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
Complete blood cell count (CBC), p. 156
Hemoglobin (Hgb), p. 251
Hematocrit (Hct), p. 248
Chest x-ray, p. 956
Bronchoscopy, p. 526
Lung biopsy, p. 688
Stool culture, p. 797
Acquired immunodeficiency syndrome
(AIDS) serology, p. 265
p24 antigen
Enzyme-linked immunosorbent assay
(ELISA)
Western blot
Lymphocyte immunophenotyping, p. 274
Total CD4
CD4%
CD4/CD8 ratio
Human immune deficiency virus (HIV)
viral load, p. 265
Results
12 g/dL (normal: 14–18 g/dL)
36% (normal: 42%–52%)
Right-sided consolidation affecting the posterior
lower lung
No tumor seen
Pneumocystis jiroveci pneumonia (PCP)
Cryptosporidium muris
Positive
Positive
Positive
280 (normal: 600–1500 cells/L)
18% (normal: 60%–75%)
0.58 (normal: >1.0)
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.
Copyright © 2018 by Elsevier Inc. All rights reserved.
Case Studies
2
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?
.
Copyright © 2018 by Elsevier Inc. All rights reserved.
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