University of Minnesota Medical Center Minneapolis, MN, United States
Danielle Hron, MD, Raiya Sarwar, MD, Nabeel Azeem, MD University of Minnesota Medical Center, Minneapolis, MN
Introduction: Acquired immunodeficiency syndrome (AIDS) incidence has decreased since the advent of highly active antiretroviral therapy (HAART). As once common AIDS complications become rarer, recognizing AIDS-associated illness is essential in the treatment of underserved populations as marginalized communities are disproportionately impacted. Psychosocial barriers, like socioeconomic status, also affect access to care and lead to complication, as seen in this case.
Case Description/Methods: A 50-year old with history of AIDS complicated by neurosyphilis, PJP pneumonia, and recent re-initiation of HAART after 3-year hiatus due to lack of insurance presented with severe cramping mid-abdominal pain and copious watery diarrhea. They were afebrile with normal vital signs. Exam revealed cachexia and right upper quadrant abdominal tenderness. Labs showed mildly elevated alkaline phosphatase, CD4 count of 71 cells/mm3, and normal transaminases, bilirubin, and lipase. An abdominal CT was positive for gallbladder wall thickening and common bile duct (CBD) dilation. Ultrasound confirmed 1 cm gallbladder wall thickening and 1.4 cm CBD dilation. There was no choledocholithiasis nor sonographic murphy’s sign. MRCP showed CBD dilation and common hepatic duct dilation without choledocholithiasis. HIDA scan showed no significant uptake. Given recent immunodeficiency and imaging findings, AIDS cholangiopathy was suspected. ERCP with sphincterotomy and biliary biopsy was performed. Biliary duct biopsy was positive for Cytomegalovirus (CMV) cholangitis and stool studies were positive for Cryptosporidium oocytes and specific antigen. Both pathogens are implicated in AIDS-associated cholangitis.
Discussion: AIDS cholangiopathy is biliary obstruction caused by opportunistic infections secondary to immunosuppression. Common pathogens include CMV, Cryptosporidium parvum,Microspora, and Cyclospora. (Naseer 2018). This case is unique in that opportunistic infection of the biliary system is less common than in the pre-HAART era, and more than one opportunistic pathogen was identified in this patient. Biliary obstruction due to AIDS-associated cholangitis with opportunistic infection should be considered in patients with an abnormal ultrasound and low CD4 count.
Naseer, M., Dailey, F. E., Juboori, A. A., Samiullah, S., & Tahan, V. (2018). Epidemiology, determinants, and management of AIDS cholangiopathy: A review. World journal of gastroenterology, 24(7), 767–774. https://doi.org/10.3748/wjg.v24.i7.767
Disclosures: Danielle Hron indicated no relevant financial relationships. Raiya Sarwar indicated no relevant financial relationships. Nabeel Azeem indicated no relevant financial relationships.
Danielle Hron, MD, Raiya Sarwar, MD, Nabeel Azeem, MD. P0100 - AIDS Cholangiopathy: A Once Common Biliary Complication of AIDS, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.