Development of Ulcerative Colitis in a Patient With Human Immunodeficiency Virus

Abstract

The relationship between the human immunodeficiency virus (HIV) and inflammatory bowel disease (IBD) is poorly understood. The coexistence of the two conditions is uncommon with scattered retrospective studies in the literature. Whereas HIV was initially thought to propagate IBD flares and increase disease severity, more studies are coming out showing that HIV may actually be protective against IBD development and relapse, particularly due to the depletion of CD4 lymphocytes. We present a HIV-positive female with new onset ulcerative colitis at the age of 42. Her HIV was poorly controlled for 25 years but with new gastrointestinal symptoms for 9 months, an endoscopic evaluation was done which revealed a new inflammatory bowel disease diagnosis, which warranted immediate therapy. In describing this patient's case, we discuss the uncommon coexistence of HIV and IBD and investigate potential relationships between the two conditions.

Keywords: human immunodeficiency virus; immunology; inflammatory bowel disease.

Figure 1

(a) Colonoscopy showing erythematous and friable mucosa in the proximal rectum with scattered diffuse erosions with circumferential involvement noted extending from the anal verge to 15 cm. (b) Colonoscopic view of the distal sigmoid showing aforementioned friable and erythematous mucosa circumferentially with contact oozing and scattered erosions.

Figure 2

(a) Exuberant mixed inflammatory infiltrate of the lamina propria with overlying mucosal erosion, 100x. (b) Colonic crypt abscess formation (arrow) alongside crypt destruction indicative of ulcerative colitis, 200x. (c) Intraepithelial neutrophilic infiltrate of the colonic crypts (arrow) characteristic for cryptitis, 200x.