Psychosis and Rectal Bleeding as the Presenting Symptoms of AIDS in an Adolescent Male

Socioeconomic status, racial health disparities, and age are some of the many barriers that may confound and delay the diagnosis of human immunodeficiency virus (HIV). Despite the new and highly effective advancements in the treatment of HIV, in the United States, there is a disparity in the rate of timely diagnosis and treatment among Black/African Americans, men who have sex with men, those who suffer from homelessness, and transgendered youth. While there are existing recommendations in place to guide the testing of adolescents for HIV, the rate of testing is highly variable, which can lead to missed diagnoses. We present the case of a previously healthy 17-year-old African American male with psychosis who was initially diagnosed with a primary psychiatric disorder. Three weeks later, the patient presented with rectal bleeding. Further evaluation revealed that the patient was positive for HIV. The psychiatric symptoms were attributed to HIV dementia and rectal bleeding to HIV colitis. To our knowledge, this is the first case report of a patient with HIV dementia and rectal bleeding as the initial presenting symptoms of AIDS. This case demonstrated the potential consequences of variable testing practices for HIV and the devastating sequela that can follow the lack of timely diagnosis.