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/mL)
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/mL
- Diagnostic Analysis: establish a diagnostic analysis of this case supported by a clinical guideline :
-summary of signficiant clinical data
- create a diagnostic rationale of the case including diagnosis and clinical data that support it
Critical Thinking Questions
- What is the relationship between levels of CD4 lymphocytes and the likelihood of clinical complications from AIDS?
- Why does the United States Public Health Service recommend monitoring CD4 counts every 3 to 6 months in patients infected with HIV?