Hoarseness of voice due to vocal cord paresis as a result of recurrent laryngeal nerve palsy has been well recognised. Recurrent laryngeal nerve palsy is commonly caused by compression due to tumour or lymph nodes or by surgical damage. Vinca alkaloids are well known to cause peripheral neuropathy. However, vinca alkaloids causing recurrent laryngeal nerve palsy has been reported rarely in children. We report a case of an adult patient with HIV who developed hoarseness of voice due to vocal cord paralysis during vinblastine treatment for Hodgkin lymphoma. Mediastinal and hilar lymph node enlargement in such patients may distract clinicians from considering alternative causes of recurrent laryngeal nerve palsy, with potential ensuing severe or even life-threatening stridor.

We report a case of acute recurrent meningitis in an HIV-positive immunocompetent woman. In this case, a 34-year-old African woman with a known HIV infection presented with symptoms of acute meningitis. She was on combination antiretroviral therapy with abacavir, lamivudine, and nevirapine. Her HIV RNA level was <70 IU/mL, and CD4 counts were 640 cells/mm3. This indicates that she was not immunocompromised. She was febrile on examination, with marked neck stiffness. Her cerebrospinal fluid revealed raised white cell counts with 100% lymphocytes and mildly raised protein. Polymerase chain reaction confirmed herpes simplex type 2 meningitis. She recovered fully with aciclovir 800 mg three times a day. However, she was readmitted with a similar presentation 5 months after the initial admission. Her cerebrospinal fluid confirmed recurrent herpes simplex type 2 meningitis. This case alerts the profession to the possibility of non-opportunistic infections in an immunocompetent HIV-positive patient and of herpes simplex virus type 2 causing recurrent lymphocytic meningitis.

The current resurgence of lymphogranuloma venereum (LGV) has drawn most attention to its potential for causing proctitis; however, this case highlights the need for awareness of LGV as a cause of isolated painful bilateral inguinal lymphadenopathy in a high-risk population and the importance of routine screening for LGV. We describe a case of a 37-year-old HIV positive man, in the population of men who have sex with men (MSM) who presented with bilateral enlarged inguinal lymph nodes and no other symptoms or signs. Urine nucleic acid amplification test was positive for chlamydia LGV-specific DNA. Tests from other sites were negative.

Background/introductionA significant proportion of patients (390/6360 (6.1%) in 2012 nationally) present with an AIDS defining illness yearly despite increasing awareness and recognition of HIV. In 2012 the British HIV Association (BHIVA) suggested newly diagnosed patients should commence Anti-Retroviral Therapy (ART) if their CD4 count <350 cells/mm3, they have an AIDS defining illness or a neurological complication.Aim(s)/objectivesA re-audit was performed following previous audits in 2006/07 and 2011/2012 to ascertain whether late presentation has improved.MethodsA retrospective study compiled data from case notes of the newly diagnosed between 01/01/2014 and 31/12/2015. Defining late presenters as a CD4 count <350 cells/mm3 or an AIDS defining illness.Results100 patients were identified, 33 were transfers and excluded. 67 remained of which 82.1% were male and 17.9% female. 52.2% were late presenters and 25.4% had an AIDS defining illness of which 9 had PCP, 6 had oesophageal candidiasis, 1 had cryptococcal meningitis and 1 had OHL. Overall 35.8% had a CD4 <200 cells/mm3 (42.9% in 2011/2012 audit) and 68% of the late presenters.Discussion/conclusionAn improvement was identified in patients presenting with a CD4 count <350 cells/mm3 (52.2%) compared with 2011/12 audit (55.7%). A high proportion continue to present with AIDS defining illnesses or depleted CD4 levels despite growing awareness of HIV and accessibility to health care. Poor prognosis, increasing morbidity and mortality is associated with late presentation. Atypical and opportunistic infections should prompt HIV testing amongst clinicians in both primary and secondary care along with improving patient education and contact tracing to minimise late presentation.