Chief Complaint: 23-year-old man with immunce deficiency History Justin Mather, a 23-year-old man, presented to the physician with a long medical history dating back to 1983 when, as a 6 - year-old, he was referred to a pediatrician by a dentist. At that time, the dentist was about to administer an anesthetic drug by injection prior to extracting a tooth when he elicited a history of easy brusing in the boy as well as a history of a brother who died at age one from an intracranal hemorthage after falling from a crib. In addition, Justin has had several instances of severe bruising following minor trauma and progressively worsening arthrits of both knee joints over the past four years. Interestingly, Justin's matemal grandfather died at age 27 of a bleeding complication following an appendeciomy Justin's maternal grandmother remarried, and Justin's mother lost complete touch with her deceased father's tamily Justin's mother's three half brothers are alive and well Lab findings in dustin at that time (1983) were as follows platelet = count 280, 000/mm3 of blood bleeding time =6 minutes prothrombin tume (PT)=11 seconds (normal =1012 seconds) partial thromboplastin time (PTT) =58 seconds (normal =20.30 seconds) Fibrin splt products =22g/ml (normal =840g/mi ) hematocit and white blood cell count were both normal Justin was told at that time that he had a "blood disease" and would require close medical attention in the past two years, Justin's health has detenoratod, starting with a mono-like iliness which resulted in tatigue, a sore throat, and swoilon lymph nodes in the neck and groin. This was tollowed a few weeks later by a dartheal iliness marked by a 23 pound weight loss. Sux months ago, Justin developed a sovere parasitic preumonia which subsided only after intensive antbiotic tieatment Three months ago, he noted the appearance of siver-dollar sized purple blotches on his skin (untke any he had seen on his skin in the past that have stil not gone way in the past week, Justin has progressively weakened suffening from chils, weakness, and a high lever that has lett han bedndden Laboratofy studies reveal a white blood celf count of 28 (2.800 WBCs per mm? normal range is A. 500 to 11,000 WBCs per mm ) with a markody reduced number of Thelper celis Discuss what has boen the primary cause of Justin's poor health in the past two yeant? is his thess of the past ho years retated in any way to the "blood disease" dagnosed in 1983 ? Explan your answer And how is Justins simmune system affected by a deficieney in T-helper cels?.

1. Chief Complaint: 23-year-old man with immunce deficiency History Justin Mather, a 23-year-old
man, presented to the physician with a long medical history dating back to 1983 when, as a 6 -
year-old, he was referred to a pediatrician by a dentist. At that time, the dentist was about to
administer an anesthetic drug by injection prior to extracting a tooth when he elicited a history of
easy brusing in the boy as well as a history of a brother who died at age one from an intracranal
hemorthage after falling from a crib. In addition, Justin has had several instances of severe
bruising following minor trauma and progressively worsening arthrits of both knee joints over the
past four years. Interestingly, Justin's matemal grandfather died at age 27 of a bleeding
complication following an appendeciomy Justin's maternal grandmother remarried, and Justin's
mother lost complete touch with her deceased father's tamily Justin's mother's three half brothers
are alive and well Lab findings in dustin at that time (1983) were as follows platelet = count 280,
000/mm3 of blood bleeding time =6 minutes prothrombin tume (PT)=11 seconds (normal =1012
seconds) partial thromboplastin time (PTT) =58 seconds (normal =20.30 seconds) Fibrin splt
products =22g/ml (normal =840g/mi ) hematocit and white blood cell count were both normal
Justin was told at that time that he had a "blood disease" and would require close medical
attention in the past two years, Justin's health has detenoratod, starting with a mono-like iliness
which resulted in tatigue, a sore throat, and swoilon lymph nodes in the neck and groin. This was
tollowed a few weeks later by a dartheal iliness marked by a 23 pound weight loss. Sux months
ago, Justin developed a sovere parasitic preumonia which subsided only after intensive antbiotic
tieatment Three months ago, he noted the appearance of siver-dollar sized purple blotches on his
skin (untke any he had seen on his skin in the past that have stil not gone way in the past week,
Justin has progressively weakened suffening from chils, weakness, and a high lever that has lett
han bedndden Laboratofy studies reveal a white blood celf count of 28 (2.800 WBCs per mm?
normal range is A. 500 to 11,000 WBCs per mm ) with a markody reduced number of Thelper celis
Discuss what has boen the primary cause of Justin's poor health in the past two yeant? is his
thess of the past ho years retated in any way to the "blood disease" dagnosed in 1983 ? Explan
your answer And how is Justins simmune system affected by a deficieney in T-helper cels?