A CASE OF CONCOMITANT OPPORTUNISTIC INFECTIONS

Document Type

Conference Proceeding

Publication Date

6-17-2022

Publication Title

J Gen Intern Med

Abstract

CASE: A 33-year-old male with Acquired Immunodeficiency Syndrome (AIDS) and antiretroviral medication noncompliance presented to our institution for chest pain. The patient was diagnosed with Human Immunodeficiency Virus (HIV) in 2012. Since that time, he had been lost to follow-up. In 2015, he presented to medical attention for several complications of AIDS, including Kaposi's sarcoma and Cytomegalovirus (CMV) retinitis. Additionally, he was recently hospitalized for disseminated Mycobacterium avium complex (MAC) pneumonia & bacteremia. The patient was actively on treatment for MAC infection upon presentation to our institution. He presented hemodynamically stable, chronically ill-appearing with cachexia. Significant physical exam findings included poor dentition, oropharyngeal thrush and widespread seborrheic dermatitis over his scalp and neck. Neurological findings included equal weakness of the bilateral lower extremities, allodynia of the feet, and urinary and fecal incontinence. He had a flat affect with delayed response and slowed speech. Lab reports were significant for a CD4+ T-cell count of 4. A Brain MRI demonstrated ventriculitis and multiple hypodense lesions in the pons. A CT chest found a left upper lung cavitary lesion. Microbial studies yielded positive fungitell and aspergillus galactomannan studies. Plasma CMV quantitative studies showed a viral titer of 1,312 IU/ml. A lumbar puncture was performed resulting with positive qualitative CMV PCR studies of cerebrospinal fluid. Based on the patient's symptoms and the constellation of our findings, our patient was diagnosed with invasive pulmonary aspergillosis and disseminated CMV with CMV viremia and CMV ventriculitis. Treatment began with multiple antibiotics, antifungals and antiretrovirals. For disseminated CMV, he was started on valgancyclovir which was later changed to foscarnet due to valgancyclovir-induced neutropenia. Despite aggressive therapy, the patient continued to deteriorate, developing septic shock and passing away from his advanced disease burden. IMPACT/DISCUSSION: We present a case of multiple concomitant opportunistic infections in a severely immunocompromised patient with AIDS. CMV is an opportunistic infection seen in patients with AIDS, reported in 10-30% of AIDS cases at autopsy. CMV can give rise to microglial nodular encephalitis, ventriculitis, necrotizing encephalitis and myelo-radiculitis. It has been hypothesized that CMV infects endothelial cells in blood vessels causing infarcts. Indeed, autopsies have identified microglial nodules and 21 areas of necrosis and infarction associated with CMV infection in prior reports. CONCLUSION: It is important to note that multiple concomitant opportunistic infections can be comorbid in an immunosuppressed patient. A thorough work-up and history gathering is necessary to establish multiple diagnoses and provide adequate treatment for the patient.

Volume

37

First Page

S385

Find It @ Sladen

Share

COinS