Inelman Emine Meral, Gasparini Giulia, Enzi Giuliano
Department of Medical and Surgical Sciences, Geriatrics Section, University of Padua, Italy.
Geriatrics. 2005 Sep;60(9):26-30.
A 75-year-old man presented in May 2003 with suspected drop attack (atonic seizure). He reported falling over and losing consciousness. He was a retired, single ex-smoker, who lived alone in an apartment that was in a poor state of repair with precarious hygienic conditions. Over the course of 2 years he had unintentionally lost more than 10 kg (22 lbs) in weight. He had been diagnosed with diabetes approximately 10 years prior, and was receiving treatment with oral hypoglycemic therapy (fenformin/ glibenclamide, 25/2.5 mg, bid). He had been hospitalized for pneumonia in 2000. In recent months, he had gone to the emergency department several times (about once every 2 weeks) due to his weight loss and asthenia, without obtaining a definite diagnosis. On physical examination, his cognitive status was normal, but his nutritional status was deteriorated. Other clinical findings were negative. Blood chemistry tests revealed hypoalbuminemia (26.00 g/L). His personal hygiene was precarious and the apartment was completely neglected despite assistance by social support networks. In conversation with the social support worker, it was revealed that the patient was homosexual; with the patient's informed consent, he was tested and found positive for HIV. He was consequently transferred to the Infectious Diseases Department where further biochemical tests revealed: HIV-RNA Quantitative > 100.000 copies/ML COBAS Amplicor, antibodies anti-HIV 1-2 reactive sample (Enzygnost HIV Integral and Axsym HIV 1/2 GO [Abbott] EIA method, antibodies anti-HIV 1 positive (Western Blot). The patient's serum also tested positive for syphilis (TPHA positive 1:320). The patient refused any specific treatment, left the hospital, and was lost to follow-up.
