Clinical Presentation & Protocol
Patient Usually Complains Of
Patient is a known HIV-positive individual presenting with chronic, non-bloody, watery diarrhea, weight loss, and abdominal cramping. Symptoms are refractory to standard anti-diarrheal agents. History significant for advanced immunosuppression (CD4 count < 100 cells/ยตL). No recent travel, but reports persistent malabsorption symptoms.
Clinical Examination Findings
General: Patient appears cachectic, chronically ill, and dehydrated. Abdomen: Soft, non-distended, hyperactive bowel sounds, diffuse mild tenderness to palpation, no rebound or guarding. Skin: Evidence of decreased turgor consistent with chronic fluid loss. Mucous membranes: Dry.
Treatment Protocol
1. Initiate Fumagillin 60 mg/day orally for 14 days. 2. Optimize antiretroviral therapy (ART) to improve immune reconstitution (CD4 count recovery is essential for clearance). 3. Aggressive fluid and electrolyte replacement. 4. Nutritional support with high-calorie, low-residue diet. 5. Monitor LFTs and CBC weekly due to potential side effects of Fumagillin.