P2.L227: HIV/AIDS as Mimicker of Inflammatory Bowel Disease

Introduction: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the digestive tract that causes symptoms such as diarrhea, abdominal pain, bleeding, and other common extraintestinal manifestations. It includes Crohn’s disease and Ulcerative Colitis, which mainly differ in their location and extent of inflammation.

Case Description: This case involves a 19-year-old male with no prior medical history, initially evaluated in our Emergency Department (ED) for a three-week history of abdominal pain, watery diarrhea, weight loss, and anemia. Despite elevated inflammatory markers and a clinical presentation indicative of possible IBD, subsequent esophagogastroduodenoscopy (EGD) with colonoscopy revealed only gastritis, with a normal colon and normal findings at terminal ileum. One year later, the patient returned to the ED experiencing episodes of dark stool progressing to bright red bloody diarrhea, accompanied by lower abdominal pain, fever, tachycardia, fatigue, and unexplained weight loss. This prompted a reevaluation with IBD as the primary differential diagnosis. Colonoscopy confirmed recent CT enterography findings of proctitis, while EGD revealed characteristics of esophageal candidiasis. This led to a more detailed infectious disease workup, as esophageal candidiasis is associated with immunocompromised states and is an AIDS defining illness. Subsequent evaluation revealed HIV infection in this sexually active teenager, along with a diagnosis of disseminated Mycobacterium Avium Complex (MAC), which can mimic IBD in the context of AIDS.

Discussion: This case emphasizes the challenges of diagnosing IBD. It highlights the need for a thorough medical history, exhaustive sexual health evaluation in sexually active patients, and potentially repeated assessments as symptoms may evolve.
Immunodeficiency can cause gastrointestinal (GI) symptoms that mimic IBD. However, the underlying causes of these GI problems differ significantly between patients with and without compromised immune systems. Therefore, when GI illnesses present atypically, immunodeficiency should be considered as a potential underlying cause as early identification allows for proper management and care.

Conclusion: This case underscores the importance of conducting thorough history and HEADSS examinations in suspected IBD cases, as well as comprehensive workups for sexually active patients, enabling the identification of potential HIV-vulnerable populations and facilitating prompt treatment interventions.