CLINICAL CASE 4 IMMUNITY A 38 -year-old man goes to the doctor because of interm
ID: 3521883 • Letter: C
Question
CLINICAL CASE 4 IMMUNITY A 38 -year-old man goes to the doctor because of intermittent fevers, recurrent night sweats, diarrhea and a 28 Ib loss. He says that he is gay, used to use IV drugs in the past, and adds that he hasn't been as careful about sex, as he should have been. The results of his blood work reveal that he is HIV positive; he is given the appropriate treatment, which he fails to follow. He shows up two more times in the Emergency Room, the first time 14 months later complaining of shortness of breath and severe diarrhea. His second coming at the ER months later is marked by a semi comatose status. His caregivers report that he is suffering from severe memory problems, persistent coughing, diarrhea, and weight loss. He dies the following day. Autopsy indicates congestion of the lungs and alveoli filled with microorganisms. His brain shows gross atrophy, chronic inflammation and collection of multinucleated giant cells. The small bowel and colon are extensively ulcerated and inflamed. Questions 1. Why can we say that the patient belongs to main AIDS risk groups? 2. What should we expect to happen with CD4+ lymphocyte count, upon the second and third encounter? 3. Which is the most common microorganism that we expect to detect in his alveoli? 4. What is your diagnosis behind the brain atrophy and inflammation? 5. What might have caused the diarrhea?Explanation / Answer
Clinical case 4:
1) The patient is a 38 year old adult male. He is a gay, practices unsafe sex and also uses IV drugs. All these are important risk factors for AIDS.
2) The CD4 count will be decreased in the second and third encounter. CD4 count is a measure of immunity and severity of symptoms correlate with decrease in CD4 count.
3) The organism most commonly implicated in pneumonia in AIDS patient is Pneumocystis carnii.
4) The brain atrophy and inflammation in AIDS patient occurs due to infection with toxoplasmosis and cryptococcus neoformans infections.
5) The most common cause of diarrhea in AIDS patient are cytomegalovirus, cryptosporidiosis, microsporidiosis and mycobacterium avium complex.
Please post other question separately.