Question:medium
A truck driver presented with a history of fever for four weeks and a dry cough. He also gives a history of weight loss of about 10 kg. Chest X-ray shows bilateral reticulonodular infiltrates. The most likely diagnosis is:
A truck driver presented with a history of fever for four weeks and a dry cough. He also gives a history of weight loss of about 10 kg. Chest X-ray shows bilateral reticulonodular infiltrates. The most likely diagnosis is:
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Truck driver plus dry cough plus diffuse bilateral interstitial shadows points to an HIV opportunistic infection.
Updated On: Jun 24, 2026
- Tuberculosis
- Pneumocystis carinii pneumonia
- Pneumococcal pneumonia
- Interstitial lung disease
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The Correct Option is B
Solution and Explanation
The stem is built to test whether you can spot an HIV-associated opportunistic infection from an exam vignette. The patient is a truck driver, a phrase that exam writers use to signal HIV risk because of the mobile lifestyle. His illness has run for four weeks with fever, a dry cough, and 10 kg of weight loss, and the X-ray shows bilateral reticulonodular shadows.
Take the radiology and the cough together. A dry, non-productive cough with diffuse bilateral interstitial shadowing is the textbook face of $Pneumocystis$ $jirovecii$ pneumonia, formerly called Pneumocystis carinii pneumonia. This organism only causes disease when cell-mediated immunity is low, so its appearance is itself a marker of advanced HIV.
Now weigh the alternatives. Pneumococcal pneumonia behaves acutely with high fever over days, a productive cough, and a dense lobar shadow, which does not fit a four-week dry illness. Tuberculosis tends to give a productive cough with apical cavitation or upper-zone disease, so the dry cough plus diffuse reticulonodular pattern fits PCP better. Interstitial lung disease evolves slowly over many months without this degree of fever and rapid weight loss.
So the picture of subacute fever, dry cough, weight loss, and bilateral interstitial infiltrates in an HIV-risk patient lands squarely on Pneumocystis pneumonia.
\[\boxed{\text{Pneumocystis carinii pneumonia}}\]
Take the radiology and the cough together. A dry, non-productive cough with diffuse bilateral interstitial shadowing is the textbook face of $Pneumocystis$ $jirovecii$ pneumonia, formerly called Pneumocystis carinii pneumonia. This organism only causes disease when cell-mediated immunity is low, so its appearance is itself a marker of advanced HIV.
Now weigh the alternatives. Pneumococcal pneumonia behaves acutely with high fever over days, a productive cough, and a dense lobar shadow, which does not fit a four-week dry illness. Tuberculosis tends to give a productive cough with apical cavitation or upper-zone disease, so the dry cough plus diffuse reticulonodular pattern fits PCP better. Interstitial lung disease evolves slowly over many months without this degree of fever and rapid weight loss.
So the picture of subacute fever, dry cough, weight loss, and bilateral interstitial infiltrates in an HIV-risk patient lands squarely on Pneumocystis pneumonia.
\[\boxed{\text{Pneumocystis carinii pneumonia}}\]
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