GINGIVAL BLEEDING AS PRESENTING SIGN OF ADVANCED HIV/AIDS – A CASE REPORT
ABSTRACT:
Introduction:
Acquired immune deficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV), remains as a significant health care problem since its discovery in 1981. Oral manifestations are considered as the earliest and important indicators of HIV infection. Most of the oral manifestations of HIV are due to immunosuppression and related opportunistic infections.
Case presentation:
A 43 year old female patient reported to our department with a chief complaint of bleeding gums for 4 days. Based on the history and clinical examination, necessary investigations has been done and she was diagnosed as clinical stage IV HIV disease with pancytopenia, disseminated tuberculosis and tuberculoma brain. The gingival bleeding was a result of severe thrombocytopenia (platelet count – 20,000cells/μl).
Conclusion:
The timely diagnosis and intervention of the underlying potentially lethal condition in this patient brought her back to life. This case was a
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Peripheral smear study showed reduced number of RBC which were normocytic and hypochromic along with tear drop cells and moderate anisopoikilocytosis, WBCs with reduced number and normal distribution and platelets with reduced number and normal morphology which was suggestive of pancytopenia. Serological testing of blood sample by ELISA showed a positive reaction to HIV-1 antibodies which was confirmed by further analysis. CD 4 count was 18 cells/mm3. Blood culture and urine analysis did not reveal any abnormality. Serological testing for HBsAG, Anti-HCV, toxoplasma were negative. Bone marrow biopsy (BMB) showed megakaryocytes with increased proliferation and clustering suggestive of megakaryocytic thrombocytopenia. It did not reveal any AFS or PAS organism or