Acute Retroviral Syndrome Presenting as Acute Hepatitis

Abstract

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.

Acute HIV infection with presentations mimicking acalculous cholecystitis

“…[1] Acute HIV infection is defined as testing negative or indeterminate by Western blot in the presence of a positive p24 antigen and detectable plasma HIV RNA, and the stages of acute HIV infection are classified according to the stages defined by Fiebig et al [2] Acute HIV infection often presents as a self-limited mononucleosis-like syndrome; however, atypical presentations of acute HIV infection, including acute hepatitis, aseptic meningitis, myopericarditis, and hemophagocytic lymphohistiocytosis, have been reported. [3][4][5][6] Atypical presentations may lead to delayed diagnosis with a risk of onward transmission. Here, we present the clinical course of an individual presenting with acute HIV infection with manifestations mimicking acute acalculous cholecystitis.…”

“…Acute human immunodeficiency virus (HIV) infection is characterized by a high concentration of HIV RNA in the plasma and rapid depletion of CD4 cell count, which often occurs 2 to 6 weeks after exposure to HIV [1] . Acute HIV infection is defined as testing negative or indeterminate by Western blot in the presence of a positive p24 antigen and detectable plasma HIV RNA, and the stages of acute HIV infection are classified according to the stages defined by Fiebig et al [2] Acute HIV infection often presents as a self-limited mononucleosis-like syndrome; however, atypical presentations of acute HIV infection, including acute hepatitis, aseptic meningitis, myopericarditis, and hemophagocytic lymphohistiocytosis, have been reported [3–6] . Atypical presentations may lead to delayed diagnosis with a risk of onward transmission.…”