History of Present Illness (HPI)
A 51-year-old woman with past medical history of HIV, end stage kidney disease (ESKD) due to HIV-associated nephropathy (HIVAN), deceased donor kidney transplant (induction therapy with anti-thymocyte globulin) recipient 7 months ago presents to the outpatient transplant clinic for a routine follow up visit. She reports feeling feel until the past few days when she has felt malaise, fatigue, and “feverish”. She also reports new onset watery diarrhea (multiple watery bowel movements per day). She has no rashes, sick contacts, difficulty breathing, chest pain, or extremity swelling. Her post-transplant nadir creatinine was 1.5 mg/dL.
Her current medications include tacrolimus, mycophenolate mofetil, prednisone, sulfamethoxazole/trimethroprim, nifedipine, and famotidine. Her most recent HIV viral load a few months ago was undetectable.
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