A typhus-like illness caused by acute HIV seroconversion

Abstract

A patient is described in whom an acute human immunodeficiency virus seroconversion illness occurred following a trip to southern Africa. The presentation was strikingly similar to that of African tick typhus and could only be distinguished by serological testing.

PIP: Physicians admitted a 27-year-old man to the Hospital for Tropical Diseases in London, England because he had had a fever for 2 days (39 degrees Celsius) and a generalized erythematous maculo-papular rash for 1 day. These symptoms appeared soon after returning from a 5-month visit to Botswana, South Africa, and Zimbabwe. Much of his visit included visits to rural areas where insects bit him frequently. He experienced vaginal intercourse with some women, but did use condoms each time. He had his last sexual experience 10 days before becoming ill. When the physicians examined the patient, they noted many small palatal ulcers, bilateral inguinal lymphadenopathy, and a 5 mm diameter nontender ulcer of the glans penis. At this point, they believed he suffered from tick typhus and primary syphilis. Laboratory tests showed 29% of his white blood cells to be lymphocytes and Treponema pallidum in the penile ulcer exudate. The physicians then prescribed daily intramuscular injections of 600 mg procaine penicillin for 10 days. The rash vanished 2 days and the fever and ulcers vanished 5 days after treatment began. Blood tests later done while still in the hospital revealed him to be HIV-I p24 antigen positive, but anti-HIV-I and -II negative. 2 months later, however, he tested HIV-I positive, but negative for rickettsiae, arboviruses, cytomegalovirus, and enteroviruses. Since he later tested HIV positive and negative for pathogens causing typhus, it was concluded that his typhuslike illness was a result of acute HIV seroconversion. Other physicians have also noted similar manifestations of seroconversion in HIV positive patients. They recommended that physicians should consider HIV seroconversion illness when a patient who recently traveled to the tropics or is sexually active exhibits an acute febrile condition with maculo-papular rash.