Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2014

Open Access 01-12-2014 | Case report

Delayed diagnosis of human immunodeficiency virus infection in a patient with non-specific neurological symptoms and pancytopenia: a case report

Authors: Marcin Moniuszko, Andrzej Moniuszko, Justyna Puciłowska, Karolina Kisluk, Marta Jeznach, Anna Grzeszczuk, Robert Flisiak, Anna Bodzenta-Lukaszyk

Published in: Journal of Medical Case Reports | Issue 1/2014

Login to get access

Abstract

Introduction

Both non-specific presentation and asymptomatic course of human immunodeficiency virus infection lead to undiagnosed long-term persistence of the virus in a patient's organism.

Case presentation

Here, we present a case of a 31-year-old Caucasian man with non-specific neurological symptoms and pancytopenia, who was referred to an internal medicine ward for further diagnosis. Upon admission to our hospital, he denied any past risky behaviors and refused to have his blood collected for human immunodeficiency virus testing. Later, he eventually provided consent to conduct the human immunodeficiency virus test which turned out to have a positive result. The overall clinical pattern indicated an advanced-stage of acquired immunodeficiency syndrome, which contrasted with the history he had provided.

Conclusions

This case report indicates the need to consider human immunodeficiency virus/acquired immunodeficiency syndrome diagnosis in patients with non-specific neurological and hematological disorders. Our report also demonstrates difficulties that can be experienced by the physician while trying to obtain both a clear history and consent to perform human immunodeficiency virus testing.
Literature
1.
go back to reference Simmons R, Ciancio B, Kall M, Rice B, Delpech V: Ten-year mortality trends among persons diagnosed with HIV infection in England and Wales in the era of antiretroviral therapy: AIDS remains a silent killer. HIV Med. 2013, 14 (10): 596-604. 10.1111/hiv.12045.CrossRefPubMed Simmons R, Ciancio B, Kall M, Rice B, Delpech V: Ten-year mortality trends among persons diagnosed with HIV infection in England and Wales in the era of antiretroviral therapy: AIDS remains a silent killer. HIV Med. 2013, 14 (10): 596-604. 10.1111/hiv.12045.CrossRefPubMed
2.
go back to reference Herek GM, Capitanio JP, Widaman KF: Stigma, social risk, and health policy: public attitudes toward HIV surveillance policies and the social construction of illness. Health Psychol. 2003, 22: 533-540.CrossRefPubMed Herek GM, Capitanio JP, Widaman KF: Stigma, social risk, and health policy: public attitudes toward HIV surveillance policies and the social construction of illness. Health Psychol. 2003, 22: 533-540.CrossRefPubMed
3.
go back to reference Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR, Ortiz DJ, Szekeres G, Coates TJ: Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS. 2008, 22 (Suppl 2): 67-79. 10.1097/01.aids.0000327439.20914.33.CrossRef Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR, Ortiz DJ, Szekeres G, Coates TJ: Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS. 2008, 22 (Suppl 2): 67-79. 10.1097/01.aids.0000327439.20914.33.CrossRef
4.
go back to reference Wenger JD, Whalen CC, Lederman MM, Spech TJ, Carey JT, Tomford JW, Landefeld CS: Prognostic factors in acquired immunodeficiency syndrome. J Gen Intern Med. 1988, 3: 464-10.1007/BF02595923.CrossRefPubMed Wenger JD, Whalen CC, Lederman MM, Spech TJ, Carey JT, Tomford JW, Landefeld CS: Prognostic factors in acquired immunodeficiency syndrome. J Gen Intern Med. 1988, 3: 464-10.1007/BF02595923.CrossRefPubMed
5.
go back to reference Marshall DW, Brey RL, Cahill WT, Houk RW, Zajac RA, Boswell RN: Spectrum of cerebrospinal fluid in various stages of human immunodeficiency virus infection. Arch Neurol. 1988, 45: 954-958. 10.1001/archneur.1988.00520330032007.CrossRefPubMed Marshall DW, Brey RL, Cahill WT, Houk RW, Zajac RA, Boswell RN: Spectrum of cerebrospinal fluid in various stages of human immunodeficiency virus infection. Arch Neurol. 1988, 45: 954-958. 10.1001/archneur.1988.00520330032007.CrossRefPubMed
6.
go back to reference Ishii R, Shiga K, Isayama R, Hosomi A, Tokuda T, Nakagawa M: CSF normocytosis in meningitis due to primary infection of human immunodeficiency virus. Rinsho Shinkeigaku. 2009, 49 (2–3): 100-103.CrossRefPubMed Ishii R, Shiga K, Isayama R, Hosomi A, Tokuda T, Nakagawa M: CSF normocytosis in meningitis due to primary infection of human immunodeficiency virus. Rinsho Shinkeigaku. 2009, 49 (2–3): 100-103.CrossRefPubMed
7.
go back to reference Sugimoto H, Konno S, Takamiya K, Nemoto H, Wakata N, Kurihara T: A case of primary HIV infection presenting as mononeuritis multiplex. Rinsho Shinkeigaku. 2006, 46 (8): 561-563.PubMed Sugimoto H, Konno S, Takamiya K, Nemoto H, Wakata N, Kurihara T: A case of primary HIV infection presenting as mononeuritis multiplex. Rinsho Shinkeigaku. 2006, 46 (8): 561-563.PubMed
8.
go back to reference Petiot P, Vighetto A, Charles N, Derex L, Trillet M, Aimard G: Isolated postural tremor revealing HIV-1 infection. J Neurol. 1993, 240 (8): 507-508. 10.1007/BF00874122.CrossRefPubMed Petiot P, Vighetto A, Charles N, Derex L, Trillet M, Aimard G: Isolated postural tremor revealing HIV-1 infection. J Neurol. 1993, 240 (8): 507-508. 10.1007/BF00874122.CrossRefPubMed
9.
go back to reference Kohler A, Burkhard P, Magistris MR, Chofflon M: Isolated peripheral facial paralysis and HIV infection: 7 cases. Rev Neurol (Paris). 1995, 151 (5): 332-337. Kohler A, Burkhard P, Magistris MR, Chofflon M: Isolated peripheral facial paralysis and HIV infection: 7 cases. Rev Neurol (Paris). 1995, 151 (5): 332-337.
10.
go back to reference Altuntas F, Yildiz O, Eser B, Gündogan K, Sumerkan B, Cetin M: Catheter-related bacteremia due to Kocuria rosea in a patient undergoing peripheral blood stem cell transplantation. BMC Infect Dis. 2004, 4 (1): 62-10.1186/1471-2334-4-62.CrossRefPubMedPubMedCentral Altuntas F, Yildiz O, Eser B, Gündogan K, Sumerkan B, Cetin M: Catheter-related bacteremia due to Kocuria rosea in a patient undergoing peripheral blood stem cell transplantation. BMC Infect Dis. 2004, 4 (1): 62-10.1186/1471-2334-4-62.CrossRefPubMedPubMedCentral
11.
go back to reference Zon LI, Arkin C, Groopman JE: Haematologic manifestations of the human immune deficiency virus (HIV). Br J Haematol. 1987, 66: 251-10.1111/j.1365-2141.1987.tb01307.x.CrossRefPubMed Zon LI, Arkin C, Groopman JE: Haematologic manifestations of the human immune deficiency virus (HIV). Br J Haematol. 1987, 66: 251-10.1111/j.1365-2141.1987.tb01307.x.CrossRefPubMed
12.
go back to reference Erhabor O, Ejele OA, Nwauche CA, Buseri FI: Some haematological parameters in human immunodeficiency virus (HIV) infected Africans: the Nigerian perspective. Niger J Med. 2005, 14 (1): 33-38.PubMed Erhabor O, Ejele OA, Nwauche CA, Buseri FI: Some haematological parameters in human immunodeficiency virus (HIV) infected Africans: the Nigerian perspective. Niger J Med. 2005, 14 (1): 33-38.PubMed
13.
go back to reference Opie J: Haematological complications of HIV Infection. S Afr Med J. 2012, 102 (6): 465-468.PubMed Opie J: Haematological complications of HIV Infection. S Afr Med J. 2012, 102 (6): 465-468.PubMed
14.
go back to reference Vannappagari V, Nkhoma ET, Atashili J, Laurent SS, Zhao H: Prevalence, severity, and duration of thrombocytopenia among HIV patients in the era of highly active antiretroviral therapy. Platelets. 2011, 22 (8): 611-618. 10.3109/09537104.2011.582526.CrossRefPubMed Vannappagari V, Nkhoma ET, Atashili J, Laurent SS, Zhao H: Prevalence, severity, and duration of thrombocytopenia among HIV patients in the era of highly active antiretroviral therapy. Platelets. 2011, 22 (8): 611-618. 10.3109/09537104.2011.582526.CrossRefPubMed
15.
go back to reference Zoufaly A, an der Heiden M, Marcus U, Hoffmann C, Stellbrink H, Voss L, van Lunzen J, Hamouda O: Late presentation for HIV diagnosis and care in Germany. HIV Med. 2012, 13 (3): 172-181.CrossRefPubMed Zoufaly A, an der Heiden M, Marcus U, Hoffmann C, Stellbrink H, Voss L, van Lunzen J, Hamouda O: Late presentation for HIV diagnosis and care in Germany. HIV Med. 2012, 13 (3): 172-181.CrossRefPubMed
16.
go back to reference Helleberg M, Engsig FN, Kronborg G, Laursen AL, Pedersen G, Larsen O, Nielsen L, Jensen J, Gerstoft J, Obel N: Late presenters, repeated testing, and missed opportunities in a Danish nationwide HIV cohort. Scand J Infect Dis. 2012, 44 (4): 282-288. 10.3109/00365548.2011.626440.CrossRefPubMed Helleberg M, Engsig FN, Kronborg G, Laursen AL, Pedersen G, Larsen O, Nielsen L, Jensen J, Gerstoft J, Obel N: Late presenters, repeated testing, and missed opportunities in a Danish nationwide HIV cohort. Scand J Infect Dis. 2012, 44 (4): 282-288. 10.3109/00365548.2011.626440.CrossRefPubMed
17.
go back to reference d’Arminio Monforte A, Cozzi-Lepri A, Girardi E, Castagna A, Mussini C, Di Giambenedetto S, Galli M, Cassola G, Vullo V, Quiros-Roldan E, Lo Caputo S, Antinori A: Late presenters in new HIV diagnoses from an Italian cohort of HIV-infected patients: prevalence and clinical outcome. Antivir Ther. 2011, 16 (7): 1103-1112. 10.3851/IMP1883.CrossRefPubMed d’Arminio Monforte A, Cozzi-Lepri A, Girardi E, Castagna A, Mussini C, Di Giambenedetto S, Galli M, Cassola G, Vullo V, Quiros-Roldan E, Lo Caputo S, Antinori A: Late presenters in new HIV diagnoses from an Italian cohort of HIV-infected patients: prevalence and clinical outcome. Antivir Ther. 2011, 16 (7): 1103-1112. 10.3851/IMP1883.CrossRefPubMed
18.
go back to reference Deblonde J, De Koker P, Hamers FF, Fontaine J, Luchters S, Temmerman M: Barriers to HIV testing in Europe: a systematic review. Eur J Public Health. 2010, 2: 422-432.CrossRef Deblonde J, De Koker P, Hamers FF, Fontaine J, Luchters S, Temmerman M: Barriers to HIV testing in Europe: a systematic review. Eur J Public Health. 2010, 2: 422-432.CrossRef
19.
go back to reference Flowers P, Duncan B, Knussen C: Re-appraising HIV testing: an exploration of the psychosocial costs and benefits associated with learning one’s HIV status in a purposive sample of Scottish gay men. Br J Health Psychol. 2003, 8: 179-194. 10.1348/135910703321649150.CrossRefPubMed Flowers P, Duncan B, Knussen C: Re-appraising HIV testing: an exploration of the psychosocial costs and benefits associated with learning one’s HIV status in a purposive sample of Scottish gay men. Br J Health Psychol. 2003, 8: 179-194. 10.1348/135910703321649150.CrossRefPubMed
20.
go back to reference Burns FM, Imrie J, Nazroo JY, Johnson AM, Fenton KA: Why the(y) wait? Key informant understandings of factors contributing to late presentation and poor utilization of HIV health and social care services by African migrants in Britain. AIDS Care. 2007, 19: 102-108. 10.1080/09540120600908440.CrossRefPubMed Burns FM, Imrie J, Nazroo JY, Johnson AM, Fenton KA: Why the(y) wait? Key informant understandings of factors contributing to late presentation and poor utilization of HIV health and social care services by African migrants in Britain. AIDS Care. 2007, 19: 102-108. 10.1080/09540120600908440.CrossRefPubMed
21.
go back to reference Campbell T, Bernhardt S: Factors that contribute to women declining antenatal HIV testing. Health Care Women Int. 2003, 24: 544-551. 10.1080/07399330303970.CrossRefPubMed Campbell T, Bernhardt S: Factors that contribute to women declining antenatal HIV testing. Health Care Women Int. 2003, 24: 544-551. 10.1080/07399330303970.CrossRefPubMed
Metadata
Title
Delayed diagnosis of human immunodeficiency virus infection in a patient with non-specific neurological symptoms and pancytopenia: a case report
Authors
Marcin Moniuszko
Andrzej Moniuszko
Justyna Puciłowska
Karolina Kisluk
Marta Jeznach
Anna Grzeszczuk
Robert Flisiak
Anna Bodzenta-Lukaszyk
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2014
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/1752-1947-8-104

Other articles of this Issue 1/2014

Journal of Medical Case Reports 1/2014 Go to the issue