New Diagnosis of AIDS Based on Salmonella enterica subsp. I (enterica) Enteritidis (A) Meningitis in a Previously Immunocompetent Adult in the United States

Abstract

Salmonella meningitis is a rare manifestation of meningitis typically presenting in neonates and the elderly. This infection typically associates with foodborne outbreaks in developing nations and AIDS-endemic regions. We report a case of a 19-year-old male presenting with altered mental status after 3-day absence from work at a Wisconsin tourist area. He was febrile, tachycardic, and tachypneic with a GCS of 8. The patient was intubated and a presumptive diagnosis of meningitis was made. Treatment was initiated with ceftriaxone, vancomycin, acyclovir, dexamethasone, and fluid resuscitation. A lumbar puncture showed cloudy CSF with Gram negative rods. He was admitted to the ICU. CSF culture confirmed Salmonella enterica subsp. I (enterica) Enteritidis (A). Based on this finding, a 4th-generation HIV antibody/p24 antigen test was sent. When this returned positive, a CD4 count was obtained and showed 3 cells/mm3, confirming AIDS. The patient ultimately received 38 days of ceftriaxone, was placed on elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (Genvoya) for HIV/AIDS, and was discharged neurologically intact after a 44-day admission.

Salmonella typhi Meningitis in an Immunocompetent Asian Adult

“…HIV positive patients [5] or patients having immune suppressing medication like steroids [7] or tumor necrosis factor antagonist [8] or a previously presumed immunocompetent patient later found as immunosuppression, i.e. AIDS [9]. Rarely it infects immunocompetent patient who has structural abnormalities or chronic conditions such as malignancy, diabetes, or sickle cell disease [10].…”

The Risk of Immunosuppression: A Case of Salmonella Meningitis

“…The patient presented here is unique because she was immunosuppressed secondary to a multiyear history of biologic DMARD use for treatment of rheumatoid arthritis. The few case reports of documented Salmonella meningitis in immunosuppressed American adults present a disease course secondary to HIV [ 5 , 7 ]. TNF antagonists such as etanercept work by interrupting the TNF pathway and suppressing the body's inflammatory response.…”