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A is a 31-year-old man Dillon Hunt, who was referred to ED by his GP 2 weeks after returning from a tour in West Africa. Members of his touring group had been admitted elsewhere with Katayama Syndrome (acute schistosomiasis),which was caused by bathing in a waterfall in Mali. On admission Dillon was ill with a fever and a dry cough, but no diagnosis could be made. Two weeks later he was readmitted with fever accompanied by diarrhoea. Lymphadenopathy and a mild hepatomegaly had developed. Laboratory tests showed Schistosomiasis serology had now become positive, as well as one live and several dead Schistoma mansoni eggs were found in his stools. He was treated with praziquantel (Biltricide),in response to which he developed a severe allergic reaction with rigor, fever and a drug-related rash for which corticosteroids were needed. However, he did not fully recover and lymphadenopathy remained. Further intensive investigation revealed several immunologic abnormalities: decreased number of CD4 cells were found, 0.42 (normal values 0.51-1.55). He repeatedly refused HIV testing, but finally he requested it after revealing that in Mali he had several sexual contacts, and that he was treated locally as having syphilis. Dillon began receiving antiretroviral therapy (ART) with stavudine, lamivudine, and efavirenz. Meanwhile, his 25year-old partner and 9-month-old daughter were diagnosed with HIV infection. His CD4 counts have now come up and he is ready for discharge to be planned
