The High Court has awarded €26,000 to an anonymised Spanish man after finding that St James’s Hospital clinicians negligently failed to reconsider his diagnosis and suspect a rare parasitic infection during a prolonged admission in 2014.
The plaintiff, identified as AMS, was admitted to St James’s on February 19, 2014 after being newly diagnosed with HIV and becoming seriously ill. Doctors promptly diagnosed haemophagocytic lymphohistiocytosis, or HLH, a dangerous inflammatory syndrome, and identified HIV and herpes virus HHV-8 as credible triggers. Chemotherapy and other treatment followed.
AMS also had visceral leishmaniasis, or VL, an infection associated with sandflies which is rare in Ireland but has an established epidemiological association with HIV in Spain. None of the five consultants treating him considered VL during his 42-day admission.
Ms Justice Emily Egan rejected AMS’s contention that VL should have been diagnosed within four or five days. She found that the initial HLH diagnosis was reasonable, that HIV and HHV-8 were credible triggers and that it was appropriate to give that treatment time to work.
The position changed, however, in March. HHV-8 levels had fallen substantially, AMS remained seriously unwell and clinical notes recorded "no response to treatment". He was transferred to the intensive Burkitt’s Ward on March 13, and by March 14 HHV-8 was no longer detectable.
The judge held that between March 10 and March 14, at the latest, those developments should have prompted clinicians to reconsider the diagnosis and specifically consider VL. A considerable suspicion of VL should then have led to empirical treatment with AmBisome.
AMS was transferred to Hospital de la Fe in Valencia on April 1. VL was diagnosed three days later and AmBisome commenced, followed by substantial improvement.
The court found the delay caused about three additional weeks of painful and debilitating symptoms and hospitalisation, but no long-term injury. General damages were assessed at €26,000. Reporting restrictions prevent publication of material likely to identify AMS.