(619) Pericardial Effusion and Renal Failure as Presenting Symptoms of HIV

Introduction: In adults, pericardial effusion is one of the more common cardiac manifestations of infection with human immunodeficiency virus (HIV). However, this is more often associated with acquired immunodeficiency syndrome (AIDS), typically has another associated infection, and usually are hemodynamically insignificant. Here we present the case of an 18-year-old transgender female who was admitted for pericardial effusion with heart failure as well as acute renal failure.

Description: An 18-year-old transgender female was admitted from endocrine clinic due to concerns for acute renal failure after routine labs had revealed a creatinine of 17 mg/dL. In the months prior to admission, she had been seen multiple times in urgent care settings for persistent chest pain and shortness of breath, for which she had been newly diagnosed with asthma. Cardiomegaly was appreciated on chest x-ray and so echocardiogram was obtained. This was remarkable for a moderate sized posterior pericardial effusion, dilated cardiomyopathy, and associated severe left ventricular dysfunction with an ejection fraction of ~25%. Her other electrolytes were reassuring, and she was started on low dose milrinone for heart failure with reduced ejection fractions (HFrEF).

Hemodialysis was initiated due to oliguric renal failure on day 1 of admission. Pericardiocentesis was performed on day 3 of admission, which drained 750ml of fluid and was performed in conjunction with a renal biopsy. Biopsy was remarkable for focal segmental glomerulosclerosis. Rheumatology and infectious disease were both consulted for further workup, during which she was found to be HIV positive approximately 1 week into her hospital course. She was ultimately discharged home after 2 weeks with plans for continued outpatient hemodialysis along with transition to care from adult nephrology.

Discussion: Cardiac manifestations of HIV infection are relatively common, however many of these are typically associated with AIDS and often are concurrent with other infections. In US pediatric patients, cardiac manifestations of HIV infection are rare and often associated with vertical transmission in infants. In adolescents presenting with pericardial effusion and HFrEF, HIV screening should be considered early on to ensure timely treatment.