Navigating through the clinical course of a patient with newly diagnosed acquired immunodeficiency syndrome - “from 3 to 1 in 2 weeks” - case report

Abstract

We present the case of a 39-year-old male, newly diagnosed with acquired immunodeficiency syndrome, after being evaluated for fever, chronic diarrhea, significant weight loss, and referred with altered sensorium. Initially, the CD4 count was 1, and the human immunodeficiency virus viral load of 28 lakh copies. Screening for other infections led to the diagnosis of syphilis, Cryptosporidium parvum, methicillin-resistant Staphylococcus aureus, skin and soft-tissue infections, multidrug-resistant organism Escherichia coli, and cytomegalovirus over a short period of time. Choosing drugs for prophylaxis and treatment, monitoring, initiation of antiretroviral therapy, and the fear of immune reconstitution inflammatory syndrome made the fortnight challenging. A new symptom, sign, or abnormal laboratory parameter kept the team brainstorming. Support from the team of microbiologists, critical inputs by infectious disease specialists remotely, and the contribution of each member of the treating team made this a case for teamwork and experiential learning.