Acute HIV infection presenting as hemophagocytic lymphohistiocytosis: case report and review of the literature View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-09-20

AUTHORS

Farheen Manji, Evan Wilson, Etienne Mahe, John Gill, John Conly

ABSTRACT

BackgroundHemophagocytic 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 presentationA 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.ConclusionThis 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. More... »

PAGES

633

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12879-017-2732-y

DOI

http://dx.doi.org/10.1186/s12879-017-2732-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1091875708

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28931369


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