Mr. stone, a 45 year old ranch hand, eventually vistited his Dr. because over the past 18 months he had been feeling poorly and had been unable to do his workon the farm. he had recently lost some weight and developed a hacking cough. however he ate well and was a non smoker. in addition he had started to develop breathlessness and had begun to cough up small amounts of blood. he has no history of respitory problems,allergies, or asthma. a white blood cell count revealed normal numbers of lymphocytes and granulocytes and only slightly elevated total serum immunoglobulin.
1. what is the preliminary diagnosis of this case and why? (include type of hypersensitivity that is mediating the disease)
2. what is the mechanism of the disease? ( in other words what is the molecular and/or cellular cause of this disorder?)
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This case presents as 45 y/o male, ranch worker with general malaise for 18 months, recent weight loss (eating well?), and dry cough changed to hemoptysis(?).
Personal history: non-smoker, no history of respiratory problems, allergies, or asthma
Lab work: WBC normal with slightly elevated total serum immunoglobulin
Without a complete physical or x-ray to accompany and help to define more the diagnosis, you start with the most common causes at 40 + years old of hemoptysis (coughing blood), difficulty breathing, and feel tired or general malaise:
(a)acute and chronic bronchitis,
(e)Lung cancer (Bidwell & Pachner, 2005; Lechtzin, 2009)
Any type of bacterial or viral infection would have required to have elevated WBC; a high lymphocytes count would have stir the diagnosis to viral infection (including TB) and high granulocytes would indicate a probable bacterial infection (high eosinophils would have indicated allergies or ...
The solution involves a step by step differential diagnosis of a 40 year old farmer with cough (ocassionally coughing blood), breathlessness and general malaise. It gives a preliminary diagnosis including type of hypersensitivity that is mediating the disease and probable mechanism of the disease. It also provide references to help study further the case.