Atypical Presentation of Childhood Acquired Immune Deficiency Syndrome Mimicking Crohn's Disease: Nutritional Considerations and Management

A child with acquired immune deficiency syndrome became severely malnourished presumably as a result of multiple gastrointestinal infections, with numerous organisms including campylobacter, giardia, and cryptosporidium. These opportunistic infections preceded laboratory evidence of immune deficiency. Despite severe diarrhea and marked weight loss, there was no laboratory evidence of significant malabsorption. By using nasogastric feedings, we were successful in promoting a 60% weight gain, and a rise in serum albumin from 1.2 to 4.3 g/dl. While eventual outcome was not altered, this particular patient's clinical course was improved. We suggest that malnutrition should not he accepted as inevitable and that malabsorption should not be assumed in similar acquired immune deficiency syndrome patients. Appropriate studies for malabsorption should be done, and high caloric enteral feedings should be used whenever feasible.