Nodular Clostridium difficile Colitis

A 29-year-old man infected with HIV presented with abdominal pain and diarrhea after an episode of P. carinii pneumonia. A 29-year-old man infected with the human immunodeficiency virus (HIV) presented with right-sided abdominal pain and diarrhea. His CD4 cell count was 24 per cubic millimeter, and his HIV viral load was greater than 200,000 RNA copies per milliliter. He had recently been discharged from the hospital after an episode of Pneumocystis carinii pneumonia, which had been treated with trimethoprim–sulfamethoxazole and prednisone. Four days later, he reported crampy abdominal pain and six to eight loose stools per day. His medications included lopinavir–ritonavir, combivir, trimethoprim–sulfamethoxazole, and azithromycin. The lopinavir–ritonavir and combivir were stopped, and his diarrhea responded to a 10-day course . . .