A 31-year-old bisexual man presented to the Johns Hopkins Hospital emergency department complaining of progressive headaches, confusion, myalgia, vivid nightmares, and diarrhea. For many years he had traveled extensively throughout sub-Saharan Africa and had recently spent 2 years in Madagascar. He had returned to the United States 1 month before admission.Once home, he developed diffuse myalgia and malaise. Stool analysis showed hookworm and Entamoeba histolytica, and he was treated with mebendazole and metronidazole 1 week before admission. During that week, he developed flulike symptoms of fever, chills, cough, and persistent diarrhea. Three days before admission, he developed a stiff neck, headaches, confusion, and vivid nightmares.His medical history included an inguinal hernia repair 12 years before admission and hepatitis A infection 7 years before admission. For the past 2 years, he had taken prophylactic chloroquine against malaria. Within the past 6 months, he had been
Quinn TC. Acute Primary HIV Infection. JAMA. 1997;278(1):58–62. doi:10.1001/jama.1997.03550010072043
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