Growth Failure and Delayed Puberty in an Adolescent with Previously Undiagnosed Advanced HIV Infection: A Case Report

Background and Clinical Significance: Longstanding human immunodeficiency virus (HIV) may remain clinically unrecognized until adolescence. Growth failure, delayed puberty, and recurrent or atypical infections may represent manifestations of underlying immunodeficiency but can initially be attributed to other conditions. Case Presentation: A 16-year-old male, adopted at 4 years of age, was admitted with prolonged low-grade fever, chronic productive cough, and recurrent sinonasal symptoms. Marked growth retardation and absent pubertal development were also present. No perinatal or early-childhood medical records were available, and maternal HIV status could not be established. Laboratory investigations demonstrated severe CD4+ T-cell depletion, hypergammaglobulinemia, and elevated liver enzymes. Repeated SARS-CoV-2 antigen/PCR tests were positive, while anti-SARS-CoV-2 antibodies were undetectable. CT demonstrated chronic pansinusitis and hepatosplenomegaly. HIV infection was confirmed by positive ELISA and Western blot, with a plasma HIV RNA level of 127,721 copies/mL. The findings were consistent with advanced HIV infection with severe immunosuppression. Although the clinical history suggested longstanding infection, the timing and route of HIV acquisition could not be established. Similarly, the available SARS-CoV-2 results did not allow definitive differentiation between persistent infection and separate infection or reinfection episodes. Previous CMV IgG positivity had contributed to an earlier attribution of the hepatic abnormalities to CMV, although active CMV disease was not documented. Conclusions: Severe growth failure, absent pubertal development, recurrent or atypical infections, and profound CD4+ T-cell depletion should prompt consideration of underlying immunodeficiency, including HIV. In patients with incomplete medical records, previous diagnoses should be reassessed, especially when the clinical course remains unexplained.