Primary HIV Infection in an Adolescent Masquerading as Acute Pancreatitis
Methods: /Case: An 18 year old previously healthy male presented with subacute onset of fever, malaise and pharyngitis. One day prior to admission, he experienced severe abdominal pain, nausea and vomiting. Physical examination revealed an ill-appearing teenager with generalized lymphadenopathy particularly in the anterior and posterior cervical area. He had marked pharyngeal erythema with impressive exudates. Abdominal tenderness was notable for tenderness in the epigastric region and was without evidence of hepatosplenomegaly. Laboratory investigation revealed elevated lipase of 1024, leucopenia of 2.5 and thrombocytopenia of 128. Alcohol level was undetectable and liver function tests were otherwise unremarkable. Abdominal and chest xray imaging were unrevealing. An abdominal US revealed no evidence of cholelithiasis. Serologic EBV and CMV testing were negative for acute infection. Further history revealed unprotected anal intercourse 2 weeks prior with a new partner. An HIV antibody screen was negative however, given a high index of suspicion, he underwent HIV RNA PCR testing which revealed primary HIV infection with viral load of 77,586.
Results: /Discussion: Primary HIV infection is the time from initial infection until complete seroconversion. While often asymptomatic, 30-40% of patients experience a ‘mononucleosis’ type syndrome. Symptoms are non-specific and often attributed to other viral etiologies. While prior studies have revealed pancreatitis in advanced HIV, there are only 6 reported cases of primary HIV infection presenting as pancreatitis, one of which was in an adolescent.
Conclusion: Screening for HIV risk factors in high risk adolescents is crucial, however, in a patient like ours with acute pancreatitis, we recommend considering primary HIV infection as an etiology. Such patients should be tested with HIV RNA PCR.
H. Hoar III, None