Acute HIV infection presenting as hemophagocytic lymphohistiocytosis: case report and review of the literature
| dc.contributor.author | Manji, Farheen | |
| dc.contributor.author | Wilson, Evan | |
| dc.contributor.author | Mahe, Etienne | |
| dc.contributor.author | Gill, John | |
| dc.contributor.author | Conly, John | |
| dc.date.accessioned | 2018-09-26T11:59:05Z | |
| dc.date.available | 2018-09-26T11:59:05Z | |
| dc.date.issued | 2017-09-20 | |
| dc.date.updated | 2018-09-26T11:59:05Z | |
| dc.description.abstract | Abstract Background Hemophagocytic lymphohistiocytosis (HLH) is an uncommon systemic inflammatory condition that can result from infections, autoimmune diseases and malignancies. It is a rarely reported life threatening complication of an acute HIV infection, with only ten documented case reports per our literature search. We present a case of HLH secondary to acute HIV infection with a negative HIV antibody-based assay and high plasma viral load. Case presentation A 45 year old male with a past medical history of well controlled hypertension presented with fever, dizziness and non-bloody diarrhea. Initial lab work revealed a new thrombocytopenia, marked renal failure and an elevated creatine kinase, ferritin, lactate dehydrogenase and D-dimer. A bone marrow biopsy revealed HLH. As part of the work up for thrombocytopenia, a rapid HIV antibody based assay was done and was negative. The sample was later routinely tested with a fourth generation antigen/antibody assay as per local protocol and was strongly positive. The plasma RNA viral load was >10,000,000 copies /mL confirming the diagnosis of an acute HIV infection. The patient was urgently started on antiretroviral therapy and recovered. Conclusion This case illustrates a diagnostic approach to HLH which is an uncommon but life threatening multisystem disease, requiring the involvement of a multidisciplinary team of experts. Following any diagnosis of HLH, rapid identification and treatment of the underlying condition is critical. A negative rapid HIV antibody test can be misleading in the context of early HIV infection and the additional use of fourth generation antigen/antibody test or plasma RNA viral load may be required within the right clinical context for diagnosis. | |
| dc.identifier.citation | BMC Infectious Diseases. 2017 Sep 20;17(1):633 | |
| dc.identifier.doi | https://doi.org/10.1186/s12879-017-2732-y | |
| dc.identifier.uri | http://hdl.handle.net/1880/107839 | |
| dc.identifier.uri | https://doi.org/10.11575/PRISM/45816 | |
| dc.language.rfc3066 | en | |
| dc.rights.holder | The Author(s). | |
| dc.title | Acute HIV infection presenting as hemophagocytic lymphohistiocytosis: case report and review of the literature | |
| dc.type | Journal Article |