OBJECTIVE:
- The following cases are designed to illustrate the clinical presentations, pathological changes, and treatment of opportunistic infections and neoplasms seen with the acquired immunodeficiency syndrome. This session will familiarize you with the concepts and the diagnoses in each clinical setting.
CASE 1
History:
- A 17 year old female noted fever of one week duration along with sore
throat, mild diarrhea, headache, and generalized aching. She saw her
family physician who noted pharyngitis, lymphadenopathy, and a very mild
diffuse erythematous rash on physical examination. The physician
suspected an acute viral illness such as infectious mononucleosis, but a
monospot test was negative and her symptoms were still present two
weeks later. Further history indicated that she had multiple episodes of
unprotected sexual intercourse with several partners over the past two
months. Consent for HIV testing was obtained. HIV antibody was present.
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- This is a schematic of the life cycle of human immunodeficiency
virus.
Questions:
- What are the major risk factors for HIV infection?
- What is the nature of this patient's acute illness?
- How reliable is the HIV test?
- What is this patient's stage of HIV infection?
(Click here to go to the answers)
CASE 2
History:
- A 37 year old male known to be HIV positive for the past 6 years,
with risk factor of homosexuality, sees his physician because of
persistent diarrhea for the past two months along with persistent fever.
On physical examination, he is found to have generalized lymphadenopathy,
oral thrush, and grouped vesicles on the skin of the trunk in a dermatomal
distribution.
Questions:
- What is the natural history of HIV infection?
- What HIV-related illnesses does he have?
- What is this patient's stage of HIV infection?
(Click here to go to the answers)
CASE 3
History:
- A 35 year old male was driving home from work when he suddenly
became short of breath. He pulled his pickup truck into the lot of a local
hospital and walked with difficulty into the emergency room. His vital
signs showed respirations 35, pulse 102, temperature 37.9, and blood
pressure 110/60. A chest x-ray showed bilateral patchy infiltrates. A
bronchoalvoelar lavage was performed. Although therapy was initiated, he
died four days after admission.
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Questions:
- How could his acute illness have been prevented?
- What is the probable underlying disease process that led to the acute
illness?
- How would you confirm this?
(Click here to go to the answers)
CASE 4
History:
- A 29 year old female became increasingly short of breath with a non-
productive cough and low-grade fever. She also had a mild watery
diarrhea. She was also noted to have hypoglycemia and hyponatremia. A
chest radiograph showed ill-defined bilateral infiltrates. A stool for ova
and parasites was negative. A bronchoalveolar lavage (BAL) with
transbronchial biopsy (TBB) was performed. After the results of the BAL
and TBB were reported, an HIV test was performed and was positive. A
CD4 lymphocyte count was 135 cells/microliter. Further history revealed
that her risk factor was a sex partner at risk (former intravenous drug
user).
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Questions:
- What is the stage of her HIV infection?
- Where else in the body might this infection be found?
(Click here to go to the answers)
CASE 5
History:
- A 28 year old woman developed an increasingly severe headache over
a two day period of time and came to the emergency room of the hospital.
Vital signs showed respirations 25, pulse 82, temperature 37.4, and blood
pressure 145/80. Physical examination revealed generalized
lymphadenopathy and needle tracks in the left arm. A lumbar puncture
was performed which showed increased opening pressure. The CSF was
fairly clear. There were no RBC's and a few WBC's.
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Questions:
- How does this account for the clinical presentation?
- What is the significance of the needle tracks in the arm?
(Click here to go to the answers)
CASE 6
History:
- A 30 year old male began to notice the appearance of small reddish-
purple patches on the skin of his face and hands. These gradually
increased in size and number and then involved the skin of the trunk and
lower extremities. The patient died 8 months after presentation with
respiratory failure.
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Questions:
- What diagnosis do you suspect?
- What laboratory testing should be requested when you suspect such a
diagnosis?
- What findings would you suspect in a clinical history?
- How often does visceral organ involvement occur in this disease?
(Click here to go to the answers)
CASE 7
History:
- A 42 year old male who had been known to be HIV positive since 1986 developed persistent fever with weight loss. Physical examination revealed hepatomegaly with splenomegaly, and lymph nodes were palpable in the posterior cervical region. A chest radiograph showed no infiltrates or masses. A lymph node biopsy was performed.
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Questions:
- What are the possible causes for these findings?
- What laboratory testing or diagnostic procedures can be performed to reach a diagnosis?
- What is his stage of HIV infection?
- What laboratory testing is available to follow the course of his HIV infection?
(Click here to go to the answers)
CASE 8
History:
- A 31 year old female was diagnosed with HIV infection in 1991 but was relatively healthy until the spring of 1996, when she developed oral thrush. A month later she was hospitalized for a respiratory tract infection. Streptococcus pneumoniae was cultured. Her most recent hospitalization followed the onset of a fever to 102 F. She also had a cough productive of sputum that was thick and yellow-tinged. A chest radiograph showed patchy areas of consolidation in both lungs.
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Questions:
- What are the possible causes for these findings?
- What laboratory testing or diagnostic procedures can be performed to reach a diagnosis?
(Click here to go to the answers)
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