Incze Andrea, Chiriac Carmen, Lucia Zaharia, Kezdi Iringo, Sincu Nina
University of Medicine and Pharmacy, 1st Clinic of Infectious Diseases Tg. Mures
Abstract
Introduction. Late presenter HIV positive patients are characterized by low CD4+ lymphocyte count (below 350/mm3) at the moment of diagnosis, frequently having severe opportunistic infections associated. The aim of this study is to present the case of a patient recently diagnosed with HIV infection, with disseminated cryptococcal infection, cryptococcal meningitis and pneumonia. Methods. We studied the case of a 21 years old male patient, admitted for asthenia, fever, cough, dyspnea, thoracic pain, myalgias, arthralgias, headache, dizziness, vomiting, altered condition, with the impossibility of maintaining orthostatism, low body weight, oral thrush, and meningeal syndrome. Results. Following the paraclinical tests performed the diagnosis of HIV infection was established, with a CD4+ lymphocyte count of 7/mm3. Cryptococcus neoformans was cultivated from the blood and cerebrospinal fluid, and the chest x-ray revealed a bilateral bronchopneumonia. The outcome was favourable with Fluconazole monotherapy. Difficulties were encountered with the introduction of antiretroviral therapy due to the appearance of severe side effects to several drugs, and adherence problems, however, undetectable viral load was achieved. Conclusions. The management of late presenter HIV positive patient is challenging because of impaired immunity, associated opportunistic infections, and oncoming adherence problems. Widening of HIV testing to a larger area might conduct to a reduction in the number of late presenters, who require a complex therapy, high costs, and have poor prognosis.