Backache with Fever: A Unique Presentation of Advanced HIV Infection

Alex Mentzer,Helen Williams,Rustom Guzder,Janaka Karalliedde,Ranja Babu Kulasegaram

doi:10.4172/2155-6113.1000107

Abstract

This case report follows a previously asymptomatic man who presented with common, non-specifi c symptoms and was diagnosed with a rare complication of non-typhi Salmonella infection. Further investigations revealed the presence of advanced HIV infection and with subsequent follow up a number of co-existing pathologies were diagnosed with fatal consequences. This case serves as an example of the complexity of patients diagnosed with late HIV disease. It serves as a clear reminder to all clinicians to have a low threshold for testing for HIV and highlights the need to introduce an opt-out system for HIV testing in all acute healthcare settings with a high prevalence of HIV infection.

Highlights

This case report follows a previously asymptomatic man who presented with common, non-specific symptoms and was diagnosed with a rare complication of non-typhi Salmonella infection
C-reactive protein (CRP) was raised (127 mg/L), as was lactate dehydrogenase (3249 U/L with normal 240 – 480) but creatinine kinase was in the normal range
An MRI performed three weeks following presentation revealed diffuse osteomyelitis involving the pelvis and femur (Figure 1b). This patient received two further percutaneous drain insertions and six weeks after initial presentation he had remained apyrexial and his CRP had reduced to 48 mg/L and he was deemed well enough to be discharged on ciprofloxacin and highly active anti-retroviral therapy (HAART)

Summary

Introduction

This case report follows a previously asymptomatic man who presented with common, non-specific symptoms and was diagnosed with a rare complication of non-typhi Salmonella infection. In view of his persistent fever an abdominal CT scan was performed which revealed a 15 x 14 millimetre collection in the left iliacus muscle (Figure 1a). The patient was commenced on Pneumocystis jirovecii prophylaxis, Figure 1: a) Transverse section abdominal CT showing left iliacus abscess (white arrow) four days after presentation described in the main text.

Results

Conclusion