Unusual Presentations in Pediatric HIV: Case Series

Abstract

We report two children on treatment for HIV disease who presented differently with difficulty in breathing and on further investigation were found to have lymphocytic interstitial pneumonia (LIP) and rheumatic heart disease respectively. The first patient's diagnosis was made with chest x-ray features suggestive of LIP and she was commenced on low dose steroid in addition to antiretroviral therapy. Her condition improved marginally before she died at home one month after. The second patient was initially thought to have pneumonia in heart failure, but when CXR showed an enlarged globular heart a suspicion of pericardial effusion was entertained. This necessitated Echocardiography which confirmed diagnosis of rheumatic heart disease (severe mitral valve regurgitation) with moderate pulmonary hypertension and moderate pericardial effusion. She also died at home. These cases are being reported to highlight the importance of thorough evaluation of HIV positive patients for other co-morbidities and the negative impact of poverty on their survival.

Pulmonary Hypertension in Children across Africa: The Silent Threat

“…Children with LIP tend to have a high viral load and low CD4 counts [ 42 ]. Clinically, they will have digital clubbing, dyspnea, effort intolerance, and features of heart failure, tricuspid regurgitation murmur, and an accentuated pulmonary component coupled with chronic hypoxia in advanced disease [ 43 , 44 ]. The goal of therapy would be to switch to highly active antiretroviral therapy (HAART) and offer the standard PH treatment, including oxygen supplementation in severe cases.…”