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In this Grand Rounds presentation, Dr. Jacobson examines 2 cases that illustrate challenges in caring for severely immunosuppressed patients. The first case presents the dilemma in deciding when to start ART for a critically ill patient with PCP and discusses how to differentiate among PCP, IRIS, and other conditions. The second case features a man who presented multiple times with headache and fever, splenomegaly, and pancytopenia before the diagnosis was determined.

Dr. Mark A. Jacobson is a UCSF Professor of Medicine and an attending physician and Director of Urgent Care Services for the Positive Health Practice at San Francisco General Hospital. He is also the Medical Director of the UCSF Clinical and Translational Science Institute Clinical Research Center at SFGH. He investigates protective and inflammatory immune responses in patients with chronic viral infections, in particular HIV, cytomegalovirus (CMV) and human papillomavirus (HPV).