A 42-Year-Old Man with HIV Comes to the Emergency Department

question 188

Multiple Choice

A 42-year-old man with HIV comes to the emergency department with 3 days of abdominal pain, decreased appetite, and diarrhea.  Temperature is 38 C (100.4 F) , blood pressure is 98/60 mm Hg, and pulse is 110/min.  Abdominal examination shows tenderness over the left lower quadrant without guarding or rebound tenderness.  CD4 count is 38/mm³.  Colonoscopy shows erythematous, friable mucosa with superficial ulcerations in the sigmoid and descending colon.  Biopsy from the ulcers reveals inflammatory infiltrate, mucosal necrosis, and enlarged endothelial cells with large, ovoid nuclei containing prominent basophilic deposits. Which of the following is the most likely cause of this patient's gastrointestinal symptoms?

• A)Disseminated mycobacterial infection
• B)Infection by a modified acid-fast protozoan
• C)Mucosal invasion by a commensal yeast
• D)Reactivation of a herpesvirus
• E)Toxin from an anaerobic bacteria

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