Case 02

Created by HELENE MOULIN on Jul 18, 2017 4:57:08 PM, Last modified by HELENE MOULIN on Jul 18, 2017 5:13:52 PM
 

Clinical information


  • A 45-year old HIV-positive man presented with severe dehydration and a 30-pound weight loss following several months of profuse watery diarrhea. He had a 9-year history of HIV infection, but maintained stable CD4 counts on HAART, and had no known opportunistic infections. He also carried a diagnosis of ulcerative colitis that was made 12 months prior to presentation. Symptoms initially improved with Asacol and prednisone, but he continued to have intermittent diarrhea. Three months prior to presentation, the patient developed severe diarrhea following a 5-day trip to Peru and was empirically treated for amebiasis. Symptoms improved upon treatment, but recurred following cessation of therapy. At the time of admission, the patient was thin and wasted, but had no localizing symptoms. Labs included a normal hematocrit, normal white blood cell count with a slight eosinophilia, and a negative C. difficile toxin assay and stool cultures. Endoscopic examination of the upper and lower GI tract revealed a slightly irregular Z-line, but no other abnormalities, and biopsies of the stomach, esophagus, ileum, and colon were normal. These biopsies are from the duodenum.

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RYantiss JFMC17 Case 2
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