Objectives: Idiopathic colonic inflammation and ulceration have been described in HIV infection, but only as isolated case reports. We have been treating this condition with a uniform corticosteroid protocol and now report our results.
Methods: We describe the cases of eight patients with HIV infection who had diarrhea for more than 4 wk and inflammation and/or ulceration in the colon at endoscopy, confirmed by biopsy, without any invasive pathogens despite extensive evaluation. Each patient was treated with prednisone, starting at 40 mg/day, then tapered according to a standardized protocol.
Results: The diarrhea completely resolved in three patients and partially improved in five. One patient had some improvement but was unable to tolerate the prednisone because of a severe exacerbation of anal warts. He responded to subtotal colectomy. After a minimum follow-up of 8 months (mean, 17 months), only one patient (complete response to prednisone) was found to have an enteric pathogen. In this patient, cytomegalovirus colitis was diagnosed 15 months after prednisone was started.
Conclusion: Idiopathic colonic inflammation or ulceration in HIV infection (1) may respond to corticosteroid therapy without life-threatening side effects and (2) is only rarely followed by the detection of a recognized pathogen. These observations suggest that enteric pathogens are not missed by standard techniques.