Department of Anatomy
University of Jos

Clinical Demonstration

Case summary


Commercial sex worker history video

NAME: MARY X

SEX: FEMALE

OCCUPATION: Undergraduate

Complain of

  • Rash on the face for 1 year\Chronic cough for 2 months
  • Chronis stooling for 1 month
  • Sores in the mouth for 3 weeks
  • Dizzy spells for over 6 months
  • Chronic headache for 3 months

 

 

HISTORY OF PRESENTING COMPLAINT

The patient was quite will until a year ago when she started to notice very dark rash on her face. The rash later spread to her neck and chest wall. They were not itchy but they were disfiguring. She had used several medications all to no avail. Then 6 months ago, she started to have periods of dizziness most especially at night and it has gradually gotten worse. Three months ago, this was compounded with headache which has not stopped since it started and does not respond to any treatment. She had used panadol, panadol extra, novalgin, etc but none has stopped the headache. One month ago, she started to stool at least four times every day. Before then her normal frequency of stooling was once in 2 days. The stool was watery and very offensive in smell and since then, she had notice that she steadily lost weight and has since lost about 1/3 of her original weight before the illness began.

FAMILY HISTORY: NIL OF NOTE

Sexual history: The patient has 10 boy friends and sleeps regularly with al of them at least once a week. In addition, she does not see anything wrong in helping others who wish to sleep with her like those who may request for her aid on the streets especially if the reward is handsome enough. She feels it is the duty of every decent girl to help men out when in need of sex, but the women must also be ready to pay for the services for only a cheap woman would allow herself to be slept with for nothing. This, according to her, is her upbringing.

EXAMINATION

On examination the patient was found to be pale by the examination of the conjunctival mucosa. She was very weak and seemed to be disoriented slightly in place and person, but not time. She was moderately dehydrated; about 5%n of the total body weight was estimated. On the examination of her tongue, she had trush together with a  wound on the left side of the tongue which had a broad base. She also had cuts at the angle of the mouth. She had rash which was maculopapular but not vesicular or pemphigoid. The rash was found in the face and anterior chest region.

Chest had crepitations at the lung bases with scattered rhonchi. Heart sounds were heard and there were no murmurs. Sputum was found to be blood stained. Abdomen was scaphoid and non protruberant. No liver enlargement or splenomegaly. Kidneys were normal in shape and size. Large lymph nodes were palpable at the groin and the cervical region. On pelvic examination, no abnormality was detected. Ovaries, uterus and remaining adnexae were clear of masses. The vagina was in normal condition.

On temperament /psychiatric tests she was found to be primarily sanguine and secondarily phlegmatic. She was also adjudged to be pseudocholeric. She did not have any symptoms or signs of schizophrenia or any of the functional psychoses or organic brain syndromes, but she was obviously depressed.

 

  INVESTIGATIONS
  • Stool for microscopy yielded Entameba spp
  • Sputum was positive for acid fast bacilli
  • High vaginal swab yielded no growth
  • Computer axial topography (CAT) scans showed a big mass in the temporal lobe of the brain.

Electrolytes and urea

Sodium 155 (135-145) mEq/l

Potassium 4.0 (3.5-5.5) mEq/l

Chloride 102 (96-106) mEq/l

Bicarbonate 26 (21-31) mEq/l

Urea 50 mg% (14-40)

Blood - WBC 2000/cumm; differentials - neutrophils 70%, lymphocytes-70%, monocytes- 6%,. eosinophils 3%, basophil 1%, CD4+- 200 (800-2000)/cumm

DIAGNOSIS

Acquired immune deficiency syndrome (Full Blown AIDS) with the following complications- Entamebic dysentery, Tuberculosis ?, Brain toxoplasmosis, Necrotizing gingivitis, angular cheilitis, thrush and slim disease.

CARE GIVING

The patent was ordered to have care from the social works department. She was to be nursed at home and no one was to discriminate against her. The utensil she uses for her feeding must not necessarily be separated from those of her family and the clothes she wears if dry, may be used by others. But her sanitary towels must be carefully and hygienically dispose off, just as her vaginal fluid if it touches any one, it must be sterilized if it touches any utensil or clothing. She must have bed side stories every night before she sleeps and must also have the attention of her Pastor and church in addition to that of hr family.

Two months after the diagnosis, Mary died. By then her slim disease had advanced so much that she had lost two third of her original weight - she weighed 23 kg shortly before her demise. Postmortem examination showed ruptured brain toxoplasmosis as the primary cause of her death, occasioned by full blown AIDS. She was buried in her village.