A Case Report of a Complex Case of Advanced New HIV Infection with CMV Meningoencephalitis, Salmonella Sepsis, and Esophageal Candidiasis: Diagnostic and Therapeutic Challenges

Abstract

Objective: Co-occurrence of multiple systemic diseases, particularly in late presenters, can obscure diagnosis and delay appropriate treatment. This work aims to highlight the complex clinical presentation, diagnostic and treatment challenges of a Human Immunodeficiency Virus infection late presenter, complicated by Salmonella sepsis, oropharyngeal candidiasis, and cytomegalovirus meningo-encephalitis, as well as the importance of a comprehensive diagnostic approach in immunocompromised patients with polymorphic symptoms.

Material and Methods: We report the case of a 43-year-old male who presented with systemic symptoms, including fever, wasting syndrome, urinary and neurological complaints. Clinical, microbiological, imaging, and molecular diagnostic tools were used to evaluate the patient. Diagnostic investigations included blood and urine cultures, Human Immunodeficiency Virus and syphilis serology, cerebrospinal fluid analysis via molecular detection tools, and imaging.

Results: The patient was diagnosed with Human Immunodeficiency Virus -1 infection, Salmonella enterica group B sepsis emerging from an urinary infection, oropharyngeal and esophageal Candidiasis, and cytomegalovirus meningoencephalitis confirmed via polymerase chain reaction testing of cerebrospinal fluid. He was treated with a combination of antibacterial (Ceftriaxone), antifungal (Fluconazole), and antiviral therapy (Ganciclovir/Valganciclovir), alongside supportive care and initiation of antiretroviral therapy. After 29 days of hospitalization, he exhibited notable clinical improvement, including weight gain, neurological recovery, and resolution of oropharyngeal lesions.

Conclusions: This case illustrates the diagnostic and therapeutic complexity of managing patients with advanced Human Immunodeficiency Virus infection and multiple opportunistic complications. The prompt use of diagnostic tools, multidisciplinary approach, and the staged initiation of antiretroviral therapy were crucial for achieving favorable outcomes. Early recognition of late presenters remains essential to prevent life-threatening complications.