ABSTRACT
A 26-year-old woman presented to the emergency department with nausea, diarrhoea, loss of appetite and general malaise. She could identify no clear precipitant to her gastrointestinal symptoms and denied having fevers or exposure to unwell contacts. Her symptoms had started approximately 10 days earlier and she was now feeling dehydrated. She also described developing peripheral oedema, beginning as mild ankle swelling a week ago, but now progressing to involve her shins. She had been treated for a lower respiratory tract infection with a course of amoxicillin 6 weeks ago but had been well for 4–5 weeks following this. The patient's past medical history included HIV diagnosed in childhood following vertical transmission (her HIV viral load was now undetectable, although her CD4 count remained low) with HIV-associated nephropathy and HIV-induced bone marrow suppression. She had been in good health over the preceding 18 months. She was taking 100 mg dapsone OD, 800 mg darunavir OD, 100 mg ritonavir OD and one tablet of Truvada (200 mg of emtricitabine and 300 mg of tenofovir) OD. She worked as a political journalist and lived alone. She had frequently travelled to rural areas of Spain over the past 2 years but had no other travel history. She occasionally smoked cigarettes (approximately five per week) and did not drink alcohol.
