S5153 A Case of Severe and Prolonged Cryptosporidiosis Revealing HIV Treated in a Multidisciplinary Hybrid GI Care Model

Introduction: Cryptosporidiosis is a parasitic infection causing watery diarrhea, typically self-limited in immunocompetent individuals. In immunocompromised hosts, it may present with prolonged and severe symptoms. We present a case in which a delayed diagnosis of human immunodeficiency virus (HIV) was revealed through a prolonged cryptosporidiosis course and managed through a virtual multidisciplinary gastrointestinal (GI) care model. Case Description/Methods: A 35-year-old man with hypertension presented via a virtual GI platform with a 2-month history of non-bloody watery diarrhea (>10 episodes/day), urgency, tenesmus, nocturnal stooling, abdominal pain, 45-pound weight loss, night sweats, and chills. Lab results revealed microcytosis (MCV 70), normal hemoglobin (14.4), leukopenia (white blood cell 3.8), elevated C-reactive protein (30), elevated creatinine (1.34), hyponatremia (Na 128), and positive Cryptosporidium EIA. Other stool studies including C. difficile, Giardia, and fecal calprotectin were negative. Celiac and thyroid studies were normal. Due to evidence of dehydration, the patient was referred to the emergency department for intravenous fluids. He was started on nitazoxanide with symptomatic improvement. Given the severity and prolonged course of illness, HIV screening was initiated and returned positive. The patient was referred to the local health department and started promptly on antiretroviral therapy. A GI dietitian was also involved for nutritional support. Discussion: This case underscores the importance of evaluating for immunodeficiency in patients with prolonged cryptosporidiosis. Notably, the patient’s HIV diagnosis was made only after being engaged through a virtual GI care platform. The case highlights how a multidisciplinary, hybrid virtual GI model—led by an advanced practice provider and supported by dietitians and local in-person care partners—can effectively manage complex presentations and facilitate timely diagnoses.