Acute retroviral syndrome (ARS) can present as a wide array of clinical manifestations. Establishing a diagnosis early in the disease course can provide an opportunity to minimize immunosuppression and limit further transmission of human immunodeficiency virus (HIV). We present a case of a previously healthy young male who presented with acute hepatitis, as a manifestation of ARS. Initial HIV antigen/antibody testing was negative; however, a high index of suspicion prompted HIV ribonucleic acid (RNA) virologic testing revealing >10 million RNA copies/mL. Anti-retroviral treatment was initiated, along with supportive measures, accomplishing resolution of the transaminitis and the restoration of CD4 counts within normal at one month. Early in the disease course, HIV screening immunoassay could still be negative; hence, confirmatory testing with HIV RNA virologic testing should be pursued when clinical suspicion is high. Prompt diagnosis and treatment can improve outcome and curtail viral transmission.
Takayasu's arteritis (TA) is a chronic, idiopathic, inflammatory disease, that is more common in females and Asian countries. A 38-year-old female presented with recurrent vertigo. Detailed examination revealed discrepancies in peripheral pulses and raised blood pressure in bilateral lower limbs. Possibility of vasculitis involving arch of aorta or its branches was kept. Investigations were suggestive of Takayasu's arteritis, and noncontrast tomographic scanning (NCCT) of head showed B/L parietal infarcts. The disease is itself uncommon, and the presentation with vertigo only is rare. In this case vertigo may be due to Takayasu's arteritis itself or due to bilateral parietal infarcts.
Superior mesenteric artery (SMA) syndrome is a rare etiology of upper gastrointestinal obstruction. The measured angle between the SMA and the aorta is typically between 38 and 65° and maintained by mesenteric fat. Excessive fat loss can lead to intestinal obstruction due to an exaggerated acute angularity of the SMA, compressing the third part of the duodenum. We present a 22-year-old female with a history of aplastic anemia, status post bone-marrow transplant, who presented with intractable nausea and had confirmed SMA syndrome on CT angiography. Subsequently, the patient underwent nasogastric decompression and successful laparoscopic duodenojejunostomy.
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