A 50-year-old man with a history of HIV presents with 2 weeks of fevers, chills, night sweats, dry cough, and malaise. He was off of his highly active antiretroviral therapy (HAART) for 2 years. The patient was incarcerated 1 month prior to his presentation. His CD4 lymphocyte count was 257 cells/μL and his HIV viral load was 177,000 copies/mL. Chest radiography revealed severe diffuse interstitial nodular and micronodular opacities in a miliary pattern throughout the lungs. Sputum cultures and bronchoalveolar lavage grew Mycobacterium tuberculosis. He was treated for miliary pulmonary tuberculosis with rifampin, isoniazid, pyrazinamide, and ethambutol and was re-initiated on HAART therapy with clinical improvement in symptoms.

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