Academic question part 2!!!!!!?

Question

BACKGROUND
A 41-year-old man presents with fever, malaise, and a 20-lb weight loss over the past 3 months. The patient also has intermittent headaches, coughing with occasional hemoptysis, and multiple chronic skin lesions. The lesions initially appeared as hyperpigmented scaly plaques on his lower back (see Image 1). They have enlarged over the last year, spreading to his arms, nose (see Images 2-3), and penis (see Image 4). The lesions are not itchy or painful. Over the last few weeks, the lesions on the patient’s nose and penis have begun to ulcerate and produce a bloody, purulent discharge.

The patient was diagnosed with HIV infection 13 years ago. He denies having any chest discomfort, shortness of breath, nausea, or diarrhea. He has not traveled recently and has not had any contact with people who were sick. He has not spent any time in environments where the risk of tuberculosis is high (eg, prison, shelters). On physical examination, the patient is afebrile with a blood pressure of 116/58 mm Hg and a heart rate of 92 bpm. His respiratory rate is 14 breaths/min, and his oxygen saturation while breathing room air is 96%.

On his nose is a crusted, indurated plaque with irregular borders and central ulceration that produces thick, blood-tinged, suppurative discharge (see Image 3). A nontender oval-shaped crusted plaque with superficial ulceration is located on his penis at the base of the glans (see Image 4). Numerous skin-colored umbilicated papules, of about 3-6 mm and with central hemorrhagic crusts, are scattered irregularly on his arms and face (see Image 2). A diffuse, hyperpigmented lichenification of the skin is noted on his back, with many small areas of superficial ulceration (see Image 1).

No retinal lesions are noted on funduscopic examination. No frank nuchal rigidity is present; however, the patient expresses moderate discomfort with neck flexion. The lungs are clear to auscultation with no rales, rhonchi, or wheezing; the cardiac examination is normal. The remainder of the physical examination yields unremarkable results.

The patient is transferred to the adjoining emergency department (ED) and, because infectious meningitis is suspected, is placed in respiratory isolation. A lumbar puncture reveals an opening pressure of 22 cm H2O. A cerebrospinal fluid (CSF) sample is sent for laboratory evaluation and shows a WBC count of 450/mm33 (0.450 X 109/L) with a mononuclear predominance, a mildly elevated protein level, and a slightly decreased glucose concentration. India ink staining reveals the presence of fungi.

What is the etiology of the patient’s symptoms? Are all of the lesions from the same disease process?

Answer 1

i believe that everything presenting is due to the HIV virus.
i am only a registered nurse and have never worked with hiv patients before but that' my thought on the subject OR thry could be from the fungi infection which due to the hiv , has more of a profound effect on him ... have you cultured one of the lesions, or remove one and send it off to the path lab. there you will most certainly get your answer. good luck

Answer 2

How can you follow its instructions faithfully? It is not written as an instruction book. It is an anthology dedicated to a traditional set of practices, many of which are only hinted at in Scripture. Let's look at some of the critiques here offered. Ridiculous nature of the claims - the interpretations may be ridiculous, but the claims are not. In the original languages, most of the 'miraculous' events in Scripture are either metaphor or natural events. It is hard to explain this when the English reads "Spirit" instead of "wind," or "whole earth" instead of "entire region." The Creation, Fall, Flood, Tower of Babel, Egyptian Plagues, Crossing of the Red Sea, Crossing of the Jordan River, and the Fall of Jericho are all described in natural terms in Scripture, especially when placed in their appropriate cultural and historical context. Funny - nobody reads the dialogs of Plato and rejects them for their miraculous claims. But the dialogs of Plato contain far more supernatural events than Scripture. Revelation was an Apocalyptic work. Anyone with any experience in early apocalyptic literature would immediately recognize the symbolism in Revelation. It was hardly the work of an insane man! On the contrary, it reflects a very common form of Hellenistic philosophical/religious writing. In Scripture, supernatural events, where they (rarely) occur, are often separated by 1500 years or more. So why would anyone assume that supernatural events happened all the time back then?

Answer 3

I am going to guess AIDS-associated cryptococcal meningoencephalitis with Cutaneous aspergillosis.