Academic question part 2!!!!!!?

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閳ユ獨 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閳ユ獨 symptoms? Are all of the lesions from the same disease process?

Academic question part 2!!!!!!?

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%26#039; 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

Academic question part 2!!!!!!?

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