Giardiasis mimicking acute abdomen in a renal transplant patient; a clinical and diagnostic challenge

Vaibhav Tiwari ¹^* , Anurag Gupta ¹, Pallav Gupta ², Devender Singh Rana ¹

¹ Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
² Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India

*Corresponding Author: Email: drvt87@gmail.com

Abstract

Background: Intestinal infection in the post-transplant period is a common source of morbidity and mortality. Diarrhea with or without abdominal pain, bloating, nausea and vomiting constitute the most common symptomology which guides the clinician towards appropriate treatment, but what happens when the clues are few?

Case Presentation: We report a case of recent renal allograft recipient who presented with severe abdominal pain without diarrhea or fever. After undergoing various tests, the diagnosis was finally clinched by jejunal biopsy since, it is supported by stool polymerase chain reaction.

Conclusions: This case highlights a common organism like giardia can have a varied presentation. This case mimicking almost as an acute abdomen while can present with a diagnostic challenge.

Keywords: Giardiasis, Abdominal pain, Transplant, Infection, Immunosuppression, Gastroenteritis

Implication for health policy/practice/research/medical education:

In an immunosuppressed individual, a common pathogen can have a varied presentation which may pose a diagnostic dilemma. Giardiasis is a common parasitic infection in the post-transplant period. Mostly symptoms include diarrhea with bloating and abdominal pain. We report a case of giardiasis which solely presented as severe abdominal pain without diarrhea. After undergoing several investigations, the diagnosis was finally made by jejunal biopsy. The patient was successfully treated with oral metronidazole. Atypical presentations of common organisms in the endemic region should always be kept in the differential diagnosis in challenging cases in immunocompromised patients.

Please cite this paper as: Tiwari V, Gupta A, Gupta P, Singh Rana D. Giardiasis mimicking acute abdomen in a renal transplant patient; a clinical and diagnostic challenge. J Nephropathol. 2020;9(1):exx. DOI: 10.15171/jnp.2020.xx.