A 32-year-old female presents to the ED with a chief complaint of fever, chills, nausea, vomiting, and vaginal discharge. She states these symptoms started about 3 days ago, but she thought she had the flu. She has begun to have LLQ pain and notes bilateral lower back pain. She denies dysuria, foul-smelling urine, or frequency. States she is married and has sexual intercourse with her husband. PMH negative.
Labs: CBC-WBC 18, Hgb 16, Hct 44, Plat 325, Neuts & Lymphs, sed rate 46 mm/hr, C-reactive protein 67 mg/L CMP wnl
Vital signs T 103.2 F Pulse 120 Resp 22 and PaO2
99% on room air. Cardio-respiratory exam WNL with the exception of tachycardia but no murmurs, rubs, clicks, or gallops. Abdominal exam + for LLQ pain on deep palpation but no rebound or rigidity. Pelvic exam demonstrates copious foul-smelling green drainage with reddened cervix and + bilateral adenexal tenderness. + chandelier sign. Wet prep in ER + clue cells and gram stain in ER + gram negative diplococci.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.
The Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
- The factors that affect fertility (STDs).
- Why inflammatory markers rise in STD/PID.
- Why prostatitis and infection happens. Also explain the causes of systemic reaction.
- Why a patient would need a splenectomy after a diagnosis of ITP.
- Anemia and the different kinds of anemia (i.e., micro and macrocytic).
Case Study Analysis:
- Factors affecting fertility (STDs): In this case, the patient presents with symptoms suggestive of a sexually transmitted infection (STI) or pelvic inflammatory disease (PID). STIs, such as chlamydia and gonorrhea, can lead to PID if left untreated. PID can cause scarring and damage to the reproductive organs, including the fallopian tubes, which may lead to infertility. Untreated STIs can also increase the risk of ectopic pregnancies, where a fertilized egg implants outside the uterus, further impacting fertility.
- Inflammatory markers rise in STD/PID: Infections, including STIs and PID, trigger the body’s immune response. Inflammatory markers like C-reactive protein and the sedimentation rate (sed rate) increase in response to infection. These markers indicate the presence of inflammation and help clinicians monitor the severity of the infection. The rise in these markers is a result of the immune system’s attempt to fight off the infection and resolve the inflammation.
- Prostatitis, infection, and systemic reaction causes: Prostatitis is the inflammation of the prostate gland, and it can be caused by various factors, including bacterial infections. In this case, the patient may have a prostatic infection that has led to systemic symptoms like fever, chills, and tachycardia. When infections occur, the body releases cytokines and other signaling molecules that mediate the immune response. These molecules trigger systemic inflammation, leading to the release of inflammatory markers (e.g., CRP, sed rate) and the systemic symptoms observed in the patient.
- Need for splenectomy after ITP diagnosis: ITP stands for immune thrombocytopenic purpura, a condition in which the immune system mistakenly attacks and destroys platelets. The spleen plays a significant role in platelet destruction, as it acts as a site for old or damaged platelets to be removed from circulation. In severe cases of ITP where the platelet count drops dangerously low and leads to life-threatening bleeding, a splenectomy (surgical removal of the spleen) may be performed to reduce platelet destruction and increase platelet counts. The removal of the spleen can help improve platelet levels and reduce the risk of bleeding complications in patients with ITP.
- Anemia and different kinds of anemia: Anemia is a condition characterized by a decrease in the number of red blood cells (RBCs) or a decrease in the amount of hemoglobin in the blood. This can lead to a reduced capacity of the blood to carry oxygen to tissues and organs.
- Microcytic anemia: In microcytic anemia, the RBCs are smaller than normal. It is often caused by iron deficiency, which is necessary for hemoglobin synthesis. Iron deficiency can result from inadequate dietary intake, blood loss (e.g., gastrointestinal bleeding), or poor iron absorption.
- Macrocytic anemia: In macrocytic anemia, the RBCs are larger than normal. One common cause is vitamin B12 deficiency or folate deficiency, both of which are essential for DNA synthesis during RBC production. These deficiencies can occur due to dietary deficiencies or malabsorption issues.
In summary, this case study highlights the importance of identifying and treating sexually transmitted infections promptly to prevent complications like pelvic inflammatory disease and its impact on fertility. It also demonstrates the relationship between infections, inflammatory markers, and systemic symptoms. The case illustrates the potential need for a splenectomy in severe cases of ITP to manage platelet destruction, and it touches upon different types of anemia and their underlying causes.