Human immunodeficiency virus 1-associated necrotizing cholangitis caused by infection with Septata intestinalis.

Abstract

A 30-year-old man with acquired immunodeficiency syndrome developed human immunodeficiency virus 1-related cholangiopathy with atypical radiographic features showing extensive hepatobiliary involvement. Extended clinical evaluation, including endoscopic retrograde cholangiopancreatography, and the results of both ultrasonic- and computed tomographic-guided liver biopsies failed to provide a diagnosis. A laparoscopic needle biopsy of a single 3-cm, firm, tan lesion on the anterior surface of the liver showed severe necrotizing cholangitis. Special stains showed numerous microsporidial spores within the regions of granulomatous inflammation and prominent necrosis. Electron micrographic findings were characteristic of Septata intestinalis, a newly recognized microsporidial species that disseminates from the intestinal tract and is associated with invasive pathology.