Case of Early Diagnosis of HIV Infection and Successful Treatment of Smooth Skin Mycosis
Introduction
On July 22, 2018, a 30-year-old patient visited a private clinic to see a general practitioner.
Complaints
The young man complained of rashes on the torso and flu-like symptoms. He attributed his general weakness, periodic fever spikes up to 37.4°C, and muscle pains to possible contact with sick individuals at work. He considered the skin changes as “ordinary” dermatitis.
During warm baths, the rashes on his skin experienced excessive peeling.
History
The patient had been experiencing weakness, fever, and muscle pains for two weeks. On the second day of illness, he consulted a local therapist who prescribed treatment: “Ingavirin,” “Lizobact,” “Miramistin.” However, his condition did not improve, and complaints persisted. On the fifth day of treatment, the patient started taking the antibiotic “Amoxiclav” 875 mg + 125 mg twice a day on his own. After seven days of treatment with no improvement, he sought help from a general practitioner. He had observed the rash on the lateral surface of his torso for a month, but assuming it was “ordinary” dermatitis, he did not seek treatment.
According to his medical history, the patient had frequent colds in childhood and had contracted chickenpox, scarlet fever, and rubella. He had pneumonia at the age of 18. He denied any history of trauma or surgery, smoking, alcohol, or drug use. His family history included hypertension on his mother’s side and duodenal ulcer disease on his father’s side. He denied any allergies or adverse reactions to medications. Regarding sexual history, he had no regular partner and engaged in unprotected sexual intercourse. His last sexual contact was five months prior with a casual acquaintance.
Examination
Examination revealed the following changes: 1. Enlarged occipital, posterior cervical, and retroauricular lymph nodes on both sides, slightly painful on palpation, firm consistency, with no changes in the skin above them. 2. Harsh breath sounds with occasional dry wheezing on expiration, more pronounced in the interscapular region. 3. The skin lesion presented as pinkish-red patches with raised scaly edges, gradually regressing towards the center as they spread peripherally. Predominantly localized on the lateral surface of the torso and in the axillary folds.
Chest X-ray showed no abnormalities. Ultrasound of the lymph nodes revealed bilateral lymphadenopathy with maximum dimensions of 0.9 cm by 1.6 cm. ECG was normal. Laboratory findings: ⠀• Complete blood count showed no abnormalities; ⠀• C-reactive protein within normal limits; ⠀• Biochemical and general blood analysis were normal; ⠀• Herpes virus antibodies test (Ig-M) for types 1-5 was negative; ⠀• Blood test for toxoplasmosis was negative. Microscopic examination of a skin scraping from the affected area revealed fungal spores (without etiological verification). HIV blood test was positive (confirmed by subsequent Western blotting in two laboratories), with negative results for syphilis, hepatitis B, and hepatitis C.
Diagnosis
Acute HIV infection with secondary diseases (stage 2B). Smooth skin mycosis.
Treatment
Patient data was transferred to the AIDS center, as HIV infection treatment is only conducted in specialized institutions under the supervision of an infectious disease specialist. The patient was prescribed local therapy with antifungal drugs.
After 21 days of treatment, the skin condition did not improve. Upon repeat blood biochemical analysis, systemic antifungal therapy was prescribed to the patient. After 10 days, the skin condition resolved.
The patient was registered at the AIDS center, where he has been receiving etiotropic therapy since September 1, 2019. He feels well. At a follow-up examination, two months after starting treatment, a hypopigmented area was observed at the site of the mycotic infection.
Conclusion
This clinical case once again proves that general practitioners, as the primary healthcare providers, should be vigilant regarding HIV infection. Any enlargement of lymph nodes, presence of fungal skin infection, or prolonged flu-like condition warrants investigation for HIV infection. This is due to the increasing number of HIV-infected patients. It is worth noting that the clinical manifestations of acute HIV infection can last from several days to several months, but typically last two to three weeks. An exception is the persistence of lymph node enlargement throughout the illness. In this case, clinical symptoms helped identify HIV infection at an early stage, allowing the patient to receive full therapy. In conclusion, it is important to remind colleagues and patients that HIV infection can be asymptomatic, so regular HIV testing is necessary.