homework

My first day off after working 12 days in a row (particularly demanding as we've had a run of patients presenting with hypercalcaemia due to cancer of unknown primary - but that's another story) and I've got homework! I've got to do a case presentation on Monday. This is how it goes: 23 year old lady from Zimbabwe presents with a 3-month history of weight loss (10kg), painful joints and muscle weakness. Her only past medical history is a miscarriage two years previously. She had a negative HIV test then. I went down to medical records to get the notes myself, and when looking through them, was amazed at the number of complex tests she had had in the space of about 3 days. My own contribution was arranging an urgent echocardiogram when a pericardial effusion was seen on high-resolution CT. She also had lung function tests, nerve conduction studies and a bronchoscopy. One ward round entry states "patient exhausted after today's investigations". The eventual diagnosis was of mixed connective tissue disease. In addition, an HIV test was positive. So the second bit of my presentation is on HIV and autoimmune disease. A quick look on pubmed reveals that this is in the 'case report'/ J Exp Med realm (i.e. vanishingly rare/ newly noticed). Unfortunate for the patient but pretty fascinating stuff re: T cell suppression etc. Takes me back to my BSc year - probably the last time I actually had to use my brain (day to day medicine is pretty brainless). I miss that.