Acute Hepatitis and Esophageal Candidiasis During Primary Human Immunodeficiency Virus Infection

Abstract

Primary human immunodeficiency virus infection (PHI) may take place without symptoms or may be associated with mononucleosislike illness. Sometimes, the clinical presentation includes aseptic meningitis, mucocutaneous ulcers, oropharyngeal candidiasis and elevated aminotransferases. We describe the case of a 25-year-old male, who had sex with other men, and presented to the emergency department with elevated aminotransferases levels and esophageal candidiasis. Acute hepatitis markers (hepatitis A, B, C, Epstein-Barr virus and cytomegalovirus) were performed and all were negative. Repeated testes revealed 3 consecutive negative HIV antibody tests with a strongly high HIV-1 RNA plasma concentration (> 500,000 copies /mL) and a loss of CD4<sup>+</sup> T cells (347 cells/µL), characterizing an acute hepatitis occurring during a course of an acute retroviral syndrome. Antiretroviral therapy was started while waiting a genotyping test performed to assess the presence of potential drug resistance mutations, and the patient recovered uneventfully, with normalization of aminotransferases, CD4 restoration and viral load become undetectable. Genotyping test indicated primary antiretroviral mutations, and appropriate changes in antiretroviral therapy were performed. Our case like other reports suggested that a diagnosis of PHI needs to be considered in patients who presented with acute hepatitis. J Med Cases. 2012;3(2):116-118 doi: https://doi.org/10.4021/jmc489w