New-Onset Mania in the Setting of Progressive HIV Infection: A Case Report

HIV infection has been known to cause or exacerbate psychiatric symptoms. In individuals with HIV, mania may present as part of a bipolar disorder or as a distinct condition referred to as Mania Associated with Advanced HIV Disease (previously known as AIDS mania). We present a case of a 57-year-old patient with new onset symptoms of bipolar disorder in the setting of HIV infection. The patient was admitted for treatment of mania and found to have an HIV infection, but with a CD4 + count that was still above the threshold of AIDS. Eventually, the patient's mood stabilized on a regimen of valproic acid 1500 mg twice daily and olanzapine 10 mg once daily. He developed infectious symptoms and was found to have cryptococcal pneumonia. He was started on fluconazole, but then subsequently left the hospital against medical advice.