What was the cause of this patient’s iron-deficiency anemia?

Copyright © 2018 by Elsevier Inc. All rights reserved.

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 Results
Complete blood cell count (CBC), p. 156

Hemoglobin (Hgb), p. 251 12 g/dL (normal: 14–18 g/dL)
Hematocrit (Hct), p. 248 36% (normal: 42%–52%)

Chest x-ray, p. 956 Right-sided consolidation affecting the posterior
lower lung

Bronchoscopy, p. 526 No tumor seen
Lung biopsy, p. 688 Pneumocystis jiroveci pneumonia (PCP)
Stool culture, p. 797 Cryptosporidium muris
Acquired immunodeficiency syndrome
(AIDS) serology, p. 265

p24 antigen Positive
Enzyme-linked immunosorbent assay
(ELISA)

Positive

Western blot Positive
Lymphocyte immunophenotyping, p. 274

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. 265

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.

Case Studies

Copyright © 2018 by Elsevier Inc. All rights reserved.

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?
.