Hemophagocytic syndrome: an unusual manifestation of acute human immunodeficiency virus infection

Abstract

An 18 year-old heterosexual man was hospitalized because of fever, chills, a sore throat, and a dry cough for 8 days. He had had sexual intercourse with a new partner within the 4 months prior to admission. At admission, the patient presented a clinical picture compatible with hemophagocytic syndrome (HPS). The presence of hemophagocytosis was subsequently determined pathologically from bone marrow and lymph node specimens. An exhaustive diagnostic work-up failed to reveal any causative etiology, the symptoms improving after 2 doses of intravenous immunoglobulin (IVIG) infusion, given at a dose of 0.5 mg/kg each, the 2 doses being administered 1 week apart. Three months subsequent to the patient's initial presentation, acute human immunodeficiency virus (HIV) infection was diagnosed, and the patient received highly active antiretrovirus therapy (HAART) from the time of diagnosis. The patient remained well for the following 2 years. HPS in the advanced stages of HIV infection has previously been described, but HPS during seroconversion of an acute form of the infection is rare. We most definitely suggest, however, that acute HIV infection be included in the list of potential causes of HPS. IVIG therapy appears to be an appropriate therapeutic modality, and HAART also is effective, for prevention of recurrence of HPS in a patient with acute HIV infection.