The Pandora's Box of AIDS: A Severe Case of Multipathogen Infections

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Chest

Abstract

INTRODUCTION: Human immunodeficiency virus (HIV) remains a significant global health burden, with delayed diagnoses leading to increased morbidity and mortality specially amongst the underserved population. Patients from endemic regions with recurrent respiratory infections should prompt early HIV screening to facilitate timely intervention. We present a case of a 51- year-old female, originally from Kenya, who presented with worsening respiratory distress and was subsequently diagnosed with advanced HIV and multiple opportunistic infections. CASE PRESENTATION: A 51-year-old female with a history of hypertension was transferred from an outside hospital for higher-level infectious disease evaluation. She had been hospitalised multiple times in the past six months for pneumonia. Upon initial presentation, she endorsed worsening shortness of breath, cough, and worsening oxygen requirements at 6 L . Of note she had been treated for community acquired pneumonia with ceftriaxone and azithromycin 2 weeks ago. Due to worsening clinical status and history of respiratory infections, HIV status was checked, demonstrating a viral load of 330,000 copies/mL and a CD4 count of 2.6 cells/mm3 . Given her profound immunosuppression, she was empirically started on IV Bactrim and prednisone for suspected Pneumocystis jirovecii pneumonia (PJP) along with Cefepime and Vancomycin. Despite treatment, she experienced worsening hypoxia, requiring escalation to 15 L of cold flow oxygen and ultimately requiring intubation and mechanical ventilation for worsening hypoxia and altered mental status. A bronchoscopy demonstrated strands of clear secretions without endobronchial lesions, and bronchoalveolar lavage (BAL) fluid was positive for PJP and VZV. Further examination revealed vesicular lesions along the T5-T7 dermatome, raising suspicion for varicella-zoster virus (VZV) infection, and IV acyclovir was initiated. MRI brain was ordered due to change in mentation demonstrating diffuse leptomeningeal enhancement following which lumbar puncture was notable for cerebrospinal fluid (CSF) positivity for cytomegalovirus (CMV), human herpesvirus 6 (HHV6), and VZV. She was noted to have facial lesions and underwent a biopsy was obtained, which resulted as Kaposi Sarcoma. She was ultimately diagnosed with AIDS complicated by multiple opportunistic infections, including PJP pneumonia progressing to ARDS, CMV viremia with retinitis, VZV encephalitis and pneumonia, esophageal candidiasis, Hepatitis B and Kaposi sarcoma. She was initiated on HAART therapy with Biktarvy, although temporarily held due to concerns for immune reconstitution inflammatory syndrome (IRIS) and later resumed. She underwent multiple intravitreal injections of ganciclovir and foscarnet for CMV retinitis. She remained in the ICU for 2 months with failure to improve and eventually expired from respiratory failure. DISCUSSION: This case underscores the importance of early HIV screening in high-risk populations, particularly those from endemic regions presenting with recurrent respiratory infections as well as with limited health literacy. Early detection and initiation of antiretroviral therapy (ART) can prevent severe opportunistic infections and improve clinical outcomes. CONCLUSIONS: Patients from high-risk regions presenting with recurrent respiratory infectious should be screened for HIV at initial presentation. Earlier diagnosis and intervention could prevent severe immunosuppression and associated opportunistic infections. This case highlights the need for improved screening guidelines to facilitate timely detection and management of HIV/AIDS in vulnerable populations.

Volume

168

Issue

4S

First Page

1635A

Comments

American College of Chest Physicians CHEST Annual Meeting, October 19-22, 2025, Chicago, IL

Last Page

1636A

DOI

10.1016/j.chest.2025.07.931

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