D. Schmassmann-suhijar et A. Schmassmann, Aphthous esophagitis as an atypical manifestation of a primary HIV-infection, DEUT MED WO, 126(41), 2001, pp. 1136-1138
Citations number
11
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
History: A 56-year-old patient from Burkina Faso (Western Africa), living i
n Switzerland for 12 years, was referred to hospital because of acute onset
of severe painful swallowing. He returned from a 3-week visit to his home
country 4 weeks prior to admission.
Clinical findings and investigations: Whereas clinical and radiological fin
dings were normal, routine laboratory testing showed increased parameters o
f infection. Endoscopy revealed an aphthous esophagitis, suggesting a viral
infection. Biopsy confirmed an active erosive esophagitis. Herpes simplex,
cytomegalovirus and candida could not be detected in the biopsy specimens
(immunohistochemistry, microbiology) and in serum. Both, the anti-HIV scree
ning-test and the Western blot antibody test for HIV-1 and HIV-2 were negat
ive on admission. Because of the persistent suspicion for an underlying HIV
Infection, a combined HIV p24-antigen/ antibody-test was performed, showin
g an indeterminate result. Following PCR-based tests for HIV-RNA on days 5
and 12 showed 86 100 and 103 700 HIV-1 RNA copies/ml plasma, respectively,
revealing the diagnosis of primary HIV-1 infection. Subsequent serological
testing (WB) finally documented HIV-1 antibody seroconversion, showing inde
terminate and positive results on days 5 and 19, respectively.
Treatment and course: Within 5 days all signs of Infection returned to norm
al and as documented by endoscopy on day 12, the esophagitis healed up spon
taneously. As the patient intended to go back to his home country and the C
D4 cell count was 615 x 10(6)/l, no antiviral therapy was initiated.
Conclusion: This case report is the first demonstrating an atypical symptom
atic primary HIV-Infection prior to seroconversion, which presented itself
exclusively as an aphthous esophagitis with no symptoms of the classic acut
e retroviral syndrome. Therefore, each clinical suspicion of an underlying
HIV-infection should be followed up carefully, even if the patient presents
with unusual symptoms.