Dyspepsia, Diarrhea, and Deafness: Some Calling Cards of the Great Mimic!

Excerpt

A 29-year-old homosexual male with no previous medical history was initially evaluated for nausea, vomiting, diarrhea, and weight loss. The patient’s symptoms started six months prior to presentation with watery diarrhea, 4–10 low-volume, and non-bloody bowel movements per day, associated with tenesmus and unintentional weight loss of 40 lb over the six-month period. A month before presentation, the patient had developed aching epigastric pain that was episodic, exacerbated by eating and was associated with postprandial nausea and vomiting ~ 10 min after food ingestion. The patient also reported that he started to experience diminished hearing in his left ear over the previous month. The patient was not taking any medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), but he smoked one marijuana cigarette 2–3 times per week for about a year. The patient is in a monogamous relationship with a male partner who is infected with human immunodeficiency virus (HIV) and admitted to having unprotected sex with him on a number of occasions. Although the exact HIV status and cluster of differentiation (CD)4 count of his partner was not known to the patient, he knew that his partner was receiving antiretroviral therapy. There was no history of recent travel or contact with animals. Family history was significant only for Crohn’s disease in his mother. …