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Diarrhea in an immunocompromised patient has a broad infectious differential. Diagnosis is difficult despite advances in diagnostic modalities. We report a case of a 45-year-old Nigerian woman who immigrated to the United States 2 years ago. She presented to the hospital with gastrointestinal bleeding, newly diagnosed HIV, and disseminated Kaposi sarcoma. During hospitalization, the patient had an onset of watery diarrhea and high eosinophilia. Subsequent stool analysis using multi-parallel real-time quantitative polymerase chain reaction for 13 parasites was positive for Cystoisospora belli. The patient was treated with trimethoprim–sulfamethoxazole, but had relapsed disease when her antibiotics were stopped prematurely. After restarting trimethoprim–sulfamethoxazole, her diarrhea and eosinophilia improved, and she had undetectable Cystoisospora belli DNA on repeat stool quantitative polymerase chain reaction. This case highlights the importance of a thorough workup for diarrhea, including parasites, especially for immunocompromised patients. Antibiotic prophylaxis is recommended in patients with Cystoisospora belli and HIV/AIDS.
†These authors contributed equally to this work.
Authors’ addresses: Roumen Borilov Iordanov, Galant Chan, and Andrew R. DiNardo, Infectious Diseases Section, Department of Medicine, Baylor College of Medicine, Houston, TX, E-mails: firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Lauren M. Leining and Rojelio Mejia, Laboratory of Human Parasitology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, E-mails: email@example.com and firstname.lastname@example.org. Meng Wu, Rheumatology & Infectious Diseases, PLLC, Houston, TX, E-mail: email@example.com.