Orthopedics Studies

CONSULTATION

Thank you for referring your patient for evaluation.  As you know, he is a 50-year-old white male who has been in basically good health, aside from some problems with asthma and allergies, when he came down with one of his many subsequent episodes of upper respiratory tract infection symptoms.  The patient had a bisexual experience and has become very concerned with regard to the possibility of having AIDS.

The patient has a complete log of his symptoms over the past
9 months, but if I can summarize, he has had some minor arthralgias for the past 3 to 6 months involving his right neck, elbow, right knee, right ankle, which have been fairly persistent.  He has no morning stiffness or any gross evidence of inflammation.  These symptoms do abate with Bufferin.  He has also had some very minor sore throats and some tenderness in his submental salivary glands.  He remained totally afebrile up until approximately 2 weeks ago, when he came down with an illness characterized by mild achiness, tinnitus, and some intermittent night sweats.  He has had no rashes during this period of time.  The patient has a negative travel history.  He has been exposed to various dogs, cats, and a rabbit, but no exotic animal exposure.

On my examination today, the only findings of note are that on his tongue he has some geographical markings which are probably normal, but do have some similarity to mucous patches which are seen with syphilis.  He does have some enlarged submandibular nodes, but these are not tender.  Aside from this, examination is totally within normal limits.

The laboratory data which you sent me, I agree, is quite normal with the exception of a mildly elevated alkaline phosphatase.  This would appear to be of bone origin in that the gamma GTP is normal.  The T-helper cell ratios which you obtained on
2 occasions are totally normal.

At this particular time, the most I can make from this patient’s symptoms is that his arthralgias may suggest an early rheumatic syndrome.  With regard to his sexual contact, I discussed with him the risk of both lues and CMV infection from this contact and feel that their screening is appropriate.  The recent fevers for the last 2 weeks may be simply a manifestation of his wife’s recent viral illness and do not feel it is worth pursuing more at this time.

I have ordered a sedimentation rate and rheumatoid factor with regard to his rheumatic complaints and have ordered a CMV titer and a VDRL.  He will check his temperature for the next 2 weeks, and I will see him back at that time.  I stressed again with him that I find no evidence of AIDS or a pre-AIDS-type illness, and I hope I reassured him sufficiently to decrease his anxiety.  I do not feel any more testing with regard to the AIDS question is appropriate unless we have more symptoms or signs.

FOOTNOTE

Line 17 (Page 1).  Alternative:  3-6 months.

Line 31 (Page 1).  Is was changed to are for proper subject-verb agreement.

Line 46 (Page 1).  Alternative:  Translate CMV (cytomegalovirus).