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13 years old male child who was averagely built & nourished weighing 32 kg was brought for stridor with fever of 2 days duration. He was the only child of a divorcee mother & was immunized upto date. He suffered from Bronchial Asthma in childhood but was off inhalers for last 5 years. There was no past history of repeated attacks of respiratory infections, chronic diarrhea, weight loss or prolonged fever. Clinical examination showed sick looking child with fever of 101 degree F, tachypnea, stridor, and bilateral crepts. Throat exam showed oral thrush & edematous larynx. There was no lymphadenopathy or hepatosplenomegaly. He was managed in ICU with oxygen, antibiotics & symptomatic treatment. Investigations showed Hemoglobin of 12.5gm%, WBC count of 13400/cumm (Polymorphs 47%, Lymphocytes 46%, Eosinophils 5%, Monocytes 2%). Chest X-ray showed bilateral haziness in mid & lower zones without pleural involvement. On next day he worsened & started desaturating inspite of oxygen & required ventilatory support. During intubation his larynx was studded with thrush. HIV by ELISA method was therefore asked for which was HIV-1 positive and was confirmed on Western blot. Mother too was tested & turned out HIV-1 positive. As he started worsening inspite of antibiotics, IV Fluconazole and ventilatory support, he was shifted to specialized HIV unit in Mumbai.
This case is being reported for its rarity in form of stridor and laryngeal candidiasis in a 13 year old as first presentation of HIV.
Last updated: 1-06-2006
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