confusing signs/unable diagnose...
Jul 28, 2002
Dr. Dieterich: Hoping for insights: Patient with: Symptoms:upper right quadrant pain, light stools, mild photophobia... Signs of hepatitis: periodic slightly raised ALTs/ AST always within range... No alcohol/drugs/vitamins Kidney function within limits, but BUN/Creatinine progressively rising... Iron progressively rising TIBC progressively falling, but still in limits... Imaging liver/kidney normal... Testosterone under 200 and falling(35 y.o.---no signs of congenital hypogonadism--patient claims dramatic decline in libido)
CD4 800 CD19/Bcells 110/6 no CD4/CD8 inversion
One possible sexual exposure with possibly co-infected person..soon after, patient claims experiencing ARS symptoms (rashes on neck/torso, light pneumonia, night sweats)
Up to 11 months post exposure, all PCR and antibody tests for HIV/Hep B/Hep C negative...
Could it be acute co-infection more than one pathogen with not enough B cells for immune response? PCRs negative also? At a loss...
Response from Dr. Dieterich
I would test for hemochromatosis with liver biopsy for iron stores. It could account for all of those symptoms. Does not sound like a virus! Send him to a liver center! Good luck! DTD
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