Manji Farheen, Wilson Evan, Mahe Etienne, Gill John, Conly John
University of Calgary and Alberta Health Services, 1403-29th Street NW, Calgary, AB, T2N 2T9, Canada.
Foothills Medical Centre, Alberta Health Services-Calgary and Area, Room AGW5, Foothills Medical Centre, 1403-29th Street NW, Calgary, AB, T2N 2T9, Canada.
BMC Infect Dis. 2017 Sep 20;17(1):633. doi: 10.1186/s12879-017-2732-y.
Hemophagocytic lymphohistiocytosis (HLH) is an uncommon systemic inflammatory condition that can result from infections, autoimmune diseases and malignancies. It is a rarely reported life threatening complication of an acute HIV infection, with only ten documented case reports per our literature search. We present a case of HLH secondary to acute HIV infection with a negative HIV antibody-based assay and high plasma viral load.
A 45 year old male with a past medical history of well controlled hypertension presented with fever, dizziness and non-bloody diarrhea. Initial lab work revealed a new thrombocytopenia, marked renal failure and an elevated creatine kinase, ferritin, lactate dehydrogenase and D-dimer. A bone marrow biopsy revealed HLH. As part of the work up for thrombocytopenia, a rapid HIV antibody based assay was done and was negative. The sample was later routinely tested with a fourth generation antigen/antibody assay as per local protocol and was strongly positive. The plasma RNA viral load was >10,000,000 copies /mL confirming the diagnosis of an acute HIV infection. The patient was urgently started on antiretroviral therapy and recovered.
This case illustrates a diagnostic approach to HLH which is an uncommon but life threatening multisystem disease, requiring the involvement of a multidisciplinary team of experts. Following any diagnosis of HLH, rapid identification and treatment of the underlying condition is critical. A negative rapid HIV antibody test can be misleading in the context of early HIV infection and the additional use of fourth generation antigen/antibody test or plasma RNA viral load may be required within the right clinical context for diagnosis.
噬血细胞性淋巴组织细胞增生症（HLH）是一种罕见的全身性炎症性疾病，可由感染、自身免疫性疾病和恶性肿瘤引起。它是急性HIV感染罕见的危及生命的并发症，经文献检索仅记录了10例病例报告。我们报告一例继发于急性HIV感染的HLH病例，该病例基于HIV抗体检测为阴性，但血浆病毒载量高。
一名45岁男性，既往有控制良好的高血压病史，出现发热、头晕和非血性腹泻。初步实验室检查发现新的血小板减少、明显的肾衰竭以及肌酸激酶、铁蛋白、乳酸脱氢酶和D-二聚体升高。骨髓活检显示为HLH。作为血小板减少检查的一部分，进行了基于HIV抗体的快速检测，结果为阴性。后来按照当地方案对样本进行了常规的第四代抗原/抗体检测，结果为强阳性。血浆RNA病毒载量>10,000,000拷贝/mL，确诊为急性HIV感染。患者紧急开始接受抗逆转录病毒治疗并康复。
本病例说明了HLH的诊断方法，HLH是一种罕见但危及生命的多系统疾病，需要多学科专家团队参与。任何HLH诊断后，迅速识别和治疗潜在疾病至关重要。在早期HIV感染的情况下，快速HIV抗体检测阴性可能会产生误导，在正确的临床背景下可能需要额外使用第四代抗原/抗体检测或血浆RNA病毒载量来进行诊断。
