Aseptic meningitis as a manifestation of HIV primary infection

Overview

A young woman was admitted to our inpatient unit during a high season of tick-borne meningoencephalitis with a history of five days lasting fever, with prevailing dysuric symptoms, and other symptoms suggestive of inflammatory pelvic disease. Laboratory investigations revealed hemoglobinuria, hypochromic anaemia, slightly increased general muscle tone, very mild nuchal rigidity, later on she developed headache. Inflammatory markers in blood tests did not show any signs of bacterial infection. Due to unclear diagnosis, we performed lumbar puncture. CSF investigation revealed aseptic inflammatory formula. Antibody tests as well as PCR assays did not detect any common etiological pathogens. However, fever lasting more than 2 weeks and low CD4+ T count pressed us on to further search and in the end, helped us to come to the diagnosis. Despite generally shared impression of an innocent, quiet girl, we tested her HIV serology, which was confirmed positive. HIV virus presence was then detected also in the original CSF sample. The CSF finding was followed-up for 10 months. The patient was given antiretroviral therapy, which lasts till present (7 years) and well cooperating patient has a very good quality of life. Pathogens causing CNS infections in Southern Bohemia are then reviewed in the discussion.

Key words:
HIV, acute retroviral syndrome, aseptic meningitis, CD4+ T cells.