A Multidisciplinary Approach to Opportunistic Infections in a Latepresenter Person Living with HIV

Abstract

Opportunistic infections remain as an important cause of morbidity and mortality in patients with human immunodeficiency virus (HIV), predominantly in patients who are not receiving antiretroviral therapy. On the other hand, the evaluation and management of patients with HIV admitted with altered mental status and abnormal neurologic examination is a challenging issue due to the non-specific nature of signs and symptoms. Cytomegalovirus (CMV) associated neurological disorders are rare in patients with HIV; however, in some cases it may lead to rapidly fatal encephalitis. Another very serious HIV-related manifestation of CMV is retinitis, which must be discerned in a clinically relevant context. We present a case of a middle age adult, presenting with a change in mental status and a wide array of neurological complaints, who was later diagnosed with HIV infection. Further clinico-radiological evaluation was conducted which revealed CMV encephalitis superimposed on a chronic ground of HIV-associated neurocognitive disorder. During the course of follow up, the patient developed AIDS-related invasive pulmonary aspergillosis and pulmonary aspergilloma, and later underwent pulmonary lobectomy in consultation with the departments of thoracic surgery and radiology. In conclusion, this case emphasizes the importance of multidisciplinary approach to patients with HIV who presents with various clinical features due to the involvement of multiple organ systems which may necessitate a tremendous amount of laboratory and radiological investigation.

Keywords

• aids
• opportunistic infections
• art