An Inflammatory Bowel Disease Mimic in a Patient With Human Immunodeficiency Virus

A 45-year-old man with human immunodeficiency virus infection and undetectable viral load on antiretroviral therapy, who engaged in sex with men, was evaluated for 1 month of constipation, abdominal pain, and intermittent rectal bleeding. He reported a transient rash, which resolved at presentation. A colonoscopy (Figure A) showed aphthous ulcers, friability, and exudates in the rectosigmoid colon and cecum with normal intervening colon and terminal ileum. A colonic biopsy (Figure B) showed long, undulating bacteria attached vertically to the brush border, and stained black with Warthin–Starry stain, consistent with human intestinal spirochetosis.

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