Panjaria S, Panda PK. Chronic diarrhoea in a human immunodeficiency virus/acquired immunodeficiency syndrome patient: A case report. World J Virol 2025; 14(2): 108412 [DOI: 10.5501/wjv.v14.i2.108412]
Corresponding Author of This Article
Prasan Kumar Panda, Professor, Internal Medicine, Division of Infectious Diseases, All India Institute of Medical Sciences, No. 409 Room, College Block, Rishikesh 249203, India. motherprasanna@rediffmail.com
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Virol. Jun 25, 2025; 14(2): 108412 Published online Jun 25, 2025. doi: 10.5501/wjv.v14.i2.108412
Chronic diarrhoea in a human immunodeficiency virus/acquired immunodeficiency syndrome patient: A case report
Sheetal Panjaria, Prasan Kumar Panda
Sheetal Panjaria, Prasan Kumar Panda, Internal Medicine, Division of Infectious Diseases, All India Institute of Medical Sciences, Rishikesh 249203, India
Author contributions: Panjaria S contributed to data collection, analysis, and writing the draft; Panda PK contributed to conceptualization, investigation, methodology, resources, and critical review. All authors approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient’s parent for publication of this case report and accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prasan Kumar Panda, Professor, Internal Medicine, Division of Infectious Diseases, All India Institute of Medical Sciences, No. 409 Room, College Block, Rishikesh 249203, India. motherprasanna@rediffmail.com
Received: April 14, 2025 Revised: April 27, 2025 Accepted: May 30, 2025 Published online: June 25, 2025 Processing time: 71 Days and 0.5 Hours
Abstract
BACKGROUND
Chronic diarrhoea in people living with human immunodeficiency virus (PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge, often resulting from opportunistic infections (OIs), malignancies, or disease progression itself. We present a case of an advanced human immunodeficiency virus (HIV) patient with chronic diarrhoea, significant weight loss, and antiretroviral therapy (ART) non-compliance, highlighting the diagnostic dilemma between HIV wasting syndrome, OIs, and malignancy.
CASE SUMMARY
A 36-year-old female, diagnosed with HIV five years ago on family screening, presented with three months of profuse watery diarrhoea, associated with crampy abdominal pain and weight loss (14 kg, 30% in 3 months). She was non-compliant with ART. There was no history of recent travel, food contamination, or tuberculosis contact. Fever episodes were mild and transient. Physical examination revealed pallor and bilateral pedal oedema without lymphadenopathy or organomegaly. Genital examination was unremarkable. Routine investigations revealed severe anaemia and confirmed PLHIV status. CD4 count was < 36 cells/µL. Empirical treatment with nitazoxanide was initiated for possible cryptosporidiosis. After ruling out OIs, ART was restarted. With treatment, her diarrhoea resolved, and she tolerated oral intake. Nutritional support was provided, and she was discharged in stable condition with ART, prophylactic antibiotics, and follow-up instructions for further evaluation.
CONCLUSION
In ART-noncompliant PLHIV with chronic diarrhoea, distinguishing between HIV wasting syndrome, OIs (Cryptosporidium, Mycobacterium avium complex, cytomegalovirus colitis) and malignancies (non-Hodgkin lymphoma and anal carcinoma) are critical. Gradual CD4 decline, systemic inflammation, and malnutrition favour progressive HIV/acquired immunodeficiency syndrome rather than an acute OI or malignancy. Early recognition and management, including ART reinitiation and nutritional support, are crucial for prognosis.
Core Tip: This case highlights chronic diarrhoea and profound weight loss in a human immunodeficiency virus-positive patient as manifestations of progressive immunosuppression, systemic inflammation, and gut barrier dysfunction rather than an identifiable opportunistic infection. It underscores the importance of early antiretroviral therapy reinitiation, nutritional support, and hygiene interventions to improve prognosis in human immunodeficiency virus-associated wasting syndrome.
