HIV: Respiratory Insufficiency in an HIV Patient

Abstract

In this report, we portray a case of a 31-year-old female who presented to the emergency room with a one-month history of asthenia, fever, night sweats, and dry cough. At admission, an inaugural HIV-AIDS diagnosis was made. The patient developed respiratory failure requiring invasive mechanical ventilation and was transferred to an ICU. Due to progressive respiratory worsening, she was referred to our tertiary center for extracorporeal carbon dioxide removal (ECCO₂R). At admission, severe multiorgan dysfunction was evident and all invasive support measures were limited. A nonexpected clinical improvement 8 h after led to the revocation of the later decision: the patient was placed on ECCO₂R for 12 h and then escalated to VV-ECMO. As part of the etiology study, CMV was isolated from BAL fluid, a weak positive antigen for cryptococcosis and EBV viral load were perceived in the blood. Despite all measures, the patient developed refractory shock and died 2 weeks later. With this case, we aim to discuss the etiology of respiratory insufficiency in AIDS patients and the implications and ethical challenges of end-of-life decisions.