Human Immunodeficiency Virus (HIV) is a fairly prevalent disease in the United States, with an estimated 1 million persons infected with HIV-1.1 Despite a decrease in Acquired Immunodeficiency Syndrome (AIDS), the prevalence of HIV is increasing, which has led to recent changes in HIV testing guidelines.2 Newly diagnosed patients should ideally be linked to care and receive intervention and antiretroviral therapy (ART) allowing them to maintain a near normal life expectancy.

Case Presentation

The patient is a 23-year-old African American male with no significant past medical history. He presented to the emergency department (ED) with fevers, weakness, worsening right-sided chest pain, and shortness of breath associated with a productive cough. When he presented with similar symptoms two weeks ago, he was treated for pneumonia with azithromycin. Symptoms initially improved but then worsened five days prior to returning to the ED. He had odynophagia for the last three weeks causing him to avoid solid foods. Additionally, he reported loss of vision in his right eye for two months which started as blurriness but progressed to only appreciating light versus dark. Left eye vision was intact. He took no chronic medications and denied drug allergies. Surgical and family history was non-contributory. He rarely drank alcohol and denied tobacco or drug use. He is homosexual and became sexually active at the age of fourteen with inconsistent condom use. He reported a negative rapid HIV test at a local clinic one month ago and his last sexual contact was three months prior to presentation.