Mosby’s Manual of Diagnostic and Laboratory Tests

    Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 5th 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. 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/L) 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 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