Multiorgan and Multisystem Involvement During Primary HIV Infection: A Case Report With a Literature Review

Abstract

The initial six months following HIV infection have a high viral load. Nonspecific presentations might lead to the missing primary HIV diagnosis. Multiorgan and multisystem diagnosis is a rare presentation of primary HIV. A 40-year-old male patient with no documented comorbidities presented with bilateral flank pain. The onset of the pain was gradual, characterized as dull and aching, with radiation toward the groin. The patient also had severe pain in the left shoulder and left ankle region. Per-abdominal examination revealed bilateral flank tenderness, with the right side being more tender than the left. Swelling of the left shoulder and ankle was observed, accompanied by tenderness and a restricted range of motion. Contrast-enhanced computed tomography of the chest and abdomen revealed bilateral pyelonephritis multiple renal abscesses and liver abscesses. Left shoulder septic arthritis was also present. Pus culture and blood culture were positive for methicillin-sensitive Staphylococcus aureus. Antibiotics, according to the culture sensitivity, were given, and retroviral therapy was started from the antiretroviral clinic. Primary HIV infection can present with a variety of signs and symptoms. This case demonstrates that AIDS can affect any organ and mimic other disease processes. The initial clinical picture might be confused with individually occurring diseases; therefore, we should consider AIDS in patients presenting with multiorgan failure. Early initiation of empiric and then culture-specific antibiotics along with antiretroviral therapy helps in the rapid improvement of the patient and controls the high viremia. The infected patient also needs appropriate counseling on ways to avoid high-risk behavior, which may prevent transmission of HIV.

Keywords: abscess; hiv-infected patients; immunocompromised patient; multiorgan; renal abscess.

Figure 1. CECT abdomen. Axial (a) and coronal (b) images showing right upper pole renal abscess and multiple other renal abscesses in bilateral kidneys (arrows represent the areas of abscesses)

CECT: contrast-enhanced computed tomography

Figure 2. MRI of the left shoulder, showing an irregular collection in the left acromioclavicular joint (arrow represents the area of collection)