Disseminated Mycobacterium: A Rare Case of Chronic Severe Diarrhea in a Patient with HIV

Abstract

Diarrhea is a common problem in people living with HIV (PLWH). Both infectious and non- infectious causes are possible, thus making the diagnosis a challenge. Non-infectious causes commonly include HIV enteropathy, antiretroviral therapy (ART), or other medications. Infectious causes vary depending on the degree of viral control and whether there is profound immunosuppression due to acquired immunodeficiency syndrome (AIDS). Infectious causes include viral, bacterial, mycobacterial, and protozoal pathogens. Due to the broad differential, diagnosis can be delayed or missed leading to increased morbidity and mortality. While mycobacterium avium complex (MAC) is a known cause of infectious diarrhea in AIDS patients, other non-tuberculous mycobacteria (NTM) are less common. Here we present a case of extrapulmonary disseminated non-MAC NTM infection in an HIV patient who presented with chronic severe diarrhea that was initially misdiagnosed as CMV colitis. Our case highlights that concomitant infections which occur in HIV can mislead the diagnosis and delay the treatment.