Rotavirus infection and epidermal necrolysis of the bowel in a patient with AIDS

Abstract

A 44-year-old man with HIV, with a CD4+ count of 45/μl and a viral load of 88 000 copies/ml, who was completing therapy for Pneumocystis carinii pneumonia, presented with severe bloody diarrhoea, fevers and abdominal pain. Endoscopy revealed total epidermal necrolysis of the colon, and partial epidermal necrolysis of the duodenum, a histologic pattern most typically seen in severe graft versus host disease. Computed tomography (CT) documented inflammation of the entire gastrointestinal tract distal to the stomach. A broad infectious work up noted only a positive stool rotavirus antigen. The patient's symptoms continued unabated until he was given high dose intravenous steroids to which he had a rapid therapeutic response. Ultimately his diarrhoea recurred and became refractory to all interventions, including antiretroviral therapy with an adequate virologic decline after therapy. Due to nutritional and functional decline, the patient requested hospice care approximately 6 months after becoming acutely ill.

Figure 1

Low and high power magnification views of colonic biopsies. Complete elimination of colonic epithelia and colonic crypts is noted with minimal lamina propria inflammation.

Figure 2

Three dimensional computed tomography of the abdomen. Pronounced bowel wall enhancement of the entire gastrointestinal tract is noted.

Figure 3

Low and high power magnification views of duodenal biopsy. Partial denudation and crypt loss is noted with villous blunting and widely dispersed apoptosis of duodenal epithelia also evident.