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 ResultsComplete blood cell count (CBC), p. 174
Hemoglobin (Hgb), p. 25912 g/dL (normal: 14-18 g/dL)Hematocrit (Hct), p. 25636% (normal: 42%-52%)Chest X-ray, p. 1014Right-sided consolidation affecting the posterior lower lungBronchoscopy, p. 587No tumor seenLung biopsy, p. 738Pneumocystis jiroveci pneumonia (PCP)Stool culture, p. 855Cryptosporidium murisAcquired immunodeficiency syndrome (AIDS) serology, p. 297p24 antigenPositiveEnzyme-linked immunosorbent assay (ELISA)PositiveWestern blotPositiveLymphocyte immunophenotyping, p. 306
Total CD4280 (normal: 600-1500 cells/mL)CD4%18% (normal: 60%-75%)CD4/CD8 ratio0.58 (normal: >1.0)Human immune deficiency virus (HIV) viral load, p. 29775,000 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.Critical Thinking 2. Why does the United States Public Health Service recommend monitoring CD4 counts every 3 to 6 months in patients infected with HIV?
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