PEDIATRICS Vol. 81 No. 3 March 1988, pp. 356-359
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Pediatric Acquired Immunodeficiency Syndrome With Negative Human Immunodeficiency Virus Antibody Response by Enzyme-Linked Immunosorbent Assay and Western Blot

David W. Goetz USAF1, Susan E. Hall USAF1, Richard W. Harbison USAF1, and Michael J. Reid USAF1

1 From the Section of Allergy-Immunology, Department of Medicine and Department of Pediatrics, Wilford Hall US Air Force Medical Center, Lackland Air Force Base, Texas

A 5-month-old white girl having persistent oral candidiasis was brought to medical attention because of acute respiratory distress, pneumonia, and hypoxia that worsened despite supportive care and antibiotics. Bronchial lavage fluid yielded Pneumocystis carinii. The diagnosis of acquired immunodeficiency syndrome (AIDS) was suspected, although enzymelinked immunosorbent assay (ELISA) and Western blot tests were both negative for human immunodeficiency virus (HIV) antibody. Immunologic evaluation included the following results: a low normal CD4/CD8 ratio 0.88, CD4 lymphocytes 493/µL, and elevated IgA 539 mg/dL and IgM 175 mg/dL with normal IgG 492 mg/dL. Lymphocyte stimulation study results were depressed. Lymphocytes sent for culture were subsequently positive for HIV. The mother was HIV antibody positive by enzyme-linked immunosorbent assay and Western blot but belonged to no high-risk group and was asymptomatic except for chronic diarrhea. The father was HIV antibody negative. The patient was treated with pentamidine and IV ggr-globulin with good clinical response and a rapid decrease of IgM and IgA toward normal values. Subsequent candidal pneumonia and candidal esophagitis were treated successfully with amphotericin B. The patient has received prophylactic IV ggr-globulin infusions for 6 months and remains HIV negative by enzyme-linked immunosorbent assay and Western blot. This case of pediatric AIDS highlights the need to consider HIV infection in the differential diagnosis of any child with physical findings or illnesses suggestive of AIDS-related complex or AIDS, even when HIV serologic findings are negative and parents belong to no high-risk group. Parental testing for HIV antibody is suggested in such cases.

Key Words: acquired immunodeficiency syndrome • human immunodeficiency virus • enzyme-linked immunosorbent assay • Western blot

Submitted on April 6, 1987
Accepted on June 2, 1987




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SERONEGATIVE HIV INFECTION IN A CHILD
Journal Watch (General), April 12, 1988; 1988(412): 8 - 8.
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