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A Complex Case of Diarrhea

Peto, Philippa MRCP*; Kubelka, Igor MD; Jayawardene, Satish MRCP

Infectious Diseases in Clinical Practice: March 2014 - Volume 22 - Issue 2 - p 110–112
doi: 10.1097/IPC.0b013e318287c758
Case Reports

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:

The authors have no funding or conflicts of interest to disclose.

© 2014 by Lippincott Williams & Wilkins.