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Isospora belli Infection Associated with Acalculous Cholecystitis in a Patient with AIDS
- Debra A. Benator, MD;
- Audrey L. French, MD;
- Lisa M. Beaudet, MD;
- Charles S. Levy, MD; and
- Jan M. Orenstein, MD, PhD
- From Washington Hospital Center and George Washington University Hospital, Washington, D.C. Requests for Reprints: Charles S. Levy, MD, Section of Infectious Diseases, Washington Hospital Center, 110 Irving Street Northwest, 2A-56, Washington, DC 20010.
Biliary disease is not uncommon in patients with the acquired immunodeficiency syndrome (AIDS) and is a cause of significant morbidity [1, 2]. Possible manifestations include sclerosing cholangitis, papillary stenosis, extrahepatic bile duct strictures, and acute or chronic cholecystitis.
The pathogens most commonly associated with biliary disease are cytomegalovirus and Cryptosporidium. Microsporidia, Mycobacterium avium complex, Candida albicans, Pneumocystis carinii, and usual enteric bacteria have been identified less frequently [1-3]. Malignancies, including lymphoma and Kaposi sarcoma, have also been associated with biliary tract disease. However, in as many as 55% of cases, a potential cause cannot be identified [1]. We report the first case of Isospora belli infection associated with biliary disease, specifically with acalculous cholecystitis.
Case Report
The patient was a 39-year-old homosexual man with a history of injection drug use. The acquired immunodeficiency syndrome was diagnosed in 1985 on the basis of Kaposi sarcoma of the skin; esophageal candidiasis was diagnosed in 1987. He began receiving aerosolized pentamidine as prophylaxis for P. carinii pneumonia. Between 1987 and 1991, he had intermittent diarrhea that was variably associated with night sweats and weight loss. Initial stool examination in 1987 showed Endolimax nana, Entamoeba coli, and Blastocystis hominis; however, fecal samples obtained between 1988 and 1991 were repeatedly negative. Examination of duodenal biopsy specimens on two occasions showed inflammation but no enteric pathogens on hematoxylin and eosin, acid-fast, and cytomegalovirus immunohistochemical …
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