R Lin, L Lugo, F Smith
R Lin, L Lugo, F Smith. Protracted diarrhea associated with eosinophilia in an HIV infected patient. The Internet Journal of Asthma, Allergy and Immunology. 2006 Volume 5 Number 2.
Eosinophils may accumulate in the colon in a variety of disorders, including eosinophilic gastroenteritis, allergic colitis of infancy, infections, drug reactions, vasculitis, and inflammatory bowel disease(1). We report the diagnostic difficulties involved in a HIV infected patient with prolonged diarrhea associated with eosinophilia. The role of therapeutic trials is also discussed.
39 year old South American male with a history of AIDS presented to the hospital on 7/30/06 with a 1.5 year history of diarrhea. The patient reported watery diarrhea up to 5 liters a day and weight loss of 13 kg. He had been hospitalized in Ecuador for several months before coming to US. He had been told that he had celiac sprue and had been treated with a course of steroids with transient improvement. At the time of hospital admission the patient had been taking lopinavir/ritonavir, emtricitavine/tenofovir, trimethropim-sulfamethoxazole(at doses for
On admission the white blood count(WBC) was 11.1 x10 3 /µL with 3% eosinophils. The prothrombin time was elevated at 15.2 sec(normal upper limit 14.6 sec). The AST was 120 u/L and the ALT was 123 u/L. The CD4 count was 41 x10 3 /µL. The HIV-1 viral load was below the level of detectability. Stool studies did not reveal
Eosinophilia is associated with numerous disorders(1), but most often relates to atopic diseases and hypersensitivity phenomenon. In the setting of HIV, eosinophilia may be associated with cutaneous disease such as eosinophilic folliculitis, hyper IgE syndrome, atopic dermatitis and prurigo nodularis(2,3). In the absence of skin disease, eosinophilia in HIV infection may relate to other conditions such as parasitic infection and drug hypersensitivity.
The patient described in this report had
Gastrointestinal manifestations accompanied by eosinophilia raise the possibility of helminthic infection, most commonly
This case demonstrates the diagnostic difficulties that may arise in HIV infection associated with diarrhea and eosinophilia.
The authors acknowledge the assistance of Ann Nelson, MD and the Armed Forces Institute of Pathology.