Unusual primary HIV infection with colonic ulcer complicated by hemorrhagic shock: a case report

Article Article scientifique Article Unusual primary HIV infection with colonic ulcer complicated by hemorrhagic shock: a case report eng 2010 author Emonet Stéphane 0000-0002-1201-742X 89139 Stéphane Paul Emonet author Dettwiler Sarah 61903 author Der Hagopian Isabelle author Yerly Ferrillo Sabine 23752 author Haustein Thomas 709387 author Strasser Susannah Véronique Régine 60155 author Hirschel Bernard 22746 279 10.1186/1752-1947-4-279 20727146 1752-1947 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933633/pdf/1752-1947-4-279.pdf INTRODUCTION: Timely diagnosis of primary HIV infection is important to prevent further transmission of HIV. Primary HIV infection may take place without symptoms or may be associated with fever, pharyngitis or headache. Sometimes, the clinical presentation includes aseptic meningitis or cutaneous lesions. Intestinal ulceration due to opportunistic pathogens (cytomegalovirus, Epstein-Barr virus, Toxoplasma gondii) has been described in patients with AIDS. However, although invasion of intestinal lymphoid tissue is a prominent feature of human and simian lentivirus infections, colonic ulceration has not been reported in acute HIV infection. CASE DESCRIPTION: A 42-year-old Caucasian man was treated with amoxicillin-clavulanate for pharyngitis. He did not improve, and a rash developed. History taking revealed a negative HIV antibody test five months previously and unprotected sex with a male partner the month before admission. Repeated tests revealed primary HIV infection with an exceptionally high HIV-1 RNA plasma concentration (3.6 x 107 copies/mL) and a low CD4 count (101 cells/mm3, seven percent of total lymphocytes). While being investigated, the patient had a life-threatening hematochezia. After angiographic occlusion of a branch of the ileocaecal artery and initiation of antiretroviral therapy, the patient became rapidly asymptomatic and could be discharged. Colonoscopy revealed a bleeding colonic ulcer. We were unable to identify an etiology other than HIV for this ulcer. CONCLUSION: This case adds to the known protean manifestation of primary HIV infection. The lack of an alternative etiology, despite extensive investigations, suggests that this ulcer was directly caused by primary HIV infection. This conclusion is supported by the well-described extensive loss of intestinal mucosal CD4+ T cells associated with primary HIV infection, the extremely high HIV viral load observed in our patient, and the rapid improvement of the ulcer after initiation of highly active antiretroviral therapy. This case also adds to the debate on treatment for primary HIV infection, especially in the context of severe symptoms and an extremely high viral load. Dewey 616 56 Département de médecine 221 false 29 Unité HIV 46 Journal of medical case reports 4 dbd07088-3234-4f05-9736-6adaedf30a78 Article (Accepted version) Public file1.pdf 2917286 application/pdf openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Unusual primary HIV infection with colonic ulcer complicated by hemorrhagic shock: a case report	Journal of medical case reports			2010	749	343

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Strasser, Susannah Véronique Régine