Acquired Immunodeficiency Syndrome With Suspected Early Inflammatory Bowel Disease Diagnosed Following Gastrointestinal Symptoms

TL;DR

A man with HIV was diagnosed with early inflammatory bowel disease after experiencing gastrointestinal symptoms and inconsistent test results.

Contribution

This case highlights the importance of considering IBD in the differential diagnosis for people living with HIV who have gastrointestinal symptoms.

Findings

The patient had HIV with low CD4 count and high viral load, along with gastrointestinal symptoms.

Inconsistent clinical and imaging findings led to a biopsy-based diagnosis of early IBD.

Antiretroviral therapy and treatment improved symptoms and resolved inflammation.

Abstract

A 35-year-old man who has sex with men (MSM) visited another hospital for soft stools, lower abdominal pain, and nausea. Gastroscopy (GS) and colonoscopy (CS) revealed esophageal candidiasis and rectal ulcers, for which fluconazole (FLCZ) and metronidazole (MNZ) were prescribed. Four days later, the patient was referred to our hospital. Blood tests showed human immunodeficiency virus (HIV) infection (CD4: 116/µL, HIV-1mRNA: 2.4 × 105 copies/mL). Computed tomography (CT) revealed rectal wall thickening and fluid retention. CS showed ulcers in the rectum, and pathological findings of ulcer margins showed disturbances in the running of the crypts and a decrease in goblet cells. Symptoms improved with fasting and fluid replacement.

After discharge, gastrointestinal symptoms flared up, and he was readmitted. CT revealed mild wall thickening and fluid retention in the entire colon. However, CS revealed that the rectal ulcers tended to regress. Since the clinical manifestations, CT findings, and CS findings were not consistent, biopsies were performed at nine random sites from the ileum to the rectum. Pathological findings showed inflammation in the entire colon, compatible with inflammatory bowel disease (IBD). The patient was diagnosed with early-stage IBD.

One month later, antiretroviral therapy (ART) was initiated. Three months later, CS revealed that the ulcers in the rectum were scarred, and pathological findings from the nine randomly biopsied sites showed disappearances of inflammation. In people living with HIV (PLWH) who develop gastrointestinal symptoms, IBD should be considered in differential diagnosis.

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