Cytomegalovirus Gastrointestinal Disease Masquerading as Inflammatory Bowel Disease in a Patient with Occult HIV Infection Receiving Biologics: A Case Report.

IF 0.7 Q4 GASTROENTEROLOGY & HEPATOLOGY

Case Reports in Gastroenterology Pub Date : 2026-07-10 eCollection Date: 2026-01-01 DOI:10.1159/000553395

Bashar Roumia, Manon Transleau

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Abstract

Introduction: Biologic and targeted synthetic therapies can obscure underlying immunodeficiency and opportunistic infections, leading to diagnostic challenges in patients with presumed autoimmune disease.

Case presentation: A 51-year-old man with ankylosing spondylitis and presumed ulcerative colitis experienced progressive systemic decline, including 40 lb. weight loss and encephalopathy, while receiving etanercept and upadacitinib. Clinical deterioration prompted reassessment, revealing advanced HIV/AIDS (CD4 count 21 cells/µL) and biopsy-confirmed cytomegalovirus esophagitis. Discontinuation of Janus kinase inhibition and initiation of antiretroviral therapy resulted in clinical stabilization.

Conclusion: This case highlights the dangers of diagnostic momentum and demonstrates how opportunistic infections can mimic autoimmune pathology, emphasizing the need for diagnostic reassessment and objectivity in patients receiving potent immunomodulatory therapies.

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隐匿性HIV感染患者接受生物制剂后，巨细胞病毒胃肠道疾病伪装成炎症性肠病：1例报告。

生物和靶向合成治疗可以掩盖潜在的免疫缺陷和机会性感染，导致对推定为自身免疫性疾病的患者的诊断挑战。病例介绍：51岁男性强直性脊柱炎，推定为溃疡性结肠炎，在接受依那西普和upadacitinib治疗期间，出现进行性全身衰退，包括40磅体重减轻和脑病。临床恶化促使重新评估，发现晚期HIV/AIDS （CD4计数21细胞/µL）和活检证实巨细胞病毒食管炎。停止Janus激酶抑制和开始抗逆转录病毒治疗导致临床稳定。结论：本病例强调了诊断冲动的危险性，并展示了机会性感染如何模仿自身免疫病理，强调了在接受强效免疫调节治疗的患者中重新评估诊断和客观性的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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