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

BMC Infectious Diseases

Case Report

Farheen Manji¹  Evan Wilson¹  Etienne Mahe¹  John Gill¹  John Conly² 

[1] University of Calgary and Alberta Health Services, 1403-29th Street NW, T2N 2T9, Calgary, AB, Canada;University of Calgary and Alberta Health Services, 1403-29th Street NW, T2N 2T9, Calgary, AB, Canada;Foothills Medical Centre, Alberta Health Services-Calgary and Area, Room AGW5, Foothills Medical Centre, 1403-29th Street NW, T2N 2T9, Calgary, AB, Canada;

关键词: Hemophagocytic syndrome;    HIV;    Human immunodeficiency virus;    Acute retroviral syndrome;    Hemophagocytic lymphohistiocytosis;   

DOI  :  10.1186/s12879-017-2732-y

 received in 2017-03-23, accepted in 2017-09-12,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017