A 28-year-old man with HIV (diagnosed eight years prior, last CD4 count 23 cells/mm3) and prior tuberculosis (cured, then confirmedly reinfected with treatment default) presented with cachexia, diarrhea, chest pain, and tachypnea with increased work of breathing that required orotracheal intubation. Admission chest CT showed extensive bilateral consolidations with air bronchograms, suggestive of previous mycobacterial infection and/or possible new bacterial infection. Initially managed as sepsis, blood cultures grew Rhodococcus equi (four samples). Molecular testing confirmed Mycobacterium tuberculosis in sputum and tracheal aspirate, establishing coinfection and exceeding the similarities in acid-fast staining, clinical, and radiological findings between the two organisms. Treatment included antituberculosis therapy associated with clarithromycin and vancomycin (14 days). The patient achieved complete clinical improvement with partial radiological resolution (residual cavitations). He was discharged after 25 days, but was lost to follow-up and died three months later from probable septic shock. This report highlights a rare M. tuberculosis/R. equi coinfection in an immunosuppressed patient, emphasizing diagnostic challenges and the importance of therapeutic adherence in advanced HIV.

A substantial proportion of mpox cases occur in people with HIV, but how HIV coinfection and immune status affect clinical outcomes remains unclear. We systematically searched major databases up to March 2025 for observational studies comparing mpox patients with and without HIV coinfection. Pooled effect sizes were calculated using random-effects models. Risk ratios (RRs) or standardized mean differences (SMDs) with 95% confidence intervals were used for dichotomous or continuous outcomes. Post hoc subgroup analyses explored differences by economic development, viral suppression, and advanced HIV disease (AHD) proportion. Among 15,522 patients from 29 studies, 52.43% had HIV. HIV coinfection was associated with higher hospitalization [RR = 1.50, 95% CI (1.17, 1.93)] and mortality [RR = 4.54, 95% CI (2.11, 9.77)]. Coinfected patients had more syphilis, HBV, and HCV coinfections, and higher rates of fever, proctitis, malaise, rectal irritation syndrome, diarrhoea, skin and soft tissue infections, and pneumonia. Blood tests showed lower albumin, calcium, and haemoglobin, and higher CK-MB. Perianal lesions were more common with HIV. HIV coinfection is linked to greater clinical severity, mortality, and STI coinfections. Exploratory analyses suggest poor viral suppression may drive adverse outcomes, and lesion severity relates to immune status. All subgroup findings are post hoc and hypothesis-generating, limited by aggregate data. Intensified monitoring and supportive care, vaccination, and optimized ART initiation are crucial for this population.

Co-infection with Entamoeba histolytica (E. histolytica) and Giardia lamblia (G. lamblia) is exceptionally rare reported in individuals with human immunodeficiency virus (HIV), despite both protozoa being well-recognized etiologic agents of intestinal disease in the general population. The overlapping clinical manifestations of protozoal infections and inflammatory bowel disease may pose significant diagnostic challenges, particularly in patients with advanced immunosuppression. We report the case of a 34-year-old man with advanced acquired immunodeficiency syndrome (AIDS) who presented with persistent mucopurulent bloody stools for 2 months. Upon evaluation in our gastroenterology department, ulcerative colitis was initially considered; however, stool microscopy subsequently identified trophozoites of E. histolytica and G. lamblia. Colonoscopic assessment, supported by histopathological examination of biopsy specimens, confirmed E. histolytica infection. The patient was initiated on intravenous metronidazole in conjunction with antiretroviral therapy, leading to a gradual improvement of symptoms, with resolution of diarrhea within 10 days. This case highlights the importance of considering mixed protozoal infections in the differential diagnosis of chronic dysentery among immunocompromised patients. It further underscores the critical diagnostic value of repeated stool microscopy and histopathologic confirmation to avoid misdiagnosis and prevent delays in appropriate therapy.

Histoplasmosis is an endemic mycosis in the central and eastern USA, Central and South America, parts of Asia, and Africa. It commonly presents as a pulmonary disease, but can involve multiple organ systems in immunocompromised individuals. In patients with HIV and low CD4 counts, usually <150 cells/μL, it can present with gastrointestinal symptoms, lymphadenopathy, and rarely as meningitis, or with mucocutaneous and adrenal involvement. Diagnostic modalities include direct visualisation of the fungus in tissue specimens, Histoplasma antigen detection in blood or urine, antibody detection, detection of DNA sequences by PCR, and culture of clinical specimens. Treatment is based on disease severity, with a long course of itraconazole and induction therapy with amphotericin B for moderate to severe infection. HIV patients with a CD4 count of <150 cells/μL in endemic areas with high disease incidence require prophylaxis. We report a case of a 35-year-old male with HIV infection who presented with diarrhoea and abdominal pain. Evaluation revealed retroperitoneal, mesenteric, supraclavicular lymphadenopathy, splenomegaly, ileitis, and colitis. Terminal ileum mucosa and supraclavicular lymph node biopsy specimens showed Histoplasma capsulatum on pathology with a positive tissue fungal culture. He was successfully treated with Itraconazole with symptomatic improvement.

Chronic noninfectious diarrhea remains a clinically important but often underrecognized complication in patients receiving long-term antiretroviral therapy (ART). Although modern human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) treatment has transformed survival, gastrointestinal adverse effects can impair adherence, quality of life, nutrition, social functioning, and treatment satisfaction. Crofelemer is an oral, plant-derived botanical drug developed as a non-systemic antisecretory therapy for noninfectious diarrhea in adults with HIV/AIDS receiving ART.

Fever is a recognized manifestation of active ulcerative colitis (UC); however, isolated fever in the absence of GI symptoms or objective evidence of active colonic inflammation is exceedingly uncommon. The diagnostic challenge is amplified in immunocompromised patients receiving biologic therapy, in whom occult infection must be rigorously excluded. We present a 68-year-old woman with a history of well-controlled HIV infection and recently diagnosed UC who was initiated on vedolizumab, mesalamine, and a prednisone taper in the outpatient setting. She presented with persistent daily fevers and initial concern for an infectious etiology of pyrexia. Ulcerative colitis appeared to be well treated, with outpatient CT demonstrating resolution of colitis, and the patient denied diarrhea, abdominal pain, hematochezia, or other symptoms suggestive of active disease. An extensive infectious workup, including blood cultures, viral studies, fungal biomarkers, Lyme disease testing, tick-borne testing, and autoimmune serologies, was negative. During the laboratory evaluation, thrombocytopenia, markedly elevated inflammatory markers, and elevated D-dimer levels were noted. Despite a comprehensive multidisciplinary evaluation, no infectious, malignant, thrombotic, or rheumatologic etiology was identified. Throughout her hospital course, the patient developed sequelae of a severe inflammatory response, including atrial fibrillation. The patient's fevers were ultimately attributed to an atypical systemic inflammatory manifestation of UC. This case highlights a rare presentation of UC manifesting predominantly as fever of unknown origin (FUO) despite apparent clinical and radiographic remission. Clinicians should recognize that significant systemic inflammation may occur even in the absence of overt GI disease activity after exclusion of alternative causes.

IntroductionLate HIV diagnosis increases hospitalization and mortality, but evidence from Latin America remains limited. This study assessed the frequency of late HIV diagnosis among hospitalized patients and described temporal trends in clinical characteristics, opportunistic infections, and short-term outcomes in the Colombian Caribbean.MethodsA retrospective cohort study was conducted at a tertiary referral hospital (2014-2023), including adults with late HIV diagnosis defined as CD4[+] T-cell counts <350 cells/µL or an AIDS-defining illness. Data was obtained from medical records, and 6-month mortality was verified through the national health insurance database. Multivariable logistic regression assessed predictors of 6-month mortality, and temporal trends were evaluated (chi-square for trend).ResultsEighty-one patients met the criteria for late HIV diagnosis. Most were male (74.1%) with a median age of 42 years (interquartile range [IQR] 32-50), low socioeconomic status, and limited education. Opportunistic infections were frequent, particularly infectious diarrhea (46.9%), Pneumocystis jirovecii pneumonia (24.7%), and tuberculosis (16%). Median CD4[+] T-cell count was 46 cells/µL (IQR 21-112). Intensive care unit (ICU) admission occurred in 27.2%, with in-hospital and 6-month mortality of 13.5% and 32.1%, respectively. CD4[+] T-cell count <100 cells/µL independently predicted 6-month mortality (OR 7.9, 95% CI 1.48-42.8; p=0.01). Over time, patients with late HIV diagnosis increased, while opportunistic infections (p=0.009), severe immunosuppression (p=0.02), and in-hospital (p=0.02) and 6-month mortality (p=0.003) declined significantly.ConclusionsThese findings underscore the substantial burden and evolving pattern of late HIV diagnosis, with increasing cases but improved short-term outcomes. Early detection and targeted interventions remain essential in this population.

Anemia, wasting syndrome, and a history of tattooing form a rare and concerning triad observed in cases of human immunodeficiency virus (HIV) infection. Although the overall prevalence of HIV/acquired immunodeficiency syndrome (AIDS) has decreased globally, there is an alarming rise in the risk of transmission linked to unregulated or unlicensed tattooing practices. In this case report, we present the medical history of a man in his 30s, who recently tested positive for HIV-1 antibodies. Upon presentation, he exhibited multiple concerning symptoms, including watery diarrhea, fever, and a significant weight loss of over 6 months. Additionally, he suffered from acute kidney injury, which further complicated his clinical picture. Comprehensive laboratory evaluations indicated dangerously low CD4 counts at 71/μL and a remarkably high HIV viral load, alongside severe anemia. The diagnosis of autoimmune hemolytic anemia (AIHA) was confirmed through several laboratory tests that demonstrated hemolysis, reticulocytosis, and a positive direct antiglobulin test. His treatment regimen included co-trimoxazole and nitazoxanide to manage his diarrhea, coupled with antiretroviral therapy specifically aimed at treating HIV/AIDS Stage three. Furthermore, prednisolone was prescribed to address the AIHA. Due to the critically declining hemoglobin levels, the patient required multiple blood transfusions to stabilize his condition. This case emphasizes the urgent need for stricter regulations surrounding tattooing practices, ensuring that proper hygiene standards and sterile equipment are upheld, particularly in developing regions where such infectious risks are heightened. The presence of this triad of symptoms should prompt healthcare professionals to maintain a high index of suspicion for HIV infection in similar patients, ultimately leading to earlier intervention and treatment.

Intestinal dysbiosis is common in people living with HIV/AIDS (PLWH), yet fungal communities of the gut microbiota (mycobiota) remain poorly characterized, especially in severely immunosuppressed patients. We analyzed the gut mycobiota of 33 PLWH and 20 healthy controls from a public hospital in central Argentina. Most PLWH presented with severe immunosuppression (<200 CD4[+] T cells/μL) and acute or chronic diarrhea, with or without antibiotic exposure or antiretroviral therapy. Fecal DNA was extracted and the ITS2 region was sequenced using next-generation sequencing. Beta-diversity analyses revealed significant segregation between PLWH and controls (PERMANOVA, Adonis: p = 0.001, R[2] = 0.0989). LEfSe analysis identified 17 fungal species enriched in PLWH, predominantly Candida albicans, Candida dubliniensis, and Nakaseomyces glabratus, whereas 31 species were differentially represented in controls, including Penicillium spp., Candida sake, and Clavispora lusitaniae. Histoplasma capsulatum, an endemic pathogen in the region, was more prevalent in PLWH and associated with low CD4[+] T cell counts. Dirichlet multinomial mixture analysis revealed two mycobiotypes: M1, with a balanced fungal composition predominating in controls, and M2, dominated by Candida species and present in PLWH. These findings provide novel insights into gut mycobiota alterations in severely immunosuppressed PLWH in Argentina, highlighting Candida-driven dysbiosis and the regional relevance of H. capsulatum.