Donald P. Kotler, MD; Jan M. Orenstein, MD, PhD
Kotler DP, Orenstein JM. Chronic Diarrhea and Malabsorption Associated with Enteropathogenic Bacterial Infection in a Patient with AIDS. Ann Intern Med. 1993;119:127-128. doi: 10.7326/0003-4819-119-2-199307150-00006
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Published: Ann Intern Med. 1993;119(2):127-128.
Chronic diarrhea and weight loss are common in patients with the acquired immunodeficiency syndrome (AIDS) . Although several infectious causes may be found, no cause is identified in as many as 50% of cases [1-4]. Other possible causes include as yet unidentified pathogens, the human immunodeficiency virus (HIV) itself , and noninfectious processes. We describe a patient who had evidence of chronic intestinal injury associated with enteropathogenic bacterial infection.
A 33-year-old white homosexual man with AIDS and Kaposi sarcoma was seen because of diarrhea of 3 months duration and 11 kg weight loss. He claimed 10 to 40 bowel movements per day, which were often malodorous, awakened him from sleep, and were associated with cramping but not tenesmus. The volume, consistency, and frequency varied. Diarrheal volume roughly correlated with the volume of food consumed and was worsened by fatty foods and dairy products. Nonspecific antidiarrheal medications brought partial relief of symptoms. He had no fever, and a physical examination was unremarkable. Stool examinations for enteric bacteria and parasites were negative on three occasions. The patient was severely immunosuppressed, with a CD4 lymphocyte count of 5/mm3 (normal range, 532 to 1571 mm3). D-Xylose absorption was subnormal, with serum concentrations of 0.84 and 0.62 mmol/L 1 and 2 hours after the test dose (normal range, 1.3 to 3.3 mmol/L), and urinary xylose excretion of 0.056 (normal, >0.20). Upper endoscopic biopsy specimens showed mild villus atrophy, moderate crypt hyperplasia, and inflammatory changes. No organisms were seen in small-bowel biopsy specimens, touch preparations, or jejunal lavage specimens examined by either light or transmission electron microscopy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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