Rapid emergence of cryptococcal fungemia, Mycobacterium chelonae vertebral osteomyelitis and gastro intestinal stromal tumor in a young HIV late presenter: a case report

Abstract

BackgroundHighly active antiretroviral therapy has significantly changed the natural history of HIV infection, leading to a dramatic reduction of HIV-related morbidity and mortality. Late Presenters, Very Late Presenters and AIDS presenters still represent, also in Europe, including Italy, a huge challenge in terms of diagnostic and therapeutic management.Case presentationA 35-year-old male with a history of fever and back pain. HIV test resulted positive with a high HIV Viral Load and a very low T-CD4 number of cells (5 cells/mm3). Imaging investigations revealed multiple vertebral and pulmonary lesions together with abdominal and thoracic lymphadenopathy. Blood cultures were positive for Cryptococcus neoformans and for Staphylococcus haemolyticus.Lymphnode biopsy resulted positive in PCR for Non-Tuberculosis Mycobacteria (Mycobacterium chelonae). A gastric biopsy also revealed a GIST. The patient also had CMV DNA positive. Although we performed antiretroviral therapy and specific-therapies for each disease, he was transferred to intensive care unit where he died due to an Acute Respiratory Distress Syndrome.ConclusionThe reported case is unusual due to the relevant number of opportunistic diseases (both infectious and tumoral) emerging not long after the HIV infection had been diagnosed.Late presenters HIV patients and AIDS presenters still represent a challenge, which is often too complex for clinicians to deal with. In spite of proper management, the risk of suboptimal results cannot be excluded.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3573-z) contains supplementary material, which is available to authorized users.

Drug resistance and pathogenic spectrum of patients coinfected with nontuberculous mycobacteria and human-immunodeficiency virus in Chengdu, China

“…[2–4] It is also an important cause of pulmonary and disseminated disease infection and death, especially in the acquired immunodeficiency syndrome (AIDS) stage. [5,6] HIV is one of the major life-threatening viruses spreading in China. Chengdu of Sichuan Province, Southwest China, has the highest incidence of HIV-infected patients.…”

Rare spondylodiscitis due to Mycobacterium mucogenicum

“…[ 2 ] In the case of vertebral bone involvement, as our case, central variant type involves abscess formation in the middle of thevertebral body, leading to significant vertebral body collapse, resulting in subsequent severe spinal deformity. [ 3 ] They are responders to most antimicrobial agents, but they are resistant to first line anti- tuberculous drugs (e.g., isoniazid, rifampin, and pyrazinamide).…”

“…In most cases, clinical features of NTM spondylodiscitis are indistinguishable from those of pyogenic or tuberculous osteomyelitis. [ 3 ] Early diagnosis and treatment of these infections are critical to avoid progressive neurological worsening. Here, we report a rare case of M. mucogenicum spondylodiscitis adequately treated with decompressive surgery/fusion.…”

Successful Extracorporeal Membrane Oxygenation Treatment in an Acquired Immune Deficiency Syndrome (AIDS) Patient with Acute Respiratory Distress Syndrome (ARDS) Complicating Pneumocystis jirovecii Pneumonia: A Challenging Case

“…Pneumocystis jirovecii pneumonia (PJP) is a seriously overwhelming complication of HIV infection, with mortality rates as high as 43% when mechanical ventilation is required and, together with bacterial pneumonia, it is the most recurrent and challenging cause of ARDS in AIDS patients [1,2].…”