An 18-year-old African American male without significant past medical history presents with a one-year history of non-bloody loose stools and 35 lb weight loss. The patient noted worsening of his diarrhea including symptoms of nausea, vomiting and loss of appetite prompting him to come to the Emergency Department for evaluation. His physical exam is significant for a thin male without cachexia and a soft, non-distended abdomen with hepatomegaly. His rectal exam is positive for occult blood and a healed perianal scar. His initial laboratory workup reveals a microcytic anemia (Hgb = 7.2, MCV = 79), BUN of 67 and Creatinine of 3.2. The remainder of his initial blood work was notable for AST = 62, ALT = 22, Amylase = 97,AP = 312 and an Albumin of 1.7. His initial stool studies showed WBC-negative, Clostridium difficile-negative and O&P negative but abundant Candida were seen on culture. In light of patient's sexual history, remarkable for multiple sexual partners, HIV testing was performed. Rapid HIV was positive and subsequently confirmed by Western Blot. His CD4 count was 29 and quantitative HIV was greater then 750,000 copies. Upper endoscopy (Figure 1) and colonoscopy (Figure 2) were performed to evaluate etiology of symptoms and anemia.
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