CASE 48
A 35-year-old man with AIDS presented to his primary care physician with a complaint of several weeks of watery diarrhea. Symptoms of low-grade fever, nausea, and anorexia were also present. In the past 2 weeks, the diarrhea had worsened considerably, and he had developed severe fatigue and weakness. He had also lost 20 lbs.
LABORATORY STUDIES
Diagnostic Work-Up
Table 48-1 lists the likely causes of illness (differential diagnosis). Fecal WBCs can initially be examined to rule out inflammatory enteritis. Investigational approach for evaluation of diarrhea in a patient with AIDS may include
TABLE 48-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Rationale: Diarrhea is the most common gastrointestinal manifestation of AIDS, occurring in 50–90% of patients. All of the enteric pathogens that cause diarrhea in the immunocompetent host may also cause diarrhea in AIDS patients. In patients with AIDS, however, the above organisms tend to produce a more virulent and protracted clinical course, and some are almost exclusively seen in AIDS patients. It is not usually possible to distinguish the likely cause of chronic watery diarrhea in AIDS patients based on clinical grounds alone. A thorough diagnostic evaluation is necessary owing to the broad range of organisms causing infection.
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