The patient, a 30-year-old homosexual man, complained

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition

AIDS (Acquired Immunodeficiency Syndrome)

Case Studies

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. 156

Hemoglobin (Hgb), p. 251 12 g/dL (normal: 14–18 g/dL)

Hematocrit (Hct), p. 248 36% (normal: 42%–52%)

Chest x-ray, p. 956 Right-sided consolidation affecting the posterior

lower lung

Bronchoscopy, p. 526 No tumor seen

Lung biopsy, p. 688 Pneumocystis jiroveci pneumonia (PCP)

Stool culture, p. 797 Cryptosporidium muris

Acquired immunodeficiency syndrome

(AIDS) serology, p. 265

p24 antigen Positive

Enzyme-linked immunosorbent assay

(ELISA)

Positive

Western blot Positive

Lymphocyte immunophenotyping, p. 274

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. 265

75,000 copies/mL

Diagnostic Analysis

The 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.

Case Studies

Critical Thinking Questions

1. 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 3–6 months in patients infected with HIV?

3. This is patient seems to be unaware of his diagnosis of HIV/AIDS. How would you approach to your patient to inform about his diagnosis?

4. Is this a reportable disease in Florida? If yes. What is your responsibility as a provider?