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Case of the Month



Enteric Complications of HIV infection

This is the case of a 44 year old immunosuppressed HIV positive male who presented with a perforated bowel. A small bowel resection and right hemicolectomy were performed. The small bowel resection demonstrated a 1.7 centimeter perforation and the right hemicolectomy specimen demonstrated several irregular pink-red and granular mucosal lesions ranging from 1.5 to 4.7 centimeters involving the terminal ileum and the right colon. Multiple white firm lymph nodes measuring up to 0.9 centimeters were also present.

Histologically, the diagnosis was acute and chronic, focally ulcerated, tuberculous, necrotizing (caseating) transmural granulomatous enteritis and colitis with focal transmural perforation demonstrating numerous acid fast bacilli by AFB stain. The acute and chronic necrotizing (caseating) granulomatous inflammatory process also involved the mesentery of the small intestine and the pericolonic-mesocolic adipose tissue as well as the wall of the vermiform appendix. Eighteen (18) benign pericolonic-mesocolic lymph nodes demonstrated acute and chronic necrotizing (caseating) granulomatous lymphadenitis, morphologically consistent with Mycobacterial etiology (tuberculous lymphadenitis).

The GMS stain was positive for fungal budding yeast forms and focal fungal pseudohyphae within serosal exudate, morphologically consistent with Candida genus.

Submitted by Richard Zitwer, MD