Advertisement

Digestive Diseases and Sciences

, Volume 63, Issue 11, pp 2858–2863 | Cite as

Duodenitis, Diarrhea, and Death in a Patient with AIDS

  • Anas Gremida
  • Davika Kapuria
  • Marissa A. Tafoya
  • Archana Kaza
  • Denis McCarthy
UNM CLINICAL CASE CONFERENCES

Case Report

A 47-year-old Native American male was initially evaluated in the emergency room with a 4-month history of diarrhea, which was described as voluminous, foul smelling, and occurring 3–6 times daily, both day and night. It was associated with diminished oral intake, lassitude, anorexia, and an unintentional weight loss of 42 lb over the past year. His roommate additionally reported that, following the diagnosis of infection with human immunodeficiency virus (HIV), the patient had become disoriented, forgetful, and anhedonic.

The patient’s HIV infection was diagnosed 8 months prior to this presentation. At the time of diagnosis, he was diagnosed with pneumococcal pneumonia and hairy leukoplakia as complications of the acquired immune deficiency syndrome (AIDS). The major risk factor was having unprotected sex with men. The patient’s cluster of differentiation (CD)4 count at the time of diagnosis was 12 cells/mm3, and his viral load was 271,000 copies/ml. After hospital...

Keywords

HIV AIDS Mycobacterium avium Diarrhea Antiretroviral therapy Whipple’s disease 

References

  1. 1.
    Knox TA, Spiegelman D, Skinner SC, Gorbach S. Diarrhea and abnormalities of gastrointestinal function in a cohort of men and women with HIV infection. Am J Gastroenterol. 2000;95:3482–3489.CrossRefGoogle Scholar
  2. 2.
    Horsburgh CR Jr. Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. N Engl J Med. 1991;324:1332–1338.CrossRefGoogle Scholar
  3. 3.
    Wilcox CM, Schwartz DA, Costonis G, Thompson SE. Chronic unexplained diarrhea in human immunodeficiency virus infection: determination of the best diagnostic approach. Gastroenterology. 1996;110:30–37.CrossRefGoogle Scholar
  4. 4.
    Havlik JA, Horsburgh CR, Metchock B, Williams PP, et al. Disseminated Mycobacterium avium complex infection: clinical identification and epidemiologic trends. J Infect Dis. 1992;165:577–580.CrossRefGoogle Scholar
  5. 5.
    Horsburgh CR, Chin DP, Yajko DM, Hopewell PC, et al. Environmental risk factors for acquisition of Mycobacterium avium complex in persons with human immunodeficiency virus infection. J Infect Dis. 1994;170:362–367.CrossRefGoogle Scholar
  6. 6.
    Chaisson RE, Moore RD, Richman DD, Keruly J, et al. Incidence and natural history of Mycobacterium avium-complex infections in patients with advanced human immunodeficiency virus disease treated with zidovudine, The Zidovudine Epidemiology Study Group. Am Rev Respir Dis. 1992;146:285–289.CrossRefGoogle Scholar
  7. 7.
    Horsburgh CR Jr. The pathophysiology of disseminated Mycobacterium avium complex disease in AIDS. J Infect Dis. 1999;179:461–465.CrossRefGoogle Scholar
  8. 8.
    Sun HY, Chen MY, Wu MS, Hsieh SM, et al. Endoscopic appearance of GI mycobacteriosis caused by the Mycobacterium avium complex in a patient with AIDS: case report and review. Gastrointest Endosc. 2005;61:775–779.CrossRefGoogle Scholar
  9. 9.
    Connolly GM, Shanson D, Hawkins DA, Webster JN, et al. Non-cryptosporidial diarrhoea in human immunodeficiency virus (HIV) infected patients. Gut. 1989;30:195–200.CrossRefGoogle Scholar
  10. 10.
    Cappell MS, Hassan T, Rosenthal S, Mascarenhas M. Gastrointestinal obstruction due to Mycobacterium avium intracellulare associated with the acquired immunodeficiency syndrome. Am J Gastroenterol. 1992;87:1823–1827.PubMedGoogle Scholar
  11. 11.
    Gillin JS, Urmacher C, West R, Shike M. Disseminated Mycobacterium avium-intracellulare infection in acquired immunodeficiency syndrome mimicking Whipple’s disease. Gastroenterology. 1983;85:1187–1191.PubMedGoogle Scholar
  12. 12.
    Bosch O, Porres JC, Martinez Quesada G, Oliva H, et al. Endoscopic appearance of a duodenal infection by Mycobacterium avium-intracellulare in AIDS. Endoscopy. 1994;26:506.CrossRefGoogle Scholar
  13. 13.
    Cappell MS, Philogene C. The endoscopic appearance of severe intestinal Mycobacterium avium complex infection as a coarsely granular mucosa due to massive infiltration and expansion of intestinal villi without mucosal exudation. J Clin Gastroenterol. 1995;21:323–326.CrossRefGoogle Scholar
  14. 14.
    Gray JR, Rabeneck L. Atypical mycobacterial infection of the gastrointestinal tract in AIDS patients. Am J Gastroenterol. 1989;84:1521–1524.PubMedGoogle Scholar
  15. 15.
    Schneebaum CW, Novick DM, Chabon AB, Strutynsky N, et al. Terminal ileitis associated with Mycobacterium avium intracellulare infection in a homosexual man with acquired immune deficiency syndrome. Gastroenterology. 1987;92:1127–1132.CrossRefGoogle Scholar
  16. 16.
    Strom RL, Gruninger RP. AIDS with Mycobacterium avium-intracellulare lesions resembling those of Whipple’s disease. N Engl J Med. 1983;309:1323–1324.CrossRefGoogle Scholar
  17. 17.
    Roth RI, Owen RL, Keren DF, Volberding PA. Intestinal infection with Mycobacterium avium in acquired immune deficiency syndrome (AIDS). Histological and clinical comparison with Whipple’s disease. Dig Dis Sci. 1985;30:497–504.  https://doi.org/10.1007/BF02966785.CrossRefPubMedGoogle Scholar
  18. 18.
    Günthard HF, Saag MS, Benson CA, Rio C, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2016 recommendations of the international antiviral society-USA panel. JAMA. 2016;316:191–210.CrossRefGoogle Scholar
  19. 19.
    Shafran SD, Singer J, Zarowny DP, Phillips P, et al. A comparison of two regimens for the treatment of Mycobacterium avium complex bacteremia in AIDS: rifabutin, ethambutol, and clarithromycin versus rifampin, ethambutol, clofazimine, and ciprofloxacin. N Engl J Med. 1996;335:377–383.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Anas Gremida
    • 1
  • Davika Kapuria
    • 1
  • Marissa A. Tafoya
    • 2
  • Archana Kaza
    • 1
  • Denis McCarthy
    • 1
  1. 1.Division of Gastroenterology and HepatologyUniversity of New Mexico School of Medicine Medical CenterAlbuquerqueUSA
  2. 2.Department of PathologyUniversity of New Mexico School of Medicine Medical CenterAlbuquerqueUSA

Personalised recommendations