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DD1 Derek Smith, a 31 y.o.,  Caucasian male injection drug user, who is homeless, presents to the ED with a chief complaint of shortness of breath. He des

DD1 Derek Smith, a 31 y.o.,  Caucasian male injection drug user, who is homeless, presents to the ED with a chief complaint of shortness of breath. He des

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DD1 Derek Smith, a 31 y.o.,  Caucasian male injection drug user, who is homeless, presents to the ED with a chief complaint of shortness of breath. He describes a 1-month history of intermittent fevers and night sweats associated with a nonproductive cough. He has become progressively more short of breath, initially only with exertion, but now he feels dyspneic at rest. He appears to be in moderate respiratory distress. His vital signs are abnormal, with fever to 39°C, heart rate of 112 bpm, respiratory rate of 20/min, and oxygen saturation of 88% on room air. Physical examination is otherwise unremarkable but notable for the absence of abnormal lung sounds. Chest x-ray film reveals a diffuse interstitial infiltrate characteristic of pneumocystis pneumonia, an opportunistic infection.

In this discussion:

1. Describe and discuss with your colleagues the underlying disease most likely responsible for this patient’s susceptibility to pneumocystis pneumonia.

2. Describe and discuss the immunosuppression caused by this underlying disease.

3. Describe and discuss the natural history of this disease and some of the common clinical manifestations seen during its progression.

4. Describe your plan of care for this patient following his hospitalization (he will likely be admitted to the “medical respite floor,” of a local homeless shelter, which has the services of a Nurse Practitioner three times per week—with on-call weekend consultation, and a registered nurse, Monday through Friday). 

Include citations from the text or the external literature in your discussions.

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