RadioGraphics 2011; 31:825-830
Fadi Aris, MDCM , Cyrille Naim, MDCM, Talat Bessissow, MDCM Ramila Amre, MD , Giovanni P. Artho, MD
History
A 43-year-old man who was positive for the human immunodeficiency virus (HIV) presented to the hospital with chronic diffuse abdominal pain, vomiting, intermittent fever, and weight loss. At presentation, his CD4+ lymphocyte count was less than 0.05 x 109/L (50/µL), and his plasma viral load was less than 50 copies per milliliter while he was receiving highly active antiretroviral therapy (HAART).
At physical examination, the patient was cachectic, with normal vital signs and mild diffuse abdominal tenderness. The results of laboratory tests were an elevated white blood cell count of 18.80 x 109/L (18,800/µL), a low sodium level of 128 mmol/L, and a low albumin level of 15 g/L. Blood cultures were positive for Mycobacterium avium-intracellulare complex (MAC) that was resistant to clarithromycin therapy.
Imaging Findings
Computed tomography (CT) was performed for the evaluation of the chronic nonspecific abdominal symptoms and demonstrated diffuse small bowel wall thickening with mucosal hyperenhancement. Segmental dilatation of the jejunum with feculent luminal content mixed with gas bubbles (small bowel feces sign) was demonstrated proximal to a focal area of stenosis (Fig la, lb).The stenotic jejunal segment appeared edematous (Fig lb). CT showed generalized