A 72-year-old man is admitted from clinic with diarrhea. Diarrhea is a common symptom, but in this man with a background of hepatocellular carcinoma and hepatitis C with cryoglobulinemia who was also on immunosuppression for membranous nephropathy, there was not 1 causative infective agent but 4. This case report explores the associations between the 4 agents—strongyloides, cytomegalovirus, Clostridium difficile, and norovirus—and highlights the importance of systematic investigation to make a full diagnosis in complex patients.
From the *Renal SpR, Renal Unit, King’s College Hospital, †King’s College Hospital, and ‡Renal Unit, King’s College Hospital, Denmark Hill, London.
Correspondence to: Philippa Peto, MRCP, Renal SpR, Renal Unit, King’s College Hospital, Denmark Hill, London SE5 9RS, Flat 11, Royal Hill Court, Greenwich, London SE10 8PH. E-mail: firstname.lastname@example.org.
The authors have no funding or conflicts of interest to disclose.