Chronic bloody diarrhea in an HIV patient

The case we discussed today was that of a patient with HIV (on HAART) who presented with bloody diarrhea, abdominal pain and weight loss (25-40 lbs) over the past 4 months.

Given that the differential diagnosis is broad in an immunodeficient patient, a CT abd/pelvis was obtained which showed segmental involvement of cecum through proximal sigmoid colon while sparing distal sigmoid colon and rectum. Patient was started on empiric systemic steroids while awaiting endoscopy. Flexible sigmoidoscopy showed congested, erythematous, friable mucosa with serpiginous ulcers involving the rectum, sigmoid and descending colon. Biopsy showed severely active IBD.

Discussed the work-up of chronic bloody diarrhea in an HIV patient and differences between Crohn’s disease and Ulcerative Colitis.

Articles referenced: NEJM review on IBD; Work-up of diarrhea in HIV; Is IBD a primary immunodeficiency?