Crystal Meth Gave Me Diarrhea! An Uncommon Cause of Diarrhea in a HIV Patient

Abstract

Purpose: Diarrhea is one of the most common gastrointestinal complaints in a HIV patient and should not be taken lightly. Infectious etiologies should always be ruled out or treated for if the clinical scenario is appropriate. However, other less common causes of diarrhea should be considered in the differential diagnosis. We present a case of severe diarrhea in an HIV patient with recent ingestion of methamphetamine. A 31-year-old male with past medical history significant for HIV presented to the hospital with the complaint of diarrhea. The patient's most recent CD4 count was 350 and viral load was undetectable. He claimed to be compliant with his anti-retroviral therapy regimen that he had been taking for the last two years. Diarrhea was of sudden onset with duration of two days. Frequency of bowel movements was 12-15 times a day. Diarrhea was described to be watery. The patients denied rectal bleeding and episodes of melena. The patient denied recent fevers and chills. On examination, patient was found to be hypovolemic with positive orthostatics. Notable laboratory findings included hypokalemia and hypomagnesemia. The patient was started on aggressive intravenous hydration and electrolyte correction. Stool studies including bacterial culture, examination for ova and parasites, examination for ova and parasites was unremarkable. In addition, acid-fast smear was negative for Cryptosporidium, Isospora, and Cyclospora. The patient also underwent a flexible sigmoidoscopy with biopsy, which was also normal. After the extensive workup, alternative diagnoses were considered with a thorough social history. It was discovered that the patient has started taking methamphetamine prior to onset of diarrhea. Diarrhea had resolved at the third day of admission without any treatment except for supportive therapy. Since discharge, the patient has abstained from methamphetamine and has not experienced similar episodes of diarrhea. Diarrhea is a common complaint in HIV patients. The differential diagnosis is broad but it is prudent to search for underlying infectious etiologies for rapid initiation of antibiotic therapy. In this case, infectious workup was negative. Because there were no recent changes in medications, prescribed drugs was an unlikely cause of the acute diarrhea. The temporal relationship with methamphetamine ingestion and onset of diarrhea makes the illicit drug the most likely cause of diarrhea. The patient in our case underwent an extensive workup but with negative findings. Past case reports have illustrated an association between methamphetamine and ischemic colitis. In this case we propose that methamphetamine use can also lead to severe diarrhea.