title: Acute human immunodeficiency virus (HIV) infection presenting with fever, elevated amylase/lipase, and hematologic abnormalities.
abstract: BACKGROUND
  Many cases of acute human immunodeficiency virus (HIV) infection (AHI) present to the Emergency Department (ED). Early diagnosis allows a patient to modify their behavior and seek early treatment. The Emergency Physician should know that the antibody response may be absent.
  
  
  OBJECTIVE
  We report a case of AHI and review its presentation to increase the awareness of this important diagnosis.
  
  
  METHODS
  A 20-year-old black man who had a history of sex with men initially presented to the ED with a chief complaint of blood per rectum when he passed stool, and chills for the prior few days. His work-up was normal, including a rapid HIV screen, and he was discharged. He returned 2 weeks later with constipation, fatigue, myalgias, decreased urination, chills, and a productive cough. His physical examination was unremarkable, HIV antibody test was negative, but his laboratory tests showed an elevation of creatine phosphokinase, amylase, and lipase. His blood count showed a normal hematocrit and white blood cell count, but there were juvenile and vacuolated white cells and giant platelets reported. HIV viral load was reported as > 1,000,000 copies/mL.
  
  
  CONCLUSIONS
  This case illustrates that AHI can present as a non-specific illness. Patients at risk should be screened for HIV. However, AHI can occur before there is a significant antibody response. In such cases, a viral load test may help make the diagnosis, allowing for early treatment and patient counseling.
authors.affiliation: Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA.
authors.forename: Joel R
authors.initials: JR
authors.lastname: Moore
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Schneider
mesh_terms: D000208:Acute Disease; D000681:Amylases / Q000032:analysis*; D001792:Blood Platelets / Q000473:pathology; D003402:Creatine Kinase / Q000032:analysis; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D005221:Fatigue / Q000209:etiology; D005334:Fever / Q000821:virology*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008049:Lipase / Q000032:analysis*; D008297:Male; D009504:Neutrophils / Q000473:pathology; D012002:Rectal Diseases / Q000209:etiology; D014617:Vacuoles; D019562:Viral Load; D055815:Young Adult
chemical_list: D003402:Creatine Kinase; D008049:Lipase; D000681:Amylases