EXTENSIVE ULCERATIVE-COLITIS AND EXTRAINTESTINAL MANIFESTATIONS IN A PATIENT WITH HIV-INFECTION AND SIGNIFICANT CD4 T-CELL LYMPHOPENIA

We report a heterosexual patient with HIV infection and a CD4 T-cell c ount of 0.45 x 10(9)/L who developed mild ulcerative proctitis, sacroi leitis and oligoarthritis. While he was treated with 5-aminosalicylic enemas, the patient rapidly developed severe pancolitis. An emergency colectomy without proctectomy was performed. A few months later he suf fered recurrence of ulcerative proctitis, aggravation of arthritic pai n and developed anterior uveitis. All symptoms disappeared after proct ectomy. There was no evidence for opportunistic infection or Kaposi's sarcoma. Antineutrophil cytoplasmic antibodies were positive and the H LA-B27 antigen was present. CD4 counts were lower during the phases of active disease than during remission. This case demonstrates that sev ere ulcerative colitis can occur in the presence of moderate T-cell de fects. In view of a recent report of remission of Crohn's disease unde r comparable circumstances, it is possible that the extent of T-cell i nvolvement in both diseases is radically different.