A False-Positive HIV Test: Severe Lupus Flare in Disguise

Systemic lupus erythematosus (SLE) and human immunodeficiency virus (HIV) infection have significant overlapping clinical features, making diagnosis challenging. We report a case of new-onset SLE initially mistreated as HIV infection due to a false-positive fourth-generation HIV antigen/antibody (Ag...

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Bibliographic Details
Published inCurēus (Palo Alto, CA) Vol. 14; no. 4; p. e24349
Main Authors Lam, Eric, Sayedy, Najia, Iqbal, Javed
Format Journal Article
LanguageEnglish
Published United States Cureus Inc 21.04.2022
Cureus
Subjects
Antibodies
Antifungal agents
Antigens
Antiretroviral drugs
Arthritis
Autoimmune diseases
Biopsy
Bronchoscopy
Case reports
Disease
Fever
Glycoproteins
Hemorrhage
HIV
HIV/AIDS
Human immunodeficiency virus
Immune system
Infections
Internal Medicine
Laboratories
Leukopenia
Lupus
Medical diagnosis
Medical tests
Microscopy
Patients
Rheumatology
systemic lupus erythematosus
immunocompromised
hiv
intensive care
false-positive
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Summary:Systemic lupus erythematosus (SLE) and human immunodeficiency virus (HIV) infection have significant overlapping clinical features, making diagnosis challenging. We report a case of new-onset SLE initially mistreated as HIV infection due to a false-positive fourth-generation HIV antigen/antibody (Ag/Ab) test. A young female in her 30s presented with fatigue, oral thrush, and a positive HIV Ag/Ab combo test. She was started on fluconazole and highly active antiretroviral therapy (HAART), but deteriorated with recurrent fevers and worsening mental status, requiring ICU admission. Surprisingly, her HIV confirmatory tests were negative, but rheumatologic serologies were positive. The overall clinical, laboratory and biopsy results confirmed the diagnosis of SLE. She was treated with pulse steroid therapy and immunosuppressive agents with marked improvement and was subsequently discharged. Rarely do SLE patients present with false-positive HIV tests, thus masking and delaying treatment for critical SLE. Clinicians should understand the limitations of screening tests and have high suspicions and consider the diagnoses of both diseases.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.24349