aidscase_08

aidscase_08 - A Disease of Particular Concern to Health...

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A Disease of Particular Concern to Health Care Professionals A 36-year-old male initially presented to the emergency room with a complaint of malaise and fever of several months' duration A history of intravenous drug abuse and occasional unprotected sex with males was obtained Physical examination was remarkable for pallor and generalized, nontender lymphadenopathy
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AIDS Lymphadenopathy A needle aspiration biopsy of one of the enlarged nodes revealed a mixed cell population, consistent with reactive hyperplasia The reactive hyperplasia was unusual showing A loss of the mantle zone (MZ) Diffuse infiltration by small lymphocytes Subsequent laboratory evaluation revealed the patient to be seropositive for HIV by both ELISA and Western blot . A CD4+ count was 350/ul (normal 500-1500) The patient was discharged with an appointment to return to AIDS clinic, but was subsequently lost to follow-up. MZ MZ Patient node Control Hyperplastic Node
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Disease Progression Radiograph He returned to the emergency room 16 months later complaining of recurrent fever, persistent dry cough, and dyspnea This chest X-ray demonstrates bilateral, fluffy pulmonary infiltrates, prominent in the hilum and base of the lungs (arrows)
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Disease Progression (2) Transbronchial Biopsy of Lung - Low Power Because of failing pulmonary function a biopsy is done Eosinophilic, frothy material, a combination of Pneumocystis organisms (an opportunistic fungal infection) and plasma constituents, is present in many of the alveolar spaces (circled) The characteristic morphology of the organism is demonstrated in the inset; a special stain highlights the wall and central body of the organism. He was begun on sulfa-trimethoprim marked improvement and was discharged for follow-up in the hospital AIDS clinic.
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Further Disease Progression The patient failed to keep his subsequent clinic appointments, and presented three months later with recurrent dyspnea, fever, voluminous watery diarrhea, and weight loss Chest X-ray revealed changes similar to those noted on his
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aidscase_08 - A Disease of Particular Concern to Health...

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