Differential Diagnosis for Abdominal Pain in an HIV Positive Patient
Single Most Likely Diagnosis
- Gastrointestinal opportunistic infections: Given the compromised immune system in HIV positive patients, opportunistic infections such as CMV colitis, cryptosporidiosis, and microsporidiosis are common causes of abdominal pain. These infections often present with diarrhea, weight loss, and abdominal pain.
Other Likely Diagnoses
- Medication side effects: Many antiretroviral therapies (ART) and other medications used in HIV management can cause gastrointestinal side effects, including abdominal pain, nausea, and diarrhea.
- HIV-related malignancies: Lymphomas and Kaposi's sarcoma are more common in HIV positive patients and can cause abdominal pain due to gastrointestinal involvement or lymphadenopathy.
- Bacterial infections: Common bacterial infections such as Salmonella, Shigella, and Campylobacter can cause abdominal pain, diarrhea, and fever in HIV positive patients.
- Pancreatitis: HIV positive patients are at increased risk of pancreatitis due to medication side effects, hypertriglyceridemia, or opportunistic infections.
Do Not Miss Diagnoses
- Perforation or obstruction: Although less common, conditions like perforation or obstruction require immediate surgical intervention. In HIV positive patients, these conditions can be caused by opportunistic infections, malignancies, or medication side effects.
- Acute abdomen due to opportunistic infections: Infections like CMV or TB can cause an acute abdomen, which is a surgical emergency.
- Lymphoma with bowel involvement: Although less common, lymphoma with bowel involvement can cause abdominal pain, obstruction, or perforation, and requires prompt diagnosis and treatment.
Rare Diagnoses
- Whipple's disease: A rare bacterial infection that can cause malabsorption, weight loss, and abdominal pain in HIV positive patients.
- Intestinal tuberculosis: Although more common in endemic areas, intestinal TB can cause abdominal pain, diarrhea, and weight loss in HIV positive patients.
- AIDS-related cholangiopathy: A rare condition characterized by biliary tract disease, including sclerosing cholangitis and papillary stenosis, which can cause abdominal pain and jaundice.