Rare Case of Chronic Diarrhoea in an Immunocompetent Host

Abstract

Chronic diarrhoea is one of the common presenting symptoms of patients attending gastroenterology clinics. Cyclosporacayetanensis is a protozoan parasite causing intestinal infections. Most of these infections are self-limiting in immunocompetent individuals. However prolonged course of infection is often observed in immunocompromised individuals and rarely in normal individuals. In our case report, 50-year-old patient from west Bengal, India presented with chronic small bowel type of diarrhoea with significant weight loss. Serology for HIV was negative. Endoscopic biopsy from duodenum showed villous atrophy and crypt hyperplasia mimicking sprue with presence of oval round structures within parasitophorous vacuoles located in the supra nuclear cytoplasm of enterocytes, consistent with cyclospora infestation. Same biopsy also showed CMV inclusion bodies in the background. He was managed with oral Trimethoprim/sulfamethoxazole for cyclospora and valganciclovir for CMV. Conclusion: Mixed infection of cyclospora and cytomegalovirus presenting as chronic diarrhoea was rarely reported in an immunocompetent individual. Duodenal biopsy may help in differentiating parasitic infections from tropical sprue by demonstrating various forms of pathogens in histology.