2 Cases of Mistaken Identity

Posted on August 4, 2012 by drtan

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In this post, I would like to talk about 2 cases that I left an impression on me. They both involved the initial suspicion of HIV but both turned out to be a complete surprise in the end.

The first case us that of a 37 years old man from theUK. Let’s call him Mr.UK. Mr.UK works for an NGO and travels frequently to developing countries. On his last trip toVietnam, he ended up in a Karaoke bar and received unprotected oral sex from a Vietnamese lady. Soon after that incident, he developed a fever. Mr.UK was understandably worried and rushed off to see a doctor. The doctor examined him and reassured him that all he had was a viral infection and told him it would all get better with some rest and water.

Mr.UK could not get HIV out of his mind and 1 month after the incident he went for a HIV test. Fortunately, the test showed that he was not infected with HIV. Unfortunately, the fever soon came back and this time he also started having diarrhea. He was utterly convinced that the first HIV test got it wrong because he was still within the window period. This was a very valid concern indeed. However, a repeat HIV test again came up negative.

By the time he saw me, he was very gaunt, dehydrated and pale. He was still having a persistent fever of above 38°C and was losing weight rapidly. To make things even worse, that morning he noticed blood in his stools and vomited twice. He broke down in my office completely convinced that he was infected with HIV. He basically had the entire laundry list of ‘HIV symptoms’ that he read on the internet.

I tested him again for HIV and again it was negative. By the time, it had been 6 weeks from his exposure date. After much counseling, I managed to convince him to expand our search and test for other diseases.

He was finally diagnosed with Typhoid fever and made a rapid recovery with antibiotics. However, the mental trauma took its toll on him and he continued to worry and test for HIV nearly every week for the next 6 months. Fortunately, his HIV tests remained persistently negative. Now he returns once a year for HIV testing and has never placed himself at risk of HIV again.

The second case involves an 18 year old boy. Let’s call him Mr. 18. In a night of curiosity, he followed some friends to the infamous red light district of Singapore known as Geylang. Being rather short on cash, he and his friends decided to pool their resources and purchase services from 1 girl. They finally found a worker who was willing to accept their price.

They started out receiving oral sex from her and when she finally undressed, they found out to their dismay that she was actually a transgender. Some of the guys decided that this was too much and left. Mr. 18 stayed on with one of his more adventurous friends and continued with the oral sex. He claimed that he did not have penetrative anal sex but admitted that he rubbed his penis on the worker’s anus.

Once the excitement of the night wore off and the harsh morning rays cleared his head, Mr. 18 started feeling very scared. His mind went wild with the prospect of having been infected with HIV. It did not help matters when soon after, he developed a fever and terrible sore throat. He attended the government sexual health clinic and tested negative for HIV.

Unconvinced, he then came to my clinic for confirmation. A repeat HIV test again showed that he had not been infected with HIV. I advised him to expand his search for other possible diseases but he refused. After much counseling, I got the mistaken impression that he was afraid of the costs. I then advised him to speak to his parents or attend the government polyclinic where there is subsidized medical care. Still he refused. He finally told me rather angrily that he was 100% sure he was infected with HIV and wonders why doctors, including myself, did not believe him. He left my clinic a very distraught young man still convinced that he has HIV and no doctor would believe him.

Soon after that visit, Mr. 18 started developing diarrhea and shortness of breath. This was accompanied by blood in his stools and pain in his joints. He went to clinic after clinic doing HIV tests until he was even denied testing at some clinics.

The rest of the story I heard from his parents. One day at home, he started having a coughing fit that would not stop. He eventually vomited blood and collapsed. He was rushed by ambulance to the hospital where he was diagnosed to have a cancer of the blood. After several days of battling for his life in ICU, he eventually recovered. He now is under treatment for his cancer and all HIV tests ever since have been negative.

Learning points:

I have kept it to just 1 learning point today because it is so important.

1. Never assume. The Internet is awash with laundry lists of so called ‘HIV symptoms’. Just because your symptoms fit this list does not mean you have HIV. Do not neglect the possibility of other disease because of the fear of HIV. You must always see a doctor.