72 year old maleHIV positive, on ART 10 years. Benign prostatic hyperplasia. Unwell for 3–4 weeks:confusion, cough, weight loss, lethargy.Pre-hospital: Co-amoxiclav and azithromycin within 1 month of admission. Week 2 TBTreatmentAdmission: Temperature 35.7°C, GCS 10. SIRS = YesRecruitment Day 5: Temperature 37.5°C. SIRS = NoBloods Day 5: CD4 158 μL-1, WCC 26.0 x109 L-1,CRP >120mg L-1, lactate 3.4mmol L-1,creatinine 862mmol L-1Antibiotics: Ceftriaxone 24 hoursOutcome: Died in hospital. The gene discussed is CD4; the disease is benign prostatic hyperplasia.