SHM Converge Scientific Abstract ePoster Gallery-No Noro, No Cry

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This case describes a 66-year-old woman with 6 months of watery, non-bloody diarrhea and severe hypokalemia after treatment for diffuse large B-cell lymphoma, including R-CHOP and CAR-T therapy. She had pan-hypogammaglobulinemia related to her cancer therapy, placing her at high risk for opportunistic infection.<br /><br />Initial workup showed potassium of 1.9 mmol/L and a gastrointestinal pathogen panel positive for norovirus. Extensive additional testing was negative, including C. difficile, ova and parasites, adenovirus, CMV, celiac testing, HIV, and thyroid studies. Colonoscopy showed congested colonic mucosa, and duodenal biopsy revealed mild focal villous blunting, minimal intraepithelial lymphocytosis, and focal foveolar metaplasia.<br /><br />She was initially treated with IVIG, nitazoxanide, colestipol, potassium replacement, and anti-diarrheal medications. Her symptoms improved briefly, but diarrhea recurred. One month later, she was readmitted with recurrent hypokalemia and worsening diarrhea; repeat testing again supported chronic norovirus infection.<br /><br />Because of persistent symptoms despite standard therapy, enteral immunoglobulin was started. This led to slower diarrhea and stable potassium levels at discharge. One year later, she remains on biweekly IVIG infusions.<br /><br />The case highlights that norovirus can cause chronic, severe diarrhea in immunocompromised patients and may be associated with villous blunting. It also emphasizes that treatments such as IVIG, nitazoxanide, ribavirin, and enteral immunoglobulin have variable and often incomplete effectiveness.

Asset Subtitle

Evan Raff

Meta Tag

Author List Christian Cook, Dimitri Trembath, Evan Raff, Jiwoo Kim

Category Clinical Vignettes

Concept Norovirus Infection

Concept Diarrhea

Concept Immunocompromised State

Concept Hypogammaglobulinemia

Concept Chronic Infection

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Evan Raff

Track Adult

Keywords

norovirus

chronic diarrhea

hypokalemia

immunocompromised

diffuse large B-cell lymphoma

CAR-T therapy

pan-hypogammaglobulinemia

villous blunting

intravenous immunoglobulin

enteral immunoglobulin

Norovirus Infection

Diarrhea

Immunocompromised State

Hypogammaglobulinemia

Chronic Infection