerate or disseminate
• HIV: discrete erythematous macules and papules on the upper trunk, palms, and soles are the most characteristic cutaneous finding of acute HIV infection.
• Human papillomavirus: genital warts (may become unusually extensive)
• Kaposi’s sarcoma (herpesvirus): erythematous macules or papules; enlarge at varying rates; violaceous nodules or plaques; occasionally painful
• Molluscum contagiosum: discrete umbilicated papules commonly on the face, neck, and intertriginous sites (axilla, groin, or buttocks)
NONINFECTIOUS
• Drug reactions: more frequent and severe in patients with HIV
infection
• Nutritional deficiencies: mainly seen in children and patients with
chronic diarrhea; diffuse skin manifestations, depending on the
deficiency
• Psoriasis: scaly lesions; diffuse or localized; can be associated with
arthritis
• Vasculitis: palpable purpuric eruption (can resemble septic
emboli)
BACTERIAL INFECTION
• Bacillary angiomatosis: numerous angiomatous nodules associated with fever, chills, weight loss
• Staphylococcus aureus: folliculitis, ecthyma, impetigo, bullous impetigo, furuncles, carbuncles
• Syphilis: may occur in different forms (primary, secondary, tertiary); chancre may become painful because of secondary infection
FUNGAL INFECTION
• Candidiasis: mucous membranes (oral, vulvovaginal), less commonly Candida intertrigo or paronychia
• Cryptococcoses: papules or nodules that strongly resemble molluscum contagiosum; other forms include pustules, purpuric papules, and vegetating plaques
• Seborrheic dermatitis: scaling and erythema in the hair-bearing areas (eyebrows, scalp, chest, and pubic area)
ARTHROPOD INFESTATIONS
• Scabies: pruritus with or without rash, usually generalized but can be limited to a single digit
VIRAL INFECTION
• Herpes simplex: vesicular lesion in clusters; perianal, genital, orofacial, or digital; can be disseminated
• Herpes zoster: painful dermatomal vesicles that may ulcerate or disseminate
• HIV: discrete erythematous macules and papules on the upper trunk, palms, and soles are the most characteristic cutaneous finding of acute HIV infection.
• Human papillomavirus: genital warts (may become unusually extensive)
• Kaposi’s sarcoma (herpesvirus): erythematous macules or papules; enlarge at varying rates; violaceous nodules or plaques; occasionally painful
• Molluscum contagiosum: discrete umbilicated papules commonly on the face, neck, and intertriginous sites (axilla, groin, or buttocks)
NONINFECTIOUS
• Drug reactions: more frequent and severe in patients with HIV
infection
• Nutritional deficiencies: mainly seen in children and patients with
chronic diarrhea; diffuse skin manifestations, depending on the
deficiency
• Psoriasis: scaly lesions; diffuse or localized; can be associated with
arthritis
• Vasculitis: palpable purpuric eruption (can resemble septic
emboli)
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Symptoms and Signs – Differential Diagnosis of HIV Infection, Esophageal Disease
• Aphthous ulcer
• Candida infection
• Cytomegalovirus (CMV) infection
• Herpes simplex
• Aphthous ulcer
• Candida infection
• Cytomegalovirus (CMV) infection
• Herpes simplex
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Symptoms and Signs – Differential Diagnosis of HIV Infection, Hepatic Disease
VIRUSES
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis D (with hepatitis B virus [HBV])
• Epstein-Barr virus
• Cytomegalovirus (CMV)
• Herpes simplex virus
• Adenovirus
• Varicella-zoster virus
MYCOBACTERIA
• Mycobacterium avium complex
• Mycobacterium tuberculosis
FUNGI
• Histoplasma capsulatum
• Cryptococcus neoformans
• Coccidioides immitis
• Candida albicans
• Pneumocystis jiroveci
• Penicillium marneffei
PROTOZOA
• Toxoplasma gondii
• Cryptosporidium parvum
• Microsporida spp.
• Schistosoma
BACTERIA
• Bartonella henselae (peliosis hepatis)
MALIGNANCY
• Kaposi’s sarcoma (human herpesvirus 8 [HHV-8])
• Non-Hodgkin’s lymphoma
• Hepatocellular carcinoma
MEDICATIONS
• Zidovudine
• Didanosine
• Ritonavir
• Other HIV-1 protease inhibitors
• Fluconazole
• Macrolide antibiotics
• Isoniazid
• Rifampin
• Trimethoprim-sulfamethoxazole
VIRUSES
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis D (with hepatitis B virus [HBV])
• Epstein-Barr virus
• Cytomegalovirus (CMV)
• Herpes simplex virus
• Adenovirus
• Varicella-zoster virus
MYCOBACTERIA
• Mycobacterium avium complex
• Mycobacterium tuberculosis
FUNGI
• Histoplasma capsulatum
• Cryptococcus neoformans
• Coccidioides immitis
• Candida albicans
• Pneumocystis jiroveci
• Penicillium marneffei
PROTOZOA
• Toxoplasma gondii
• Cryptosporidium parvum
• Microsporida spp.
• Schistosoma
BACTERIA
• Bartonella henselae (peliosis hepatis)
MALIGNANCY
• Kaposi’s sarcoma (human herpesvirus 8 [HHV-8])
• Non-Hodgkin’s lymphoma
• Hepatocellular carcinoma
MEDICATIONS
• Zidovudine
• Didanosine
• Ritonavir
• Other HIV-1 protease inhibitors
• Fluconazole
• Macrolide antibiotics
• Isoniazid
• Rifampin
• Trimethoprim-sulfamethoxazole
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Symptoms and Signs – Differential Diagnosis of HIV Infection, Lower GI Tract Disease
CAUSES OF ENTEROCOLITIS
Bacteria
• Campylobacter jejuni and other spp.
• Salmonella spp.
• Shigella flexneri
• Aeromonas hydrophila
• Plesiomonas shigelloides
• Yersinia enterocolitica
• Vibrio spp.
• Mycobacterium avium complex
• Mycobacterium tuberculosis
• Escherichia coli (enterotoxigenic, enteroadherent)
• Bacterial overgrowth
• Clostridium difficile (toxin)
Parasites
• Clostridium parvum
• Microsporida (Enterocytozoon bieneusi, Septata intestinalis)
• Isospora belli
• Entamoeba histolytica
• Giardia lamblia
• Cyclospora cayetanensis
Viruses
• Cytomegalovirus (CMV)
• Adenovirus
• Calicivirus
• Astrovirus
• Picobirnavirus
• HIV
Fungi
• Histoplasma capsulatum
CAUSES OF PROCTITIS
Bacteria
• Chlamydia trachomatis
• Neisseria gonorrhoeae
• Treponema pallidum
Viruses
• Herpes simplex
• CMV
CAUSES OF ENTEROCOLITIS
Bacteria
• Campylobacter jejuni and other spp.
• Salmonella spp.
• Shigella flexneri
• Aeromonas hydrophila
• Plesiomonas shigelloides
• Yersinia enterocolitica
• Vibrio spp.
• Mycobacterium avium complex
• Mycobacterium tuberculosis
• Escherichia coli (enterotoxigenic, enteroadherent)
• Bacterial overgrowth
• Clostridium difficile (toxin)
Parasites
• Clostridium parvum
• Microsporida (Enterocytozoon bieneusi, Septata intestinalis)
• Isospora belli
• Entamoeba histolytica
• Giardia lamblia
• Cyclospora cayetanensis
Viruses
• Cytomegalovirus (CMV)
• Adenovirus
• Calicivirus
• Astrovirus
• Picobirnavirus
• HIV
Fungi
• Histoplasma capsulatum
CAUSES OF PROCTITIS
Bacteria
• Chlamydia trachomatis
• Neisseria gonorrhoeae
• Treponema pallidum
Viruses
• Herpes simplex
• CMV
