Acute retroviral syndrome diagnosed via fourth-generation HIV assay

This image-based case presents a previously healthy 26-year-old man with a 5-day history of malaise, sore throat, fevers, and an asymptomatic maculopapular rash across the upper chest and neck. Oral exam revealed palatal petechiae, buccal ulcers, and pharyngeal erythema. Initial HIV antibody test was negative; however, a fourth-generation combination HIV antigen/antibody test was positive, with an HIV viral load >10 million copies/mL. Diagnosis: Acute HIV infection, confirmed within weeks of exposure during condomless sex. Key findings include leukopenia, lymphopenia, thrombocytopenia, elevated CRP, and absence of lymphadenopathy. Antiretroviral therapy was initiated, rapidly resolving symptoms. Case underscores serologic window period, value of fourth-generation assays, and importance of clinical suspicion in acute retroviral syndrome.

This image-based case presents a previously healthy 26-year-old man with a 5-day history of malaise, sore throat, fevers, and an asymptomatic maculopapular rash across the upper chest and neck. Oral exam revealed palatal petechiae, buccal ulcers, and pharyngeal erythema. Initial HIV antibody test was negative; however, a fourth-generation combination HIV antigen/antibody test was positive, with an HIV viral load >10 million copies/mL. Diagnosis: Acute HIV infection, confirmed within weeks of exposure during condomless sex. Key findings include leukopenia, lymphopenia, thrombocytopenia, elevated CRP, and absence of lymphadenopathy. Antiretroviral therapy was initiated, rapidly resolving symptoms. Case underscores serologic window period, value of fourth-generation assays, and importance of clinical suspicion in acute retroviral syndrome.