A Matter of Time: Woman with Leg Wounds and Chills

Initial labs showed anemia, thrombocytosis, and elevated inflammatory markers; the patient began empirical antibiotics for cellulitis and treatment for symptoms of opiate and benzodiazepine withdrawal. Despite wound improvement, she developed drenching night sweats and leukopenia. Testing for HIV with antibodies to HIV-1 and -2 and for p24 antigen, and nucleic acid testing for HIV, were all negative. MRI ruled out osteomyelitis of her legs, but a PET scan showed diffuse lymphadenopathy and splenomegaly. The treatment team planned an excisional lymph-node biopsy. However, given high suspicion of a prior false-negative test, they repeated HIV testing, which returned positive, helping to avoid further invasive assessments.