Document Type
Conference Proceeding
Publication Date
5-3-2024
Abstract
Introduction AIDS-associated cholangiopathy is a biliary tract condition seen in AIDS patients who are severely immunosuppressed, contributing to significant mortality in this population even in developed countries with access to HAART therapy. Case Description We discuss a thirty-six-year-old HIV positive male, non-compliant with HAART therapy, who presented with a one year history of weight loss, persistent fatigue and chronic diarrhea, which had worsened significantly in the past few weeks. Routine laboratory studies on presentation indicated elevated liver enzymes and alkaline phosphatase, a CD4 count of two, and a high HIV RNA count of 8.8 million. Imaging via CT abdomen and pelvis and ultrasound abdomen both displayed thickening and edema in the gallbladder with evidence of gallstones, raising concerns of acalculous cholecystitis. The patient subsequently decompensated, requiring intravenous vasopressors to maintain hemodynamic stability, broad-spectrum antibiotics, and resumption of antiretroviral therapy. Biliary fluid drainage was performed, and Cryptosporidium and cytomegalovirus (CMV) were detected via PCR testing. The diagnosis of AIDS cholangiopathy was established, however the patient's diarrhea worsened upon the introduction of tube feeds. Despite ongoing antimicrobial treatment, the patient developed a fever of 101.4°F, became asystolic and subsequently passed away. Clinical Significance This case highlights the diagnostic, management and therapeutic challenges of AIDS cholangiopathy, and also underscores the importance of thorough investigation into even mild or intermittent diarrhea and abnormal liver function tests in all HIV-infected patients, particularly in the severely immunosuppressed patients. Discussion AIDS cholangiopathy should be considered in AIDS patients with diarrhea and abnormal liver function tests, irrespective of age, due to its associated morbidity across all age groups. Laboratory investigations often reveal markedly elevated alkaline phosphatase, gamma–glutamyltransferase, and mild to moderate liver enzyme elevations as hallmark findings of AIDS cholangiopathy. Ultrasonography is the first line screening modality of AIDS cholangiopathy. Cryptosporidium parvum is the most common infectious etiology of AIDS cholangiopathy, and can be identified by PCR antigen testing of the stool or acid fast staining of the stool specimens. Early detection of HIV infection and the prompt initiation and adherence to Highly Active Antiretroviral Therapy (HAART), which helps with maintaining a normal CD4 count and a low HIV viral load through HAART therapy, thereby significantly reducing the risk of developing AIDS cholangiopathy in HIV patients.
Recommended Citation
Alsharif N, Gunaseelan L, Souleiman M, Big C. AIDS associated Cryptosporidial and CMV cholangiopathy. Presented at: American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day; 2024 May 3; Troy, MI
Comments
American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day, May 3, 2024, Troy, MI