Febrile Pharyngitis as the Primary Sign of HIV Infection in a Cluster of Cases Linked by Sexual Contact

Abstract

Three cases of febrile pharyngitis were recorded retrospectively in a cluster of 5 men and 1 woman linked by sexual contact to a human immunodeficiency virus (HIV) carrier. In all 3 patients, a progression into clinical HIV disease was noted during an observation period of 20–25 months. The febrile pharyngitis developed similarly in each patient after an incubation time of 3–5 weeks. High fever of sudden onset and a sore bright red throat were accompanied by extreme lethargy and, in 2/3 patients, a morbilliform rash. The acute illness lasted 4–7 days and was followed by mild lymphadenopathy. All 3 patients were HIV seropositive 17–19 months later, when they first entered the study. By contrast, those 2 cases who did not fall ill, continued to be seronegative for 19–39 months after the exposure. Seroconversion of HIV could retrospectively be demonstrated in 1 of the 3 patients 2 weeks after the onset of the febrile illness. A simultaneous lack of rise in the EBV and CMV titres suggests HIV as the causative agent for this febrile mononucleosis-like pharyngitis.