Copyright (c) 2026 Bélgica Isabel Tejada Concepción , Diego Arcia De la Ossa
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Primary adrenal insufficiency (PAI), known as Addison's disease, is characterized by decreased cortisol levels and elevated serum adrenocorticotropic hormone (ACTH) levels, mainly due to autoimmune causes. We present the diagnostic approach to a patient with chronic diarrhea associated with PAI of infectious etiology.
A 51-year-old male with a 3-month clinical history characterized by diarrheal stools associated with constitutional symptoms and the appearance of hyperchromic macules on the face and back.
Admission laboratory tests revealed de novo HIV, associated with bicytopenia, moderate hyponatremia, hypoglycemia, and metabolic acidosis with normal anion gap. He received treatment with cefotaxime for 7 days for Salmonella and enteropathogenic E. coli isolated in stool.
With minimal improvement, a colonoscopy was requested, which reported severe proctosigmoiditis with multiple ulcerations and ileitis with inflammation of the ileocecal valve suggestive of CMV infection, which was confirmed by biopsy and serum PCR.
Due to the macules described, associated with persistent normotension, the diagnosis of Addison's disease is confirmed by decreased cortisol levels (5 ug/ml) and elevated ACTH (289 pg/ml). Treatment is started with prednisone 5 mg PO daily and Ganciclovir, with progressive improvement and discharge after 3 weeks.
