The child had had these complications since he was 6 months old. He had had several hospital admissions due to bouts of acute abdominal pain, consistent with intestinal obstruction. Abdominal radiography showed dilated bowel loops, in favor of intestinal obstruction. Abdominal sonography and upper gastrointestinal series were normal. Barium enema showed a dilated long segment of the sigmoid colon, suggestive of Hirschsprung’s disease. So, laparotomy was performed to differentiate between intestinal obstruction and probable Inhibitors,research,lifescience,medical Hirschsprung’s disease. No evidence of obstruction was observed in laparotomy. Therefore, full thickness

biopsy sample of the sigmoid colon was taken. The biopsy Inhibitors,research,lifescience,medical sample showed normal ganglion cells. Anorectal manometry was done and showed normal rectoanal inhibitory reflex (RAIR) without any evidence of Hirschsprung’s disease. Upper gastrointestinal endoscopy was done, and a duodenal biopsy sample was also taken. It showed villous atrophy and cyclospora infestation without any evidence of celiac disease. Inhibitors,research,lifescience,medical Medical treatment for cyclospora was started with Trimethoprim/Sulfamethoxazole. However, diarrhea and abdominal

distension continued. Moreover, stool examination was positive for cryptosporidium, and hence, Nitazoxanide was started for the patient. To rule out the immune system dysfunction, immunological Inhibitors,research,lifescience,medical examinations were performed, which showed normal CD4+, CD8+, and NK cells but CH4+/CH8+ was 0.05 (normal: 0.9-1.9). The enzyme-linked immunosorbent assay (ELISA) test was positive for HIV. Further investigation using the western blot approved the diagnosis of HIV in the child and his parents. Since intestinal pseudo-obstruction is not usually found in following patients with HIV, the medical team was misguided in the diagnosis of HIV for this patient. A complete medical history taking and physical examination was done for the parents. The

father was known to be addicted to inhalational Inhibitors,research,lifescience,medical opium and a tattoo was found on his arm. Discussion Intestinal obstruction is a common cause of acute abdominal pain in children. Although intestinal obstruction may be seen in patients with HIV either before treatment or as a consequence of medical therapy especially after treatment with Batimastat Ritonavir and Lopinavir, intestinal pseudo-obstruction is not a common manifestation of HIV disease. In our patient, cryptosporidium was found in the stool examination. Imaging studies were performed and led to the diagnosis of intestinal pseudo-obstruction. The patient’s condition was improved after treating the cryptosporidium infection. It is probable that the gastrointestinal pseudo-obstruction had arisen from cryptosporidium infection. Cryptosporidium is usually found in patients with HIV and is often asymptomatic. It may also cause diarrhea and abdominal colics. A previous report by Aeri Moon et al.