Here, we present a unique case of a 17-year-old boy who presented with progressive lower extremity weakness, functional decline, and mood changes and was ultimately found to have a new diagnosis of AIDS from perinatally acquired HIV infection. This case demonstrates the discovery of a delayed diagnosis of HIV with important lessons for all pediatricians. It highlights the need for pediatricians to maintain a high index of suspicion and consider broad differentials and appropriate workup for at-risk youth with known psychiatric conditions. It is essential to identify at-risk youth early to prevent progression and severity of illness.
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