Diagnosis and treatment analysis of one patient with acute human immunodeficiency virus infection presented with acute suppurative tonsillitis as the initial manifestation

Feng Lizhi; He Haolan; Chen Zhimin; Liu Bo; Liu Xinhua; Zhao Han

doi:10.3969/j.issn.1672-8521.2025.02.011

Abstract：Objective:To report the diagnosis and treatment process of a patient with acute human immunodeficiency virus(HIV)infection presented with acute suppurative tonsillitis as the initial manifestation,in order to enhance the clinical understanding of this disease.Methods:On June 5,2023,a middle-aged male patient with acute HIV infection who presented with acute suppurative tonsillitis as the initial manifestation was admitted.The patient was admitted due to sore throat for one week,aggravated and accompanied by fever for two days.Summarize the clinical manifestations,diagnostic process and treatment of the patient.Results:The result of the patient's first HIV preliminary screening test after admission was negative.After anti-infective treatment,symptoms such as sore throat were relieved.However,laboratory tests indicated significant abnormalities in immune function:the count of CD4+T lymphocytes decreased to 147 cells/μL,CD8+T lymphocytes were abnormally activated and increased,and the ratio of T helper/suppressor lymphocytes was inverted.Given that the characteristics of immune disorders were highly consistent with the manifestations during the window period of HIV infection,the HIV primary screening test was conducted again.Subsequently,the HIV confirmation test(Western blotting),viral load detection and epidemiological investigation were completed.Eventually,it was diagnosed as acute HIV infection.On June 14,2023,the patient began antiviral treatment with Bictegravir Sodium,Emtricitabine and Tenofovir Alafenamide Fumarate Tablets.Later,the patient's condition stabilized and was discharged for follow-up.Conclusions:Acute suppurative tonsillitis as the initial manifestation in the acute stage of HIV infection is relatively rare.During diagnosis,attention should be paid to the investigation of the epidemiological history.Anti-hiv treatment should be initiated as soon as possible after diagnosis to reduce the possibility of transmission.