Posters
Presenting Author Academic/Professional Position
Nida Asif
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Resident
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Resident
Discipline/Specialty (Author 3)
Internal Medicine
Discipline Track
Community/Public Health
Abstract Type
Case Report
Abstract
Background: Cryptosporidiosis is a common cause of chronic diarrhea in patients with acquired immunodeficiency syndrome particularly those with CD4 counts below 100 cells/mm3. In such cases, persistent gastrointestinal losses can result in severe electrolyte abnormalities, including life threatening hypokalemia. Recognizing this association is critical as delayed correction may result in serious morbidity. Reporting cases with this complication enhances clinical awareness and may guide more vigilant electrolyte monitoring in similar patients.
Case presentation: A 41-year-old male with a history of HIV diagnosed in 2005 and progression to AIDS (acquired human immunodeficiency) presented to the emergency department with a one-month history of profuse chronic non bloody watery diarrhea occurring 4-5 episodes per day. His symptoms were associated with intermittent subjective fevers, muscle cramps, fatigue and an unintentional weight loss of approximately 25-30 pounds. The patient had a history of non-adherence to antiretroviral therapy (ART), previously prescribed dolutegravir-lamivudine (Dovato) and darunavir-cobicistat ( Prezcobix). He reported seeing his primary care physician a few days prior where laboratory results revealed a critically low serum potassium of 2.0 mmol/L. On presentation his vital signs were stable. Physical examination unremarkable. Laboratory investigations revealed a potassium level of 2.0 mmol/L, magnesium levels of 2.30 mg/dl, hypernatremia of 148 mmol/L, creatinine of 1.71mg/dl. CD4 count of 95 cells/mm3. Unknown HIV viral load, electrocardiogram showing no changes. A stool gastrointestinal PCR panel returned positive for cryptosporidium species. He was admitted with the diagnosis of severe hypokalemia secondary to chronic diarrheal losses from cryptosporidium. He was started with aggressive potassium repletion with both IV and oral supplementation. Antiretroviral therapy was resumed, infectious disease consultation was done, and patient was initiated on nitazoxanide and azithromycin with a planned four-week course. Over the subsequent days, the patient's diarrhea improved, and his electrolyte abnormalities normalized.
Conclusion: Cryptosporidium is a well-recognized opportunistic infection in patients with HIV/AIDS but profound hypokalemia as a presenting complication remains underreported. Persistent diarrhea in immunocompromised individuals can result in significant electrolyte loss, particularly of potassium posing a risk for arrhythmias and neuromuscular complications. This case emphasizes the need for heightened clinical awareness and close monitoring of serum electrolytes in patients with AIDS-related diarrhea. Early recognition and prompt correction of hypokalemia, along with immune restoration with antiretroviral therapy and also initiation of antiparasitic therapy is essential to reduce morbidity and mortality outcomes.
Presentation Type
Poster
Recommended Citation
Asif, Nida; Mills, Elizabeth; and Zia, Sikandar, "Chronic diarrhea and severe Hypokalemia in an AIDS patient: unmasking cryptosporidium infection" (2025). Research Colloquium. 77.
https://scholarworks.utrgv.edu/colloquium/2025/posters/77
Included in
Chronic diarrhea and severe Hypokalemia in an AIDS patient: unmasking cryptosporidium infection
Background: Cryptosporidiosis is a common cause of chronic diarrhea in patients with acquired immunodeficiency syndrome particularly those with CD4 counts below 100 cells/mm3. In such cases, persistent gastrointestinal losses can result in severe electrolyte abnormalities, including life threatening hypokalemia. Recognizing this association is critical as delayed correction may result in serious morbidity. Reporting cases with this complication enhances clinical awareness and may guide more vigilant electrolyte monitoring in similar patients.
Case presentation: A 41-year-old male with a history of HIV diagnosed in 2005 and progression to AIDS (acquired human immunodeficiency) presented to the emergency department with a one-month history of profuse chronic non bloody watery diarrhea occurring 4-5 episodes per day. His symptoms were associated with intermittent subjective fevers, muscle cramps, fatigue and an unintentional weight loss of approximately 25-30 pounds. The patient had a history of non-adherence to antiretroviral therapy (ART), previously prescribed dolutegravir-lamivudine (Dovato) and darunavir-cobicistat ( Prezcobix). He reported seeing his primary care physician a few days prior where laboratory results revealed a critically low serum potassium of 2.0 mmol/L. On presentation his vital signs were stable. Physical examination unremarkable. Laboratory investigations revealed a potassium level of 2.0 mmol/L, magnesium levels of 2.30 mg/dl, hypernatremia of 148 mmol/L, creatinine of 1.71mg/dl. CD4 count of 95 cells/mm3. Unknown HIV viral load, electrocardiogram showing no changes. A stool gastrointestinal PCR panel returned positive for cryptosporidium species. He was admitted with the diagnosis of severe hypokalemia secondary to chronic diarrheal losses from cryptosporidium. He was started with aggressive potassium repletion with both IV and oral supplementation. Antiretroviral therapy was resumed, infectious disease consultation was done, and patient was initiated on nitazoxanide and azithromycin with a planned four-week course. Over the subsequent days, the patient's diarrhea improved, and his electrolyte abnormalities normalized.
Conclusion: Cryptosporidium is a well-recognized opportunistic infection in patients with HIV/AIDS but profound hypokalemia as a presenting complication remains underreported. Persistent diarrhea in immunocompromised individuals can result in significant electrolyte loss, particularly of potassium posing a risk for arrhythmias and neuromuscular complications. This case emphasizes the need for heightened clinical awareness and close monitoring of serum electrolytes in patients with AIDS-related diarrhea. Early recognition and prompt correction of hypokalemia, along with immune restoration with antiretroviral therapy and also initiation of antiparasitic therapy is essential to reduce morbidity and mortality outcomes.
