When dyspnea is a Hickam's Dictum.

Area of Science:

• Infectious Diseases
• Immunology
• Public Health

Background:

• Highly effective antiretroviral therapy has significantly reduced opportunistic infections in people living with HIV (PLWH).
• However, delayed diagnosis of HIV infection can still lead to severe, concurrent opportunistic infections.
• Awareness of potential concurrent infections is crucial for timely diagnosis and management in PLWH.

Purpose of the Study:

• To report a rare case of synchronous opportunistic infections in a newly diagnosed individual with human immunodeficiency virus (HIV).
• To emphasize the importance of considering concurrent infections in patients presenting with symptoms suggestive of advanced HIV.
• To remind clinicians about the diagnostic challenges and potential severity in long-standing, undiagnosed HIV cases.

Main Methods:

• Case report of a middle-aged male patient.
• Clinical presentation with diarrhea and shortness of breath.
• Diagnostic workup revealing Pneumocystis pneumonia, disseminated histoplasmosis, and disseminated Mycobacterium avium complex infection.

Main Results:

• The patient was diagnosed with concurrent Pneumocystis pneumonia, disseminated histoplasmosis, and disseminated Mycobacterium avium complex infection.
• These infections were identified alongside a new diagnosis of human immunodeficiency virus (HIV) infection.
• The case illustrates a rare presentation of multiple, simultaneous opportunistic infections in an individual with long-undiagnosed HIV.

Conclusions:

• Individuals with undiagnosed HIV can present with multiple, synchronous opportunistic infections.
• Clinicians must maintain a high index of suspicion for HIV and concurrent infections in patients with severe, unexplained symptoms.
• Prompt diagnosis and initiation of antiretroviral therapy and treatment for opportunistic infections are critical for improved outcomes in PLWH.