Question

HPI: A 28 YO HM presents to the physician's office for evaluation of a rash on his chest and back. He started with one oval-shaped purplish area that he thought was a bruise but has subsequently developed multiple new lesions. The growths do not hurt, itch, or bleed, but he continues to get new ones, and the existing ones are getting larger. He has never had anything like this before, has no history of allergies and denies exposure to any new medications, foods, lotions, or soaps.

PMHx: His past medical and family histories are unremarkable.

ROS: His review of systems (ROS) is significant for a 15-pound weight loss in the past 2 months, ~6 weeks of diarrhea, and a 3-week history of a sore throat.

PE: WD WN WM in NAD

VSS Afebrile

On physical examination, he is a thin but generally well appearing male. His vital signs are normal.

Pharynx: +++ thick white plaques on the posterior pharynx and soft palate.   

Skin - on his chest are multiple oval-shaped purple or brown macules. They are firm on palpation and vary in size from 0.5 - 4 cm in length. Several of them appear to be growing together into larger, confluent plaques.

You perform a punch biopsy of one of the lesions. In 5 days you get the pathology report with the diagnosis of Kaposi sarcoma (KS).

Definitions

Retrovirus: An RNA virus. Retroviruses have an enzyme called reverse transcriptase that gives them the unique property of transcribing RNA into DNA. The retroviral DNA can then integrate into the chromosomal DNA of the host cell to be expressed there.

HAART: Highly active antiretroviral therapy. It is the treatment for HIV infection that uses a combination of several antiretroviral drugs. The drugs inhibit the ability of the virus to multiply in the body, and they slow down the development of AIDS.

AIDS: Acquired immunodeficiency syndrome. A cell-mediated immunity (CMI) caused by infection by HIV leading to depletion of CD4 helper T-lymphocyte cells.

Discussion Questions

1. With what virus is this patient likely infected?

2. What specific cell types are most commonly infected with this virus?

3. What cell surface receptor is the binding site of this virus?

4. What serologic testing is most frequently performed to make this diagnosis?

Answer 1

1, Retrovirus

2, CD4 helper T- lymphocyte cells

3, RNA virus

4, HIV antibody test..