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Infeção Aguda pelo Vírus da Imunodeficiência Humana 1: uma janela de oportunidade
Abstract
portuguesA infecao aguda pelo Virus da Imunodeficiencia Humana 1 (VIH-1) constitui um desafio, sendo crucial um elevado indice de suspeicao clinica para se alcancar o diagnostico, sobretudo na ausencia de contexto epidemiologico aparentemente relevante. Os autores descrevem o caso de uma mulher de 52 anos internada por um quadro clinico sugestivo de mononucleose infeciosa associada a nauseas, vomitos e diarreia com uma semana de evolucao. A doente negava atividade sexual, consumo de drogas injetaveis ou transfusoes sanguineas. Objetivamente salientava-se a presenca de febre elevada, lesoes ulceradas da cavidade oral, hiperemia da faringe, exantema maculopapular e adenopatias cervicais bilaterais. Os exames laboratoriais evidenciavam bicitopenia, padrao hepatico de citocolestase, aumento da lactato desidrogenase e da lipase, tendo-se concluido apos investigacao etiologica por Infecao aguda pelo VIH-1 com Pancreatite aguda nesse contexto. Apos inicio da terapeutica antiretroviral verificou-se resolucao completa do quadro clinico. Assim, pretende-se ilustrar a necessidade da consideracao da sindrome retroviral aguda no diagnostico diferencial da sindrome mononucleosica, salientando a relevância dos testes de 4a geracao, bem como o papel da terapeutica antiretroviral na infecao aguda. EnglishThe diagnosis of acute infection by the Human Immunodeficiency Virus 1 (HIV-1) is a challenge, being essential a high degree of suspicion to achieve the diagnosis, particularly in the absence of an apparent epidemiological context. The authors present a case of a 52 years old woman with a clinical picture suggestive of infectious mononucleosis, associated with nausea, vomiting and diarrhea with one week of evolution. The patient denied sexual activity, injection drug use or blood transfusions. Physical examination pointed out the presence of prostration, ulcerative lesions of the oral cavity, sore throat, maculopapular rash and bilateral cervical lymphadenopathies. Laboratory studies showed bicytopenia, citocolestase pattern, increased lactate dehydrogenase and lipase. After etiological investigation it was assumed the diagnosis of acute HIV-1 infection with acute pancreatitis in this context. After the beginning of the antiretroviral therapy there was complete resolution of symptoms. The authors pretend to show that acute retroviral syndrome should be considered in the differential diagnosis of mononucleosis like syndrome, the relevance of 4th generation tests as well as the role of antiretroviral therapy in the acute infection.
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