The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic diarrhea, and respiratory congestion during the past 6 months. Physical examinatio

AIDS (Acquired Immunodeficiency Syndrome)

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

1. 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

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 to 6 months in patients infected with HIV?