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HIV-Infection and Worsening Diarrhea: What's Your Dx?

HIV-Infection and Worsening Diarrhea: What's Your Dx?

A 54-year-old man with HIV infection presents with increasingly worsening diarrhea. His CD4 cell count is 32/µL. Upper endoscopy with duodenal biopsies is performed. Specimens reveal sheets of foamy macrophages in the lamina propria. Periodic acid–Schiff (PAS) and acid-fast bacillus stains are notable for rod-shaped organisms.

What is the most likely diagnosis?

a. Mycobacterium avium complex
b. Cytomegalovirus
c. Whipple disease
d. Tropical sprue

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