Tropical Sprue in a Case of Heterosexually Transmitted Acquired Immune Deficiency Syndrome

A heterosexual patient presented with severe diarrhea, malabsorption and weight loss. He was found to have acquired immune deficiency syndrome (AIDS) on the basis of candida esophagitis. Pneumocysris carinii pneumonia, inversion of T lymphocyte subpopulation ratio and the presence of serum anti-HIV virus antibodies. The patient had travelled to Haiti and the Dominican Republic where he had multiple sexual contacts with indigenous women. Despite thorough evaluation to identify the cause of diarrhea no infection, agent was discovered. Duodenal biopsy showed partial villous atrophy, slight crypt hyperplasia and increased number of intraepithelial lymphocytes. After two weeks treatment with tetracycline and folic acid. the patient was symptom free and intestinal histology had returned ro normal. Tropical sprue must thus be considered in the differential diagnosis of intestinal villous atrophy in patients with AIDS.