Multiple Health Issues in a Homeless Adolescent

A 19-year-old homeless youth presented to the emergency department with right arm pain at the site of previous intravenous line and abdominal pain following a fight. Several days previously he had been treated for an unwitnessed grand mal seizure. The patient stated his history of seizure disorder, cardiac arrhythmia, reactive airway disease, and HIV infection (he reported CD4 count of 350 cells/mm(3)), and physical and sexual abuse. Upon admission, his CD4 count and percent were normal and HIV antibody test was negative. He refused to accept those results and kept none of his follow-up appointments. The case was consistent with factitious HIV disorder in adolescents.