[Case report about an initial diagnosis of HIV-infection in a young sailor through two AIDS-defining diseases with lethal progression]. / Fallbericht über die Erstdiagnose einer HIV-Erkrankung eines jungen Seemanns durch 2 AIDS-definierende Erkrankungen mit letalem Intensivverlauf.

ANAMNESIS: We saw a previously healthy 30-year-old Southeast-Asian sailor with progredient coughing and fever. EXAMINATION: We found an atypical pneumonia along with a positive HIV-test. We performed a bronchial lavage and further diagnostics for opportunistic infections. The lab work showed a viral load of 3340 000 copies/ml and a CD4-cell-count of 36/µl. DIAGNOSIS: HIV late presenter in CDC stadium C3 with Pneumocystis jirovecii and CMV pneumonia. THERAPY: We treated with Meropenem, Moxifloxacin, Cotrimoxazol, Ganciclovir and Genvoya. CLINICAL COURSE: Due to a cardio-pulmonal deterioration invasive ventilation was necessary. In the end the patient died of multi organ failure twelve days after admission despite intensive care, hemodialysis and prone positioning. CONCLUSION: This case demonstrates the difficulties in the pharmacotherapy and with drug interactions in a HIV late presenter with multi organ failure. Consultation and advice of the hospital pharmacy and the antibiotic stewardship team was vital for treating this patient. In the end cases like the portrayed should be treated in specialized clinics.