Thrombotic microangiopathy as first manifestation of acute human immunodeficiency virus infection: A case report and review of the literature

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Abstract

Background: We present the case of a patient with acute human immunodeficiency virus infection and a thrombotic microangiopathy as the first clinical manifestation, a presentation that has not, to the best of our knowledge, been previously reported. Case presentation: A 35-year-old Bolivian man presented with epistaxis and thrombocytopenia. We found microangiopathic anemia, lymphopenia, elevated lactate dehydrogenase, progressive acute renal failure, negative direct antiglobulin test, and normal activity of ADAMTS13. An human immunodeficiency virus ELISA test was negative, with an human immunodeficiency virus viral load of 10,000,000 RNA copies/mL. Antiretroviral therapy and three sessions of therapeutic plasma exchange were able to control thrombotic microangiopathy. Conclusions: Hematologic manifestations of human immunodeficiency virus infection are frequent. However, the debut of acute human immunodeficiency virus infection with thrombotic microangiopathy is a rare event. A high index of suspicion and early treatment is required.

Figures

  • Table 1 Laboratory values at diagnosis and follow-up
  • Fig. 1 Peripheral blood smear with microangiopathic anemia (×100 optical microscopy). Scarce platelets and abundant schistocytes, acanthocytes and red cell destruction are evident
  • Fig. 2 Chronological schema of clinical and laboratory follow-up characteristics. Cr creatinine, Hb hemoglobin, LDH lactate dehydrogenase, PLT platelets, TPE therapeutic plasma exchange

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Megakaryocytes of human immunodeficiency virus-infected individuals express viral RNA

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CITATION STYLE

APA

Sarmiento, M., Balcells, M. E., & Ramirez, P. (2016). Thrombotic microangiopathy as first manifestation of acute human immunodeficiency virus infection: A case report and review of the literature. Journal of Medical Case Reports, 10(1). https://doi.org/10.1186/s13256-016-0938-z

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