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A 36-year-old man of Eastern European origin presented with a 4-week history of odynophagia, dysphagia, 10 kg weight loss and night sweats. There was no significant past medical history, he was on no regular medications but the travel history was notable with several years spent working in Africa. Clinical examination revealed loss of subcutaneous fat, muscle wasting, extensive lymphadenopathy and oral candidiasis. Initial blood tests revealed Hb 9.0 g/dL (13.0–16.7), white cell count 6.2×109/L (3.5–11), erythrocyte sedimentation rate 44 mm/h, C reactive protein 113 mg/L (<5) and albumin 25 g/L (35–50). HIV infection was suspected and confirmed by both serology …
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