NURS 6501 WEEK 2 CASE STUDY ANALYSIS This paper examines a case study of a 49-year-old male patient. The patient has rheumatoid arthritis. He has come to the clinic with a chief complaint of fever.

The patient currently uses medications, including atorvastatin 40 mg at night, methotrexate 10 mg every Friday morning, and prednisone 5 mg. He reports a fever for about a week and admits to sweats and chills. He also has hemoptysis, fatigue, and chest pain. The patient works as a grain inspector at a large farm cooperative. An extensive work-up led to the client being diagnosed with invasive aspergillosis. Therefore, the purpose of this essay is to examine the reasons for the client presenting with the above symptoms, genes associated with the development of the disease, the immunosuppression process, and its effect on the body systems.

Why the Patient Presented with the Described Symptoms

The patient developed the above symptoms because of the combination of the prolonged use of immunosuppressive drugs and environmental exposures from his occupation. Methotrexate and prednisone are two drugs that increase the risk of immunosuppression when used over a long period. Corticosteroids such as prednisone work by inhibiting the body’s inflammatory responses. They also repress the activity of key immunomodulatory transcription factors such as NF-kB and AP-1 factors, which play a crucial role in strengthening the body’s immune systems (Luo et al., 2021). Prolonged use of these drugs weakens the immunity, which predisposes patients to opportunistic infections, including invasive aspergillosis.

The patient in the case study has also been using methotrexate. Methotrexate is a drug that inhibits dihydrofolate reductase, an enzyme involved in the reduction of folate to tetrahydrofolate. The effects of methotrexate include suppression of the immune responses and inflammatory processes. Methotrexate suppresses the immune system through processes such as inhibition of pyrimidine and purine syntheses and the blockage of transmethylation reactions. These inhibitions cause the release of adenosine, uncoupling of nitric oxide synthase, and inhibition of NF-kB signaling, JAK-STAT signaling, and regulation of long noncoding RNAs (Valer et al., 2021). The changes cause immunosuppression, hence, the increased risk of opportunistic infections.

The immunosuppression from the use of corticosteroids and methotrexate, coupled with environmental exposure to Aspergillus bacteria caused invasive Aspergillosis. The patient in the case study reports that he works as a grain inspector at a large farm cooperative. His workplace could have predisposed him to Aspergillus, a fungus that causes Aspergillosis in immunocompromised individuals. The fungus causes three types of bronchopulmonary aspergillosis, including invasive, chronic, and allergic aspergillosis (Fosses Vuong et al., 2024). Patients with invasive aspergillosis experience symptoms, including fever, dyspnea, hemoptysis, increased sputum production, and pleuritic chest pain.