Hematologic manifestations in a child with HIV; a Case Report

Area of Science:

• Pediatrics
• Infectious Diseases
• Immunology

Background:

• Immune deficiency can be primary or secondary, presenting with diverse clinical manifestations.
• Human Immunodeficiency Virus (HIV) infection is a significant cause of secondary immunodeficiency.
• Prompt diagnosis and management are essential for improving patient outcomes.

Observation:

• A pediatric patient presented with fever of unknown origin (FUO), prolonged cough, failure to thrive (FTT), cervical lymphadenopathy, hepatosplenomegaly, and bilateral optic neuritis.
• Previous hospitalizations revealed fever, cytopenia, and hepatosplenomegaly, with persistent thrombocytopenia.
• Diagnostic workup identified bicytopenia, elevated ESR, hyperlipidemia, hyperproteinemia, cerebral venous thrombosis, antiphospholipid antibodies, and altered levels of coagulation factors.

Findings:

• The patient's diagnostic evaluation ultimately confirmed a positive HIV antibody test.
• Coagulation abnormalities, including antiphospholipid antibodies and altered protein S, antithrombin III, and factor V Leiden levels, were noted.
• The constellation of symptoms, including cytopenias and thrombotic events, pointed towards an underlying immunodeficiency.

Implications:

• This case underscores the importance of considering HIV infection in the differential diagnosis of children presenting with unexplained cytopenias, lymphadenopathy, hyperproteinemia, or hyperlipidemia.
• Early identification of HIV infection allows for timely initiation of antiretroviral therapy, potentially preventing severe complications.
• Comprehensive evaluation for secondary causes of immune deficiency is critical in pediatric patients with complex clinical presentations.