The 31-year-old has not seen a healthcare provider in more than 10 years and claims good health until now. Lab and imaging results tell a different story.
Patient history. A 31-year-old woman, new to the US from Tanzania, complains of one week of epigastric pain, jaundice, and scleral icterus. She has had extreme watery diarrhea and been fatigued for approximately 6 weeks. Until recently she has always been in good health and has not seen a healthcare provider in >10 years.
Laboratory and imaging results. Laboratory results are notable for elevated LFTs, high viral load, and a CD4 count of <100 cells/mm3. Abdominal ultrasound reveals diffuse intrahepatic and extrahepatic ductal dilation and ERCP is positive for papillary stenosis and stricturing of the intrahepatic ducts.
Answer: Cryptosporidium. Papillary stenosis and sclerosing cholangitis are hallmarks of AIDS cholangiopathy and are pathognomonic if seen. With the widespread use of highly active antiretroviral therapy, the condition has become rare in the US but can be seen in patients with very low CD4 counts. Cryptosporidiosis is the opportunistic infection most commonly seen and diarrhea is often the initial presenting symtpom.
Cryptosporidium parvum. Biliary tract disease has been shown to develop in approximately 20% of HIV-positive patients with diarrhea secondary to Cryptosporidium parvum.
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Tonolini M, Bianco R. HIV-related AIDS cholangiopathy: pictorial review with emphasis on MRCP findings and differential diagnosis. Clin Imaging. 2013;37:219-226.
Forbes A, Blanshard C, Gazzard B. Natural history of AIDS related sclerosing cholangitis: a study of 20 cases. Gut 1993; 34:116-121.
Hashmey R, Smith NH, Cron S, et al. Cryptosporidiosis in Houston, Texas. A report of 95 cases. Medicine (Baltimore). 1997;76:118-139.
The young woman, a native of Tanzania, has been in good health until about 6 weeks ago when she developed severe diarrhea and fatigue; more recent onset jaundice and scleral icterus are presenting symptoms. Laboratory and imaging results point to what diagnosis?