Case Study 2:

Madam B, a 32-year-old woman, presents to the polyclinic with complaints of recurrent yeast infections, increased thirst, and urinary frequency. She has no previously known medical conditions. Her family history is unknown as she was adopted. On physical examination, her blood pressure is 141/90 mmHg, her pulse is 69 beats per min, and her respiratory rate is 15 breaths per min. Her body mass index (BMI) is 30.

There is darkened skin that appears to be thickened on the back of her neck. Her pelvic examination reveals a thick, white, vaginal discharge. A wet preparation from the vaginal discharge confirms vaginal candidiasis. Her urinalysis is negative for leukocyte esterase, nitrites, protein, and glucose. A fasting blood test and a finger-prick test have been done to confirm the diagnosis of her presenting complaints.

a. What is the MOST likely diagnosis of Madam B’s condition (Please provide only ONE diagnosis and briefly justify your answer).

b. Based on the case study, discuss the etiology (or risk factors), pathogenesis, clinical features, and complications of the diagnosis given in question a.

c. Explain the pharmacotherapy for this diagnosis (include appropriate local drug examples, mechanisms of action, and adverse effects). Madam B is given 2 different oral medications for this diagnosis. 2 weeks later, she calls
the polyclinic and reports that she is experiencing profuse sweating, giddiness, nausea, and hand tremors now.

d. What is the MOST likely explanation for her current complaint? What advice(s) should be given to her?