Case Report: A 39-year-old Man with AIDS Cholangiopathy and Chronic Diarrhea Due to Cryptosporidium Infection

Abstract

Cholangiopathy and chronic diarrhea are relatively common manifestations of AIDS. Cryptosporidium parvum infection is the most common cause of AIDS cholangiopathy globally. This is the first report of documented Cryptosporidium parvum infection in a patient with AIDS in Iran. The patient was a 39-year-old man from Afghanistan with watery diarrhea, crampy periumbilical abdominal pain and 20 kg weight loss during the past 6 months. He was cachectic with a distended, tympanic abdomen. Laboratory findings were significant for hypokalemia, markedly elevated serum alkaline phosphatase and lymphopenia. Bilirubin and other liver function tests were in normal range. Stool exam was positive for giardia cysts, WBC and trace RBC's. Sonography showed dilated common bile duct and normal intrahepatic ducts. In ERCP there was papillary stenosis, dilated common bile duct and multiple small strictures in intrahepatic ducts. Endoscopy showed candida esophagitis, gastritis and duodenitis. Oocysts of cryptosporidium parvum were seen on duodenal biopsy. His HIV-Ab was positive. He was treated with fluconazol, metronidazol, paramomycin and UDCA and referred to a special center for antiretroviral therapy.