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.