Epigastric Pain in an AIDS Patient; a Case of Misdiagnosis

Abstract

Epigastric pain is one of the commonest complaints that primary care physicians and gastroenterologists encounter. With the lack of any alarm symptoms, the treatment is usually proton pump inhibitors which are mostly successful secondary to the prevalence of gastritis and gastroesophageal reflux disease. However, in certain scenarios, more aggressive investigations should be done. We present a 61 year old female with AIDS who was in and out of hospitals for 4 months with epigastric pain and diarrhea. The patient had multiple endoscopies with no specific diagnosis made. During her last hospitalization, she underwent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy for suspected AIDS cholangiopathy which relieved her symptoms completely within 24 hours. Because ERCP is considered an invasive procedure, it is rarely done without specific indications such as a suspected biliary stone or papillary stenosis however, a certain subgroup of patients may benefit from ERCP despite lack of specific signs. Sphincterotomy results in significant decrease in morbidity in AIDS cholangiopathy but should patients with AIDS undergo ERCP without definite indications? That is the question we raise after analyzing this stimulating case.