In a HIV-positive patient with diffuse ST elevations and chest pain, which exam finding is most likely?

• A. Roth spots
• B. Splenic enlargement
• C. Janeway lesions
• D. Pericardial friction rub

Answer: (D)

Acutely inflamed pericardium gives a friction rub, which is the hallmark finding here. Diffuse ST elevations on the ECG with chest pain strongly point to acute pericarditis, and in an HIV-positive patient the pericardium can be involved due to infections or inflammatory processes. The friction rub is a scratchy, high-pitched sound heard with a stethoscope, best at the left lower sternal border and often more noticeable when the patient leans forward. This sound confirms pericardial inflammation rather than other causes of embolic or endocardial signs, such as Roth spots or Janeway lesions, or non-specific splenic enlargement.