BMJ Case Reports 2017; doi:10.1136/bcr-2016-218739
  • Myth exploded

Multiple simultaneous infections in a patient with well-controlled HIV: when Occam’s razor fails

  1. Sarah Jane Martin1,2
  1. 1Canberra Sexual Health Centre, Canberra Hospital, Canberra, ACT, Australia
  2. 2Australian National University Medical School, Australian National University College of Medicine Biology and Environment, Canberra, ACT, Australia
  1. Correspondence to Dr Miranda Sherley, miranda.sherley{at}
  • Accepted 7 November 2017
  • Published 1 December 2017


Multiple concurrent infectious processes have previously been reported in the context of advanced HIV with significant immunosuppression. Here we report a case of multiple infections in a 56-year-old man with well-controlled HIV diagnosed 5 years earlier. Soon after returning to Australia following 12 years living in Thailand, he became unwell with fevers, night sweats, arthralgia and myalgia. There were no localising symptoms and examination was unremarkable. Investigations revealed positive syphilis (Treponema pallidum) serology with an RPR of 16, a positive urine culture (Klebsiella pneumoniae), a pulmonary nodule, a liver abscess and colitis (Entamoeba histolytica). Recovery was only complete when all the individual infections were treated.


  • Contributors MS: conceived the idea for this publication, reviewed the patient file, carried out appropriate literature review and drafted the paper. SJM: reviewed and discussed the patient file, provided feedback on the initial manuscript and approved the final version.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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