Mediastinal teratocarcinoma as initial manifestation of asymptomatic HIV infection: a case report.

A 29-year-old healthy Italian man suddenly developed sign of respiratory disease with fever (38°C) and dry cough. After 45 days he was admitted to the Section of Infectious Diseases. Routine biochemical analyses showed a decreased lymphocytes CD4+/CD8+ count (362.5 and 96, respectively; Th/Ts ratio 0.52), and increased serum alfa fetoprotein levels. Specimens cultures and serological tests for bacterial, protozoarian and viral infections were negative. A contrast-enhanced chest tomography scan showed a large mass (about 15 x 13 cm) in the right paracardiac site without homogeneous density, suspected to be a mediastinal germ cell tumor (GCT). The biopsy specimen confirmed the diagnosis of GCT, classified as teratocarcinoma. Since the lymphocytes CD4+/CD8+ levels were unexplainable reduced, we asked the patient, even if he did not have any obvious risk behaviour (i.e., multiple sexual or homosexual partners, intravenous drug use), to undergo serological tests for HIV infection. The patient tested positive to antibodies against HIV I by ELISA assay and Western blot assay; in addition, the reverse polymerase chain reaction showed HIV-RNA level about 15,000 copies/ml. The patient was offered cis-platinum therapy that he elected to receive at another hospital. After therapy was successfully completed, the patient was still asymtpmatic for HIV infection; serum HIV load was 40,000 copies and CD4+ 465/mmc. This case report confirm that extragonadal teratocarcinoma may be very rarely a first sign of HIV infection. Thus we feel that young people with a diagnosis of teratocarcinoma, even if not belonging to classic risk groups for infection, could be asked to undergo serological test for HIV.