Maciej M. Kowalik, Hanna Trocha, Małgorzata Lemańska
Med Sci Monit 1998; 4(4): CS720-723
An acute retoviral disease under the form of a mononucleosis-like syndrome 14 to 60 days following an HIV infection is rarely observed. . The case presented, concerns a 32 year old woman, sexually active with a seropositive male. She was admitted to our clinic due to 6 weeks of general weakness, fever of 39¡ C and musculo-articular pains. The physical examination revealed anemia, a palmar rubella- like rash, generalized lymphadenopathy, hepatomegaly and whitish deposits on the buccal mucosa. Biochemical parameters revealed: an increased erythrocyte sedimentation rate, the presence of atypical lymphocytes, thrombocytopenia and a rise in AlAT titers. The Paul-Bunnell-Davidson reaction test was positive. Serologic tests towards HAV, HBV, HCV, CMV and toxoplasmosis turned out negative. The epidemiologic history and clinical picture obliged us to perform the ELISA test for the presence of HIV antibodies. We performed the test twice receiving positive dubious results. A positive Western-blot test (8 weeks from exposition) confirmed our diagnosis. The lymphocytic subpopulation test revealed the presence of CD4 lymphocytes- 520/mm3, CD8 lymphocytes-3420mm3 and the CD4/CD8 ratio of 0.2. We noted hypergammaglobulinemia. Following the patients consent we started therapy with zidovudine (AZT) at a dose of 500 mg per day. After 5 days of hospitalization, following
the remission of acute symptoms, the patient was discharged home.
During the following 7 months of ambulatory observation, the woman presented lymphadenopathy buccal and vaginal mycosis, leucopenia, an increased erythrocyte sedimentation rate, hypergammaglobulinemia, reduction of the CD4 subpopulation and a decreased CD4 /CD8 ratio. The epidemiological history confirmed our preliminary diagnosis.
Keywords: retroviral disease