A 36-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 and metronidazole 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 the ulcers in the rectum, and pathological findings of ulcer margins showed disturbances in 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 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). As there was a dissociation between the rectal mucosal lesions and the submucosal lesions of the entire colon, 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.

Conclusion: HIV infection and IBD are both Immune-Mediated Inflammatory Diseases (IMIDs) and are associated with the development of other IMIDs. However, the risk of developing IBD after HIV infection remains unknown. In People Living With HIV (PLWH) who develop gastrointestinal symptoms, IBD should be considered as a  differential diagnosis for early diagnosis and treatment.

TBA