AIDS Patient With Persistent Diarrhea

A 42-year-old man with a 2-year history of AIDS sought medical advice for intractable diarrhea, which he had had for several months. Standard AIDS medications were prescribed, but his compliance with the drug regimen was poor.

Endoscopy demonstrated white granularity diffusely involving the duodenum (A). A biopsy revealed intact villous architecture (B), but many macrophages (histiocytes) with granular-to-foamy cytoplasm (C) were seen within the lamina propria mucosae. A stain for acid-fast bacilli was floridly positive with innumerable Mycobacterium avium-intracellulare organisms (D).

Dr John B. Williams of Sacramento, Calif, points out that typically there are few mycobacteria that are detected only after a prolonged search of a slide specially stained for acid-fast organisms. However, in patients with highly compromised immune responses-such as those with AIDS-these organisms flourish and are abundantly evident.

Dr Williams adds that this case illustrates how sorely deranged the immune system can become in persons with AIDS. Antituberculous therapy was started, and the patient was given antidiarrheal agents-but to little avail. He died several months later from a combination of AIDS-related dementia and wasting.