title: Fatal disseminated cryptococcus as the initial presentation of HIV infection in the era of highly active antiretroviral therapy.
abstract: 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.
authors.affiliation: Department of Dermatology, Division of Infectious Diseases, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 19104, USA. carrie.kovarik@uphs.upenn.edu
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Kovarik
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Barnard
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000328:Adult; D001921:Brain / Q000473:pathology; D003453:Cryptococcosis / Q000175:diagnosis*; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D017809:Fatal Outcome; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008168:Lung / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008578:Meninges / Q000473:pathology; D011654:Pulmonary Edema / Q000473:pathology; D013163:Splenomegaly / Q000473:pathology