Acute Human Immunodeficiency Virus Infection Presenting as Disseminated Gonococcal Infection

Offer Amir, MD, Vinh D. Nguyen, MD, Ben J. Barnett, MD


South Med J. 2003;96(3) 

In This Article

Case Report

A 43-year-old black man was admitted to a Houston hospital with a 1-week history of fever, chills, and rash. The rash was described by the patient as erythematous with discrete papules, and appeared initially on the bilateral inner thighs, then briefly generalized, and disappeared after 2 days of the onset of fever. He also reported a mild sore throat, cough productive of clear sputum, and some nonbloody diarrhea. He did not report dysuria, urethral discharge, joint symptoms, or headache. The patient did not have a history of homosexual contact or any recent sexual exposures, except for a single episode of insertive vaginal sex with a prostitute approximately 2 weeks before the present illness. He had a history of IV drug use, but none in the last 6 years. He had never before been tested for HIV infection.

The physical examination revealed that the patient had a body temperature of 101.3°F, blood pressure of 140/75 mm Hg, and pulse of 60 beats/min. His oropharynx was clear and there were no meningeal signs. There was diffuse, less-than-1-cm lymphadenopathy present in the axillary, cervical and inguinal areas, which were nontender and mobile. There was a soft, II/VI systolic injection murmur at the left sternal border. There was no rash on presentation, and he had no signs of joint inflammation or tendonitis. There were no genital lesions.

Initial laboratory findings revealed a white blood count of 1,900 cells/µl with a predominance of lymphocytes, hemoglobin of 11.5 g/dl, and a platelet count of 52,000/µl. Serum electrolytes and liver function tests were normal, as were the chest x-ray and urinalysis. A DNA probe of the urethra was negative for chlamydia and gonorrhea. Cultures of other mucosal surfaces, such as the rectum and pharynx, were not obtained. However, two sets of blood cultures at the time of admission grew Neisseria gonorrhoeae. ELISA for HIV-1 and HIV-2 was negative.

Because of the recent high-risk sexual exposure to a prostitute and the clinical findings of leukopenia and thrombocytopenia, which are not characteristic of DGI, the diagnosis of acute HIV infection before seroconversion was considered. HIV RNA viral load by polymerase chain reaction was performed (Roche Amplicor, version 1) and was positive with a value of more than 750,000 copies/ml, consistent with the diagnosis of acute HIV infection. Bone marrow biopsy and transesophageal echocardiograms were normal.

The patient was treated with IV ceftriaxone for DGI. Despite extensive counseling on the importance of treatment for his acute HIV infection, he left the hospital against medical advice and was lost to follow-up.