Kwame is a 38-year-old African man who presents with a dry cough and dyspnoea on exertion for 3-4 weeks. Kwame has been on antiretroviral therapy — efavirenz, emtricitabine and tenofovir — for HIV/AIDS for 3.5 years, with no other significant medical or surgical history. Kwame identifies as bisexual and last had unprotected sex with male partners five months previously. 

There is no past history of opportunistic infections and Kwame is consistently adherent with his antiretroviral therapy (ART) regimen. He is a non-smoker without any illicit drug or alcohol use history, and denies receiving any blood transfusions.

On examination, he is mildly febrile at 37.5°C, with a regular heart rate of 92bpm, blood pressure of 132/76mmHg and respiratory rate of 20. Dual heart sounds, without added murmurs, were heard on auscultation, with a focal wheeze intermittently audible that cleared with coughing. Examination of other systems was unremarkable. Notably no mucocutaneous lesions were appreciable. 

As Kwame is immunocompromised, opportunistic infections, including lung Mycobacterium tuberculosis (MTB) and HIV-associated pneumocystis pneumonia (PCP), are differential diagnoses.