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.

Opportunistic infections are common in patients with acquired immunodeficiency syndrome (AIDS) or advanced human immunodeficiency virus infection when adherence to anti-retroviral is poor. We present a case report of multiple opportunistic infections simultaneously present in a patient with AIDS who presented with fevers, abdominal pain, and diarrhea. He was ultimately diagnosed with Streptococcus pneumoniae pneumonia, oral thrush, esophageal histoplasmosis, cytomegalovirus esophagitis and herpes simplex esophagitis. This case is a reminder of the severity of illness in AIDS and the need for thorough workups to address all disease processes.

Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome caused by unregulated immune activation, leading to a "cytokine storm" and multisystem failure. In people living with HIV (PLWH), it is frequently triggered by opportunistic infections like Mycobacterium tuberculosis. This report describes a 28-year-old transgender woman with HIV (on ART, undetectable viral load) admitted with a 20-day history of high fever, diarrhea, and hepatosplenomegaly. Admission labs showed severe pancytopenia (Hb 6.2 g/dL, WBC 1,590/µL, platelets 102,000/µL) and a CD4 count of 164 cells/mm[3]. Investigation revealed extreme hyperferritinemia (peaking at 18,366 ng/mL) and a positive urinary lateral flow urine lipoarabinomannan assay (LF-LAM) test, indicating extrapulmonary tuberculosis (TB). Abdominal CT showed mesenteric and para-aortic lymphadenopathy. Bone marrow biopsy confirmed HLH through frequent hemophagocytosis figures. Despite immediate initiation of antituberculosis therapy (ATT) combined with intravenous immunoglobulin, methylprednisolone pulse, and cyclosporine, the patient developed acute kidney injury and severe hepatitis, progressing to refractory shock and death on the 37th day. This case highlights the diagnostic challenge of HLH due to clinical overlap with sepsis. The LF-LAM test was crucial for rapid TB identification. Although integrated immunomodulation and ATT are recommended, the prognosis remains poor in advanced immunosuppression. High clinical suspicion is vital for early intervention in HIV-positive patients with fever and cytopenias in TB-endemic regions.

We present the case of a 28-year-old male with diarrhea, headache, and significant weight loss. He was diagnosed with HIV in the AIDS stage (CD4: 3 cells/μL), Cryptococcus neoformans meningoencephalitis, and multisystemic tuberculosis. Given the persistence of diarrhea and negative coproparasitological studies, endoscopic studies were performed. Upper digestive endoscopy incidentally showed esophageal erosions coated with fibrin and punched-out ulcers; these findings were identified as herpetic esophagitis by histopathological and immunohistochemical analysis. Treatment with intravenous acyclovir was initiated, followed by oral administration for 14 days. This case highlights the importance of considering herpetic esophagitis in immunosuppressed patients, even in the absence of esophageal symptoms, and emphasizes the value of upper digestive endoscopy with biopsy in the comprehensive diagnosis of HIV/AIDS.

Histoplasmosis is a potentially life-threatening opportunistic fungal infection in patients with advanced human immunodeficiency virus (HIV), particularly in endemic regions such as the Ohio and Mississippi River valleys. Despite advances in antiretroviral therapy, delayed diagnosis, lack of linkage to care, and treatment nonadherence continue to contribute to severe opportunistic infections in individuals with untreated HIV. We present the case of a 43-year-old woman with a 23-year-long history of untreated HIV infection who presented with fever, weight loss, diarrhea, and malaise. Laboratory evaluation revealed a viral load of 327,000 copies/mL and severe immunosuppression with a Cluster of Differentiation (CD4) count of 8 cells/µL, hyponatremia, and elevated liver transaminases. Computed tomography imaging demonstrated extensive mesenteric and retroperitoneal lymphadenopathy. Biopsy of a retroperitoneal lymph node revealed granulomas containing fungal organisms consistent with disseminated histoplasmosis. The patient was initially treated with empiric broad-spectrum antibiotics and intravenous amphotericin B, followed by long-term itraconazole therapy and initiation of antiretroviral treatment, resulting in clinical and immunologic improvement. This case highlights the direct relationship between prolonged untreated HIV infection, advanced immunosuppression, and disseminated histoplasmosis, while underscoring the impact of stigma and barriers to care on delayed diagnosis and disease severity. Early HIV diagnosis, timely linkage to care, and sustained patient engagement remain essential to preventing severe opportunistic infections.