Case presentation
A 17-year-old female patient with HIV infection complaining of
voluminous and watery diarrhea from 4-5 months ago without tenesmus and
blood with occasional vomiting refers to the emergency room of Loghman
Hakim Hospital. The patient has lost 20 kg in the last 4-5 months. The
patient has no symptoms other than cachexia and malaise. The patient is
born from the HIV-positive parents, whose disease is discovered in the
sixth month of pregnancy. The patient’s parents were expired due to HIV
at a young age. The patient started treatment after this incident, but
the patient’s treatments were not complete, and she has used the
treatment completely intermittently. The patient marries at a young age.
In the last pregnancy, her HIV was diagnosed during work up to get
pregnant again, the patient is enforced to use the treatments in the HIV
center. Immediately after the discovery of the disease, she has been
treated with Trovada, Dolutgravir, and trimethoprim/sulfamethoxazole.
The patient has used therapies in a short period of pregnancy. But she
stopped the treatments again. HIV in the patient’s infant was negative
at birth, but the last patient cd4 was 37 a year ago. The patient is
alert and erect, but sometimes has memory impairment and sometimes she
answers questions. The patient does not have accurate information about
her disease and, the information we get is through patient health
liaisons. The patient has oral candidiasis with reduced skin turgor and
dry mucus. She has temporal atrophy. She has pale conjunctiva. It does
not have systemic lymphadenopathy. Other examinations of the patient
were normal. Stool exam is requested for the patient that the patient
S/E was non inflammatory (rbc = 0, wbc = 0). Specific staining was
performed for the patient including fast acid which was non-specific.
Other stainings were not available. Patient tests include: wbc: 6.5, HB:
11.5, PIT: 509, AST: 61, AIT: 55, BILT: 0.4, VBG: HCO3: 19.4PCO2: 43.8,
PH: 7.28, S/E: WATERY, RBC: 0, WBC: 0, PARASITE: NO. The patient became
systemic work up due to weight loss, which was observed in CT (Computed
tomography) scan of the abdomen and pelvis of the patient, hepatomegaly
and hypo-density infiltrative were observed in both lobes of the liver.
In endoscopy, biopsy of the antrum, bulb of the antrum, and two parts of
the duodenum were performed to determine the direction and pathology.
Section showed gastric and duodenal mucosa with moderate chronic active
inflammation and small (2-5) spherical bodies. Protrude form apex of
mucinous columnar cells of glandular epithelium. These microorganisms
also present on the surface of partially flattened duodenal mucosa with
evidence of chronic active inflammation. These microorganisms are giemsa
and pas positive. Gastric antral and duodenal biopsies: moderate chronic
active gasterodudonitis with cryptosporidiosis. No evidence of dysplasia
or malignancy (Figure 1).
Based on histopathology and lab tests cryptosporidium gastroduodenitis
was diagnosed.
Rapid rehydration treatment was performed for the patient. Paromomycin
500 tablets were administered every 6 hours and the patient underwent
endoscopy.
Outcome:
The patient was discharged after reducing stool frequency and improving
general condition with the prescription of paromomycin and continuing
AIDS (acquired immunodeficiency syndrome) treatment.