A 31-year old man with a history of IV drug use presents to the E.R. with a chief complaint of shortness of breath. He reports a 1 month history of intermittent fever and night sweats, accompanied by a nonproductive cough. Initially, he was only short of breath on exertion but now he experiences dyspnea even when at rest. When he presents at the E.R. he appears to be in moderate respiratory distress. Vital signs are as follows: T 39 degrees C, P 112, R 20, and 02 Sat. 88% on room air. Physical exam is unremarkable except for diminished lung sounds. Chest x-ray reveals diffuse infiltrate, characteristic of pneumocystis pneumonia, an opportunistic infection. -What underlying disease is most likely responsible for this current illness? – Discuss opportunistic infections. -Describe the pathophysiology of the immunosuppression caused by the underlying disease. -Describe the natural history of this disease and the clinical manifestations seen as the disease progresses.
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