WHEN THE TRUTH IS HIDDEN- A CASE REPORT

Introduction: The HIV infection is a chronic disease with continuous viral replication, immune system compromise and late clinical manifestations. The diagnosis is, unfortunately,often late and challenging. Case Report: Woman of 64 years, with a history of essential hypertension, depressive syndrome, chronic gastritis, diverticulosis and thyroid nodule. Medicated with:bromazepam, lisinopril/amlodipine and omeprazole. Came to the health center, in June 2015, with multiple complaints, one of progressive dysphagia, epigastric pain and fullness in the upper abdomen, despite medicated with proton pump inhibitors. The physical examination was normal.The diagnostic hypotheses was reflux esophagitis. We asked a upper gastrointestinal(UGI)endoscopy and clinical analysis. In the subsequent consultation, she brought the result of UGI endoscopy: white plaques around the esophagus and gastric mucosa with marbled aspect. Biopsies were performed. The diagnosis was esophageal candidiasis and biopsy revealed no active chronic gastritis without metaplasia. Order Helicobacter pylori research that came negative. Analytically without changes. In the same consultation was treated with fluconazole and asked of viral serology. The patient returns to consultation with weight loss (8kg in three months) and positive tests for HIV 1/2. Western Blot test and Infectious Diseases / Gastroenterology consultation are requested. The HIV confirmation tests came positive. Discussion: This case highlights the clinical suspicion of HIV after confirmation of esophageal candidiasis, as it often appears associated with HIV. Early diagnosis, here made possible by the appearance of opportunistic infection, allows preventing the advanced stages of the disease, which allows a better quality of life for the patient.