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Immunocompromised Patient Question

Discussion in 'Medical Students - MD' started by Spookster831, Dec 1, 2008.

  1. Spookster831

    2+ Year Member

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    Hey,

    I have a sample exam question I am trying to answer... I think I know the answer but I'd just like to have a second opinion if anyone minds?

    A 60 year old English man
    - abdominal pain and abdominal tenderness.
    - bloody diarrhea
    - heart transplantation 2 years ago.
    - past medical history included coronary artery disease, hypertension, deep venous thrombosis.
    He is on cyclosporin and dexamethasone.
    Exam - temp of 38 degrees C
    - abdomen the doctor finds that it is rigid and tender
    - X-Ray shows that there is free air under the diaphragm and distended loops of - Diagnosis of perforation - colostomy and tissue has numerous multi nucleated giant cells


    a. acute HIV
    b. aspergillus fumigatus
    c. candida albicans
    d. coagulase neg staph
    e. cryptococcus neoformans
    f. cryptosporidium parvum
    g. cytomegalovirus
    h. EBV
    i. Giardia Iamblia
    j. HHV 6
    k. HHV 8
    l. Legionalle pneumophilia
    m. mucor species
    n. mycobacteria tuberculosis
    o. mycobacterium avium intracellularae
    p. PCP
    q. toxoplasma gondii

    thanks!
     
    #1 Spookster831, Dec 1, 2008
    Last edited: Dec 12, 2008
  2. phospho

    phospho SDN Lifetime Donor
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    Just a premed, but I'm gonna try doing this. I'll use google also.:laugh:

    Multinucleated giant cells are associated with granulomas arising from immunological and nonimmunological inflammatory reactions. They are an integral part of the host immune response to chronic infectious diseases.


    adverse rxns of cyclosporin can include gum hyperplasia, convulsions, peptic ulcers, pancreatitis, fever, vomiting, diarrhea, confusion, breathing difficulties

    adverse rxns of dexamethasone are Stomach upset, increased sensitivity to stomach acid to the point of ulceration of esophagus, stomach, and duodenum. Also, Immunsuppressant action, particularly if given together with other immunosuppressants such as ciclosporine. Bacterial, viral, and fungal disease may progress more easily and can become life-threatening. Fever as a warning symptom is often suppressed.

    okay, this isn't working....i just realized that the only answer option I've ever heard of is A...:D
     
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  3. LadyWolverine

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    I was thinking CMV colitis, but I guess it could be other stuff, too?
     
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  4. IHeartNerds

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    CMV. Classic for patients on immunos s/p transplant. Most of the others don't make sense for a GI infection; of those that do, most are bacterial and would not cause giant cell formation. The other common agent, at least in HIV patients (dunno about s/p transplant), is MAC, but I don't know of it causing perforation or giant cells, rather there would be foamy macrophages.
     
  5. OP
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    Spookster831

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    Thanks, I was thinking that but for some reason I also had it in my head it might be MAI (even though there wasn't much basis lol)
     
  6. LadyWolverine

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    This is the other one that I got hung up on as well. I think MTB can actually infect the colon, too, although I'm not sure how often that really happens. And I thought you could see giant cells with MAC? I'm afraid that my path has gotten a little rusty.
     
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  7. OP
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    Spookster831

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    Yeah I think you can.
     
  8. IHeartNerds

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    MTB can infect the colon, at least according to RR Path. Not sure on how common that is either. MAC/MAI has no association with multinucleated giant cells that I'm aware of, although the macrophages can get pretty big.
     
  9. njbmd

    njbmd Guest
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    I believe the key to answering this question is the presence of multinucleated giant cells. MAC can coexist with CMV (and crytosporidium) especially in the gut of the immunosuppressed patient. CMV can cause ulceration/perforation but has the inclusion body cells (Owl eyes). The only guy on that list that makes sense is MAC which does produce multinucleated giant cells (chronic inflammatory reaction). MTB causes caseous granulomas so it isn't a good candidate here. My guess from my rusty path (and transplant surgery rotation as an intern ) is MAC.
     
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  10. IHeartNerds

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    for what it's worth, "transplant infections" which is a text we have online access to puts CMV at the top of the differential for a transplant patient with perforative colitis.
     
  11. Flopotomist

    Flopotomist I love the Chicago USPS
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    Interesting question.. my first pick was CMV, but then I don't recall that being assoc with the multinucleated giant cells. My second choice would be TB as that sounds vaguely familiar... what is the answer?
     
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  12. mjl1717

    mjl1717 Senior Member
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    Im not copying but if I see giant cells I think CMV..:scared:
     
  13. Tiger26

    Tiger26 Senior Member
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    Buzzword Bingo time . . . . .
     
  14. PeepshowJohnny

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    Agreed. If you follow the classic "Read the last line first" you'll get this in half the time.
     
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  15. meister

    meister Senior Member
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    What the hell is A and E? English version of an emergency room?
     
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    Spookster831

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    Yep.
     
  17. USArmyDoc

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    So answer is.....:confused:
     
  18. OP
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    Spookster831

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    lol, I don't know, they don't give us the answers. I was trying to figure it out for myself.
     

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