Multiple Organ Failure during Primary HIV Infection

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Abstract
A 16-year-old woman presented to a health care facility with fever of acute onset and a 4-day history of chills, myalgia, and diarrhea. Her past medical history was unremarkable. The only prescription medication that she was taking was oral contraceptive pills, and she reported only 1 regular sexual partner in the last 6 months. At admission, the patient appeared to be acutely ill, with a body temperature of 40.4°C and a blood pressure of 80/40 mm Hg. Physical examination revealed diffuse lymphadenopathy, hepatomegaly, and muscle tenderness. The patient's WBC count was 0.9 × 109 cells/L with 0.61 × 109 cells/L segmented neutrophils. The patient's aspartate aminotransferase and alanine aminotransferase levels were 4266 and 1875 IU/L, respectively (normal value for each, <40 IU/L), her creatinine phosphokinase level was 2734 IU/L (normal value, <190 IU/L), her troponine Ic level was 2.18 ng/mL (normal value, 70%). She was administered 1000 mL of normal saline and was admitted to the intensive care unit for severe sepsis of unknown cause. Transthoracic echocardiography revealed slightly impaired cardiac function with an ejection fraction of 55% despite adequate preload. A chest radiograph had normal findings. Abdominal CT revealed homogenous hepatomegaly. Three sets of blood sample cultures and urocultures remained sterile. The patient received intravenous amoxicillin-clavulanate and gentamicin without any improvement in her condition.