Rectal Ulceration as an Atypical Initial Gastrointestinal Manifestation of Advanced HIV Infection: A Case Report

Human immunodeficiency virus (HIV) infection can involve the gastrointestinal tract, most commonly resulting in esophageal ulceration. Rectal ulceration associated with HIV is rare and sparsely reported. We describe a 34-year-old male who presented with melena and rectal pain and was found to have large, deep rectal ulcers on colonoscopy. Expanded infectious testing revealed a new diagnosis of advanced HIV infection with an HIV RNA viral load greater than one million copies/mL (log 6.16) and a positive hepatitis C antibody. Additional evaluation demonstrated negative test results for syphilis, gonorrhea, and chlamydia, while the rectal biopsy was negative for cytomegalovirus (CMV), herpes simplex virus (HSV), fungal organisms, granulomatous disease, and malignancy. This case highlights the importance of considering HIV infection in the differential diagnosis of atypical rectal ulceration and illustrates a rare presentation of HIV-associated gastrointestinal disease.