Cases from the Medical Grand Rounds of the Osler Medical Service at Johns Hopkins University

Presenting features

A 39-year-old male with acquired immunodeficiency syndrome (CD4 count of 3) presented with the chief complaints of left-sided abdominal pain, fevers, and night sweats of three-weeks duration. He was noncompliant with prophylaxis against Pneumocystis carinii pneumonia and Mycobacterium avium complex and was not currently on highly-active antiretroviral therapy (HAART). Physical examination on admission was noteworthy for a temperature of 39° C and abdominal pain to deep palpation in the left mid-epigastric region. An extensive work-up was undertaken, including an esophagogastroduodenoscopy with enteroscopy which raised papular lesions in his jejunum (Figure 1, arrows). What is the diagnosis?