Multisystemic Convergence in Advanced HIV Disease without Antiretroviral Therapy: Enteroperitoneal Tuberculosis, Neurotoxoplasmosis, Intestinal Polyparasitism, and Highly Suspected Gastric Oncologic Lesion

Abstract

Advanced HIV disease without antiretroviral therapy (ART) can trigger a fulminant multisystemic convergence of opportunistic infections that challenge conventional diagnostic paradigms. We report the case of an ART-naive 28-year-old male with a de novo HIV diagnosis (stage C3) and profound cachexia who initially presented with an exophytic Borrmann type I gastric lesion carrying a high oncological suspicion. However, histopathological analysis revealed an inflammatory-granulomatous process consistent with enteroperitoneal tuberculosis (confirmed via stool GeneXpert testing), coexisting with intestinal polyparasitism by Cryptosporidium spp., Giardia lamblia, and Blastocystis hominis. During his clinical course, the patient experienced a rapid neurological decline—manifested as akinetic mutism and neuroparesis—secondary to probable multifocal neurotoxoplasmosis. This central nervous system injury, with probable involvement of the hypothalamic nuclei, triggered an unusual central diabetes insipidus characterized by massive polyuria (5,020 mL/24h) and refractory dehydration. Due to the active central nervous system infection, ART initiation was mandatorily deferred. Despite targeted antimicrobial and antituberculous regimens, the patient progressed to mixed shock and irreversible multiorgan failure. This case highlights the extremes of immunological vulnerability, emphasizing the critical need for rapid molecular diagnostics and vigilant monitoring for atypical, highly lethal neuroendocrine complications.