Epigastric pain as the initial presentation of undiagnosed HIV and its associated pulmonary arterial hypertension

Introduction: Due to increase in survival of HIV positive patients on antiretroviral therapies, longer term complications of HIV infection have started to surface including HIV related pulmonary arterial hypertension (HIV­PAH). In the 1990’s the occurrence of HIV­PAH was estimated to be at 0.5% (1:1200) in HIV positive patients which is 2500 times higher than in the general population (1­2:1,000,000) and seems to remain at the same level despite advances in diagnosis and treatment. Case Report: A case of a 28­year­old African­American female presenting with abdominal pain, increased abdominal girth, weigh gain, and lower extremity swelling of one week duration is presented. She was not previously diagnosed with HIV. Upon admission she was diagnosed with HIV related pulmonary arterial hypertension World Health Organization functional class III. Conclusion: What makes our case unique, is the rarity of the disease entity, unique gastro intestinal presentation, young age and newly diagnosed HIV and associated pulmonary arterial hypertension. The presence of epigastric pain and increased abdominal girth should increase the suspicion of PAH with right heart failure.