An HIV-positive patient with progressive leg redness and hypotension and CD4 count of 75 cells/μL presents; what is the most appropriate next step?

• A. Oral antibiotics and follow-up
• B. Transfer to ED
• C. Wound care and discharge
• D. Unsupervised home meds

Answer: (B)

Urgent evaluation for a potentially life-threatening infection in an immunocompromised patient. A CD4 count of 75 cells/μL shows advanced HIV with high susceptibility to rapid, severe infections. The combination of progressive leg redness and hypotension signals possible septic progression or septic shock, and may indicate a rapidly spreading soft-tissue infection that could require surgical intervention. Such a scenario requires hospital-based care with IV fluids, broad-spectrum IV antibiotics, and continuous monitoring, often in an emergency department setting. Outpatient oral antibiotics, wound care and discharge, or unsupervised home meds would delay essential treatment and risk worsening illness. Transferring to the ED is the appropriate next step.