PICTURES IN DIGESTIVE PATHOLOGY

 

Diarrhea in an immunocompromised patient: endoscopic findings

Diarrea en un paciente immunosuprimido: hallazgos endoscópicos

 

 

P. Estévez-Boullosa, R. Pardeiro-Pértega, J. Pombo-Otero¹, R. Estévez-Loureiro² and P. A. Alonso-Aguirre

Departments of Gastroenterology, ¹Pathology and ²Cardiology. Complejo Hospitalario Universitario A Coruña. Spain

 

 

Case report

A 56-year old man, HIV negative, submitted to heart transplantation six months previously, treated with everolimus, tacrolimus, mycophenolate and steroids was admitted because of diarrhea and deterioration of general condition in the last month. After an initial colonoscopy with nonspecific findings and suspecting a possible drug side effect, immunosuppressive therapy was changed without clinical improvement. An abdominal computer tomography scan showed data consistent with a tumoral lesion in the hepatic flexure (Figure 1A); therefore, a new colonoscopy was performed observing two ulcers in right and left colon of 3 and 2.5 cm each one (Figure 1B and D), in which the presence of Cryptosporidium was identified (Figure 1C).

 

Discussion

Cryptosporidium is a protozoan of which there are over ten species, being C. parvum the primarily responsible for human disease (1). Today it represents an important cause of diarrhea, resulting in self-limited disease in immunocompetent hosts, diarrhea and malnutrition in children in developing countries or a life-threatening illness in immunocompromised patients. Diagnosis is made by identification of the oocysts in stool or tissue, as in our patient. Despite their limited efficacy, nitazoxanide and paromomycin can be a helpful therapy, besides antidiarrheal agents, enteral or parenteral nutrition (2). We think the case is interesting because it is unusual to find ulcerated lesions associated with Cryptosporidiosis.

 

References

1. Fayer, R, Ungar, BL. Cryptosporidium spp. and cryptosporidiosis. Microbiol Rev 1986;50:458.         [ Links ]

2. Kaplan, JE, Benson, C, Holmes, KH, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 2009; 58:1.         [ Links ]