Deep Vein Thrombosis Following Enteric Fever & Immunological Failure in HIV Positive Soldier: Case Report

Abstract

Incidence of deep vein thrombosis (DVT) is 2–10 times more in human immunodeficiency virus (HIV)-infected persons than non-HIV cohort. Risk factors involved with DVT in HIV-infected patients are age older than 45 years, use of protease inhibitor in highly active antiretroviral therapy (ART), most common indinavir, hospitalization and presence of AIDS-defining opportunistic infections such as cytomegalovirus, Pneumocystis jiroveci (is a yeast like fungus particularly in immune-compromised host), and Mycobacterium-intracellular. Others well known thrombogenic risk factors include are such as immobility, cigarette smoking, advanced age, pregnancy, pelvic surgery, and personal or family history of DVT may be absent in HIV-infected patients presenting with DVT. Inflammation and venous thrombosis are related to each other, and the associations between them are strong when the inflammation or the infection has occurred recently, or the inflammation is active. A 29-year-old HIV-positive soldier on first line ART with poor adherence presented with fever pain abdomen and diarrhea and was diagnosed to have an enteric fever with immunological and clinical failure. He was treated for enteric fever but during treatment of enteric fever he complains of painful left lower limb swelling after 4 weeks and was suspect to have DVT of left lower limb based on Doppler studies. After confirmation of DVT by Doppler images, thrombolytic therapy was started, and gradually improvement was seen in the condition. Recent Infection or inflammation has a strong association with the development of thrombosis in HIV-positive patients, absent with classical predisposing factors of DVT. Physicians involved in the care of HIV-positive patients should be aware of this condition and the associated aggravating risk factors in them so as to provide timely management.