Case Study 1AIDS (Acquired Immunodeficiency Syndrome)
The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed right-sided pneumonitis. The following studies were performed:
Studies
Results
Complete blood cell count (CBC), p. 174
Hemoglobin (Hgb), p. 259 12 g/dL (normal: 14-18 g/dL)
Hematocrit (Hct), p. 256 36% (normal: 42%-52%)
Chest X-ray, p. 1014 Right-sided consolidation affecting the posterior lower lung
Bronchoscopy, p. 587 No tumor seen
Lung biopsy, p. 738
Pneumocystis jiroveci pneumonia (PCP)
Stool culture, p. 855 Cryptosporidium muris
Acquired immunodeficiency syndrome (AIDS) serology, p. 297 p24 antigen Positive
Enzyme-linked immunosorbent assay (ELISA)
Positive
Western blot Positive
Lymphocyte immunophenotyping, p. 306
Total CD4 280 (normal: 600-1500 cells/L)
CD4%
18% (normal: 60%-75%)
CD4/CD8 ratio
0.58 (normal: >1.0)
Human immune deficiency virus (HIV) viral load, p. 297 75,000 copies/mLDiagnostic AnalysisThe detection of Pneumocystis jiroveci pneumonia (PCP) supports the diagnosis of AIDS. PCP is an opportunistic infection occurring only in immunocompromised patients and is the most common infection in persons with AIDS. The patient’s diarrhea was caused by Cryptosporidium muris, an enteric pathogen, which occurs frequently with AIDS and can be identified on a stool culture. The AIDS serology tests made the diagnoses. His viral load is significant, and his prognosis is poor.
The patient was hospitalized for a short time for treatment of PCP. Several months after he was discharged, he developed Kaposi sarcoma. He developed psychoneurologic problems eventually and died 18 months after the AIDS diagnosis.Critical Thinking Questions1. What is the relationship between levels of CD4 lymphocytes and the likelihood of clinical complications from AIDS?2. Why does the United States Public Health Service recommend monitoring CD4 counts every 3 to 6 months in patients infected with HIV? Case Study 2
Multiple Sclerosis (MS)A 35-year-old woman was active in jogging and horseback riding until 1 year ago. During the past year she began to notice severe weakness and paresthesia in her legs. Her gait became unsteady, and she developed loss of vision in one eye. A neurologist suspected multiple sclerosis (MS) and ordered the following studies:
Studies
Results
Routine laboratory work Within normal limits (WNL)
Lumbar puncture with cerebrospinal fluid (CSF) examination, p. 651
Immunoglobulin (Ig) G index
0.8 (normal: 0.3-0.7)
IgG determination
20% (normal: 0%-11% of total protein)
Oligoclonal bands
Present (normal: none)
Evoked potentials (EPs), p. 562
Visual-evoked potentials
Abnormal latency
Auditory brainstem-evoked potentials
Normal
Somatosensory-evoked responses
Abnormal latency
Magnetic resonance imaging (MRI), p. 1106
Plaques indicative of multiple sclerosisDiagnostic AnalysisThe wide variety of symptom manifestation often makes MS difficult to diagnose; however, the above studies clearly identified MS as the patients problem. The CSF study results were classic for the diagnosis of MS. The abnormal latency demonstrated on the EP studies was the result of the demyelination process of MS. MRI revealed plaques indicative of MS.
The patient was given prednisone to decrease the inflammation and associated edema of the myelin sheath. When remission occurred, she was instructed about factors that exacerbate, prevent, or ameliorate symptoms.Critical Thinking Questions1. 2. What is latency, and why is it increased in MS?Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.
Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
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