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Fatal Disseminated Cryptococcus as the Initial Presentation of HIV Infection in the Era of Highly Active Antiretroviral Therapy
Author(s) -
Kovarik Carrie L.,
Barnard Jeffrey J.
Publication year - 2009
Publication title -
journal of forensic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.715
H-Index - 96
eISSN - 1556-4029
pISSN - 0022-1198
DOI - 10.1111/j.1556-4029.2009.01050.x
Subject(s) - medicine , autopsy , cryptococcosis , human immunodeficiency virus (hiv) , antiretroviral therapy , cause of death , immunology , pediatrics , intensive care medicine , viral load , disease
Despite the availability of highly active antiretroviral treatment, many HIV‐positive patients still present for the first time with a low CD4 count or an acquired immune deficiency syndrome (AIDS) defining illness. This may be due to patients’ refusal to be tested for HIV, delay in seeking medical treatment, or the misdiagnosis of an AIDS‐associated condition. We present a 39‐year‐old African American male with undiagnosed HIV, who died shortly after arrival to the emergency room. An autopsy was performed at the Dallas County Medical Examiners’ Office, and the cause of death was determined to be disseminated cryptococcosis. Further investigation at autopsy revealed HIV 1/2 antibody positivity and HIV western blot positivity. This case demonstrates the importance of considering complications of HIV as a cause of death, even when the patient has no prior history.