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Case Reports
. 2018 Dec 27;18(1):693.
doi: 10.1186/s12879-018-3573-z.

Rapid emergence of cryptococcal fungemia, Mycobacterium chelonae vertebral osteomyelitis and gastro intestinal stromal tumor in a young HIV late presenter: a case report

Andrea Marino  1 , Eleonora Caltabiano  2 , Aldo Zagami  2 , Anna Onorante  2 , Carmela Zappalà  2 , Maria Elena Locatelli  2 , Alessio Pampaloni  2 , Daniele Scuderi  2 , Roberto Bruno  2 , Bruno Cacopardo  2
Affiliations
Case Reports

Rapid emergence of cryptococcal fungemia, Mycobacterium chelonae vertebral osteomyelitis and gastro intestinal stromal tumor in a young HIV late presenter: a case report

Andrea Marino et al. BMC Infect Dis. .

Abstract

Background: Highly active antiretroviral therapy has significantly changed the natural history of HIV infection, leading to a dramatic reduction of HIV-related morbidity and mortality. Late Presenters, Very Late Presenters and AIDS presenters still represent, also in Europe, including Italy, a huge challenge in terms of diagnostic and therapeutic management.

Case presentation: A 35-year-old male with a history of fever and back pain. HIV test resulted positive with a high HIV Viral Load and a very low T-CD4 number of cells (5 cells/mm3). Imaging investigations revealed multiple vertebral and pulmonary lesions together with abdominal and thoracic lymphadenopathy. Blood cultures were positive for Cryptococcus neoformans and for Staphylococcus haemolyticus. Lymphnode biopsy resulted positive in PCR for Non-Tuberculosis Mycobacteria (Mycobacterium chelonae). A gastric biopsy also revealed a GIST. The patient also had CMV DNA positive. Although we performed antiretroviral therapy and specific-therapies for each disease, he was transferred to intensive care unit where he died due to an Acute Respiratory Distress Syndrome.

Conclusion: The reported case is unusual due to the relevant number of opportunistic diseases (both infectious and tumoral) emerging not long after the HIV infection had been diagnosed. Late presenters HIV patients and AIDS presenters still represent a challenge, which is often too complex for clinicians to deal with. In spite of proper management, the risk of suboptimal results cannot be excluded.

Keywords: Cryptococcosis; GIST; HIV; Late presenters; Non-tuberculous mycobacteria; Opportunistic infections.

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Not applicable.

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Written informed consent for publication of clinical details was obtained from the patient and it is contained in the patient’s clinical record.

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The authors declare that they have no competing interests.

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