Multisystem Processes & Disorders


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M62_F1.jpg"}},{"insert":"\n\n"},{"insert":"Your clinic has been uneventful today, and you find yourself almost yearning for a challenge.\r\n\r\nNo sooner has the thought materialized in your mind, that the next patient is shown in.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M62_F2.jpg"}},{"insert":"\n\n"},{"insert":"Twenty-nine-year-old Mary greets you and hands over a referral letter. You quickly peruse its contents.\r\n\r\nApparently, Mary presented to the dermatology clinic last week, complaining of yellowish discolouration of all ten toenails. Subsequently, she was found to have proximal subungual onychomycosis.\r\n\r\nThe dermatologist also noted a milky white patch on the hard palate, suggestive of oral candidiasis, and decided to refer her to your clinic for further evaluation.\n"}]}


{"ops":[{"insert":"You put the letter down, and start asking targeted questions.\r\n\r\nAside from her dermatological complaints, Mary has also had intermittent mild fever and diarrhea for around a month now. She lost around 4 kilograms of weight over the same period. No other symptoms are present.\n\nHer medical, surgical, and gynecological histories are unremarkable. She is currently on oral fluconazole, as prescribed by the dermatologist. She is not on any other ongoing medications, over-the-counter drugs, or herbal supplements.\r\n\r\nDuring university, she engaged in frequent unprotected sex with multiple partners. Since graduating, she has had three partners in total. She has been with her current boyfriend James for around eight months now.\r\n\r\nShe used marijuana liberally while in university, but has never used hard drugs, or engaged in intravenous drug abuse.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M62_F4.jpg"}},{"insert":"\n\n"},{"insert":"On examination, you find Mary\u0027s BMI to be 18.3 kg\/m2. Her vital signs are stable. You note the subungual onychomycosis and oral candidiasis detected by the dermatologist.\r\n\r\nExamination of the heart, lungs, abdomen, and central nervous system is unremarkable.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M62_F5.jpg"}},{"insert":"\n\n"},{"insert":"You inform Mary that she has signs and symptoms suggestive of immunosuppression, and proceed to explain why testing for human immunodeficiency virus (HIV) infection might be advisable.\r\n\r\nMary is visibly stunned, and takes several moments to respond. After several follow-up questions, she agrees to testing.\n"}]}