Reference no: EM133117406 , Length: word count:750
Case Study - Monty
Monty is a 34-year-old male with a history of immune deficiency diagnosed in early childhood and on lifelong intravenous immunoglobulin (IVIg) therapy. Monty also suffers from chronic sinusitis and is treated with clarithromycin prophylactically. He lives with his partner James and their cat Theo.
Monty complained of feeling ill reporting fatigue, muscle aches and pains, headaches, and feverish. His partner was concerned so they went to their local Emergency Department.
In the Emergency Department, Monty was febrile (38.9ºC), Blood pressure was 130/ 80mmhg, Pulse post 90bpm Respiration 20 bpm. He denied having any vision changes, abdominal pain, vomiting, urinary or bowel changes. He also had swollen lymph nodes around the neck.
Monty's initial laboratory evaluation was within normal limits, with the exception of an elevated white blood cell (WBC) count of 12,800 cells/ and C-reactive protein (CRP) of 20 mg/L.
Magnetic resonance imaging (MRI) of the brain showed innumerable enhancing lesions scattered throughout the cerebral and cerebellar hemispheres, with involvement of the cortex, subcortical and periventricular white matter, bilateral basal ganglia, thalami and brainstem, with target and nodular enhancement.
Lumbar puncture and cerebrospinal fluid analysis for Toxoplasma revealed 2,600 copies/mL. Serologies were negative for HIV, Epstein-Barr virus, hepatitis B and hepatitis C. T. gondii IgG was positive (145 IU/mL: normal 0.0-7.1 IU/mL). T. gondii IgM was normal.Monty has been diagnosed with cerebral toxoplasmosis.
He was commenced on Clindamycin (an antibiotic). During his course of treatment, Monty had two episodes of tonic-clonic seizures within one hour and then became unresponsive. A head CT revealed a large, left thalamic, intraparenchymal haemorrhage with intraventricular extension causing obstructive hydrocephalus.
Question 1: Describe and rationalise how and why Monty has developed cerebral toxoplasmosis
(approx. 250 words)
Question 2: Explain the physiology behind why Monty has developed seizures and is now unresponsive.
(approx. 250 words)
Question 3: Explain why Monty has swollen lymph nodes and what are their usual functionof the lymph nodes, rationalise why they are swollen (approx.250 words)