title: HAART toxicity masquerading as a surgical abdomen.
abstract: BACKGROUND
  Intussusception is a rare disease in adults and poses a challenge to identify and manage. In adults, surgical resection is the preferred treatment since half are due to malignancy. This case reveals an association between highly active antiretroviral therapy (HAART) and intussusception.
  
  
  METHODS
  A 44 year-old female with history of HIV on highly active antiretroviral therapy (HAART) presented with 3 month history of epigastric pain, nausea, emesis, weight loss, and lactic acidosis. CT of abdomen showed two small bowel intussusceptions and pericolic fat infiltration. A diagnosis of mitochondrial toxicity secondary to HAART medication was made. HAART medication was discontinued with resolution of symptoms. Further work-up to exclude a mechanical cause for her symptoms including colonoscopy, small bowel follow through, esophagogastroduodenoscopy, and repeat CT were performed. All established an absence of malignancy and intussusception.
  
  
  CONCLUSIONS
  Mitochondrial toxicity (MT) is a well-known complication of HAART. A hallmark of MT is lactic acidosis which when untreated can be fatal. Although MT is known to cause gastrointestinal symptoms, intussusception has not been previously reported. In our patient with MT, prolonged usage of HAART medication resulted in severe gastrointestinal symptoms and intussusception mimicking a surgical abdomen. Laparotomy has been recommended on adult patients with intussusceptions because of the high likelihood of identifying a pathologic lesion. The doctrine of adult intussusception is to operate for concern of malignancy.
  
  
  CONCLUSIONS
  Surgeons, gastroenterologist and internist caring for patients on HAART therapy must be aware of the possibility of MT when evaluating HIV patients for possible surgical abdomen.
authors.affiliation: Lincoln Medical and Mental Health Center, Department of Surgery, United States. Electronic address: feghalia@upstate.edu.
authors.forename: Anthony
authors.initials: A
authors.lastname: Feghali
authors.affiliation: Lincoln Medical and Mental Health Center, Department of Surgery, United States.
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Lincoln Medical and Mental Health Center, Department of Surgery, United States.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Irizarry
authors.affiliation: Lincoln Medical and Mental Health Center, Department of Surgery, United States.
authors.forename: Meno
authors.initials: M
authors.lastname: Lueders