A 23-year-old man with fever and malaise.

Acute infection with human immunodeficiency virus (HIV) is infrequently diagnosed, owing in large part to vague or non-specific symptoms. Among the most common of these symptoms are fever, fatigue, pharyngitis, lymphadenopathy, anorexia, arthralgia, myalgia, rash, and headache. Some patients seek no medical attention for such symptoms, and others recall no symptoms whatsoever. Physicians in all healthcare environments must maintain a high index of suspicion for HIV in the setting of these symptoms. For suspected acute infection, rapid serologic tests should be supplemented with assays of p24 antigen and/or HIV RNA viral load. We report here a case of acute HIV infection in a young man who presented with a negative rapid serologic test, as well as pancytopenia and transaminitis. We also review the epidemiology, transmission, diagnosis, and management of acute HIV infection.