P3685 - A Rare Case of Overlapping CMV Gastroduodenitis With Colitis and Disseminated Strongyloidiasis in the Setting of Newly Diagnosed AIDS

Magnus Chun, MD, Preet Patel, MD, Jose Aponte-Pieras, MD
Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, NV

Introduction: Strongyloidiasis is a parasitic infection of the aerodigestive tract which can be asymptomatic or present only with abdominal pain. A high index of suspicion for early diagnosis and treatment is required due to its increased disease burden and susceptibility to co-infections. We present a rare case of overlapping cytomegalovirus (CMV) gastroduodenitis with colitis and disseminated strongyloidiasis in an individual with HIV-AIDS.

Case Description/Methods: A 55-year-old Hispanic male with a history of type 2 diabetes mellitus and hypertension presented with a 2 week-long history of diffuse abdominal pain and melena. Blood work showed a hemoglobin of 8.5 g/dL, white blood cell of 8.81 K/mm3 with elevated absolute eosinophils of 1.59 K/mm3. HIV antibody screen was positive (HIV-1 RNA count of 757,000 copies/mL, CD4 count of 33 cells/µL). CMV viral load was 39,000 IU/mL. Parasitological examination of the stool was positive for Strongyloides stercoralis. EGD revealed esophagitis, gastropathy with cobblestoning of mucosa, and severe enteropathy with mucopurulent exudate in the duodenum (Figures 1a-b). Colonoscopy revealed mild segmental colitis in the ascending colon, cecum, sigmoid and rectosigmoid colon. Biopsies obtained from the duodenum, stomach, terminal ileum and colon showed S. stercoralis as well as positive immunostaining for CMV diffusely in the colon. Both were further noted in the gastric and duodenal biopsies on a subsequent EGD two months later despite being started on antiretroviral therapy, ivermectin, and valganciclovir for HIV, S. stercoralis, and CMV, respectively.

Discussion: To our knowledge, concurrent infection with CMV colitis and S. stercoralis in an AIDS patient has only been reported in literature twice in the past, in a patient on immunosuppressants and with Hodgkin lymphoma. In patients who are immunocompromised or HIV positive, like in our case, endoscopy with gastric and duodenal biopsy should be done to rule out S. stercoralis and CMV. Our patient who emigrated from a tropical environment, where he likely contracted strongyloides, remained asymptomatic until after he developed AIDS as the immune response to S. stercoralis is mediated by CD4+ TH2 cells. Co-infection with S. stercoralis especially in cases of immunosuppression presents with mortality up to 86%, despite early diagnosis and treatment. As our case reveals, ivermectin is the mainstay treatment for S. stercoralis but close monitoring for ongoing symptoms is required as a single course is often insufficient.



Disclosures:


Magnus Chun, MD, Preet Patel, MD, Jose Aponte-Pieras, MD. P3685 - A Rare Case of Overlapping CMV Gastroduodenitis With Colitis and Disseminated Strongyloidiasis in the Setting of Newly Diagnosed AIDS, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.