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Cryptosporidial diarrhea is uncommon in immunocompetent individuals, more often seen in severely immunocompromised patients. Severe refractory cases have been described in patients with HIV/AIDS before the advent of modern antiretroviral therapy due to an inability to mount an adequate cellular immune response. We describe an 85-year-old patient post–chimeric antigen receptor T-cell therapy relapsed lymphoma who developed refractory Cryptosporidium spp. diarrhea in the setting of persistent CD4+ cytopenia. Despite receiving multiple antiparasitic agents, including failure of a prolonged course of nitazoxanide, the patient experienced persistent symptoms for 9 months with repeatedly positivity stool Cryptosporidium spp. direct fluorescent antibody (DFA) test. We highlight this case of refractory Cryptosporidium spp. and the importance of recognizing the pathogen in a non–HIV-infected immunosuppressed host.
Authors’ addresses: Caitlin Trottier, Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, E-mail: email@example.com. Christina F. Yen, Infection Control, Beth Israel Deaconess Medical Center, Boston, MA, E-mail: firstname.lastname@example.org. Grace Malvar, Pathology, Beth Israel Deaconess Medical Center, Boston, MA, E-mail: email@example.com. David E. Avigan, Hematology and Hematologic Malignancies, Beth Israel Deaconess Medical Center, Boston, MA, E-mail: firstname.lastname@example.org. Jon Arnason, Beth Israel Deaconess Medical Center, Oncology, Boston, MA, E-mail: email@example.com. Carolyn D. Alonso, Beth Israel Deaconess Medical Center, Infectious Diseases, Boston, MA, E-mail: firstname.lastname@example.org.