Ref Number = PITIKA-ASPR0140
Dewi Apriani, Nahwa Arkhaesi, Helmia Farida, MMDEAH Hapsari
OBJECTIVE: Gastrointestinal(GI) bleeding is quite common HIV complication. Upper GI bleeding can be caused by several conditions related to HIV: Cytomegalovirus (CMV)infection, Kaposi's sarcoma, oesophageal ulcer while lower GI bleeding is caused most commonly by CMV colitis. The prevalence of upper and lower GI bleeding were 1% and 5,6% respectively. We present a case of a 5 year-old HIV patient with GI bleeding. 
CASE: A 5-year-old girl presented to the emergency department with prolonged fever, bloody stool and 5 kg body weight-loss in the last 2 months. Patient was diagnosed HIV and got ARV therapy since the age of 11 months. Physical examination showed severe chronic malnutrition, anaemic conjunctiva, oral ulcer, and muscle wasting. Laboratory examination revealed normocytic normochromic anaemia, IgG CMV (222 IU/ml), CD4 count of 46cells/mm3. Ulcerative colitis assessed by colon in loop. She also developed urinary tract infection (UTI) caused by E.coli ESBL(+). The final diagnosis were ulcerative colitis, HIV grade IV, CMV, severe immunodeficiency, severe chronic malnutrition, and UTI. She was treated with steroid, antiretroviral, ganciclovir, antibiotics, and adequate nutrition. Colitis therapy was based on the patient Paediatric Ulcerative Colitis Activity Index (PUCAI) score of 65. The patient was discharged on the 14th day of treatment with improved conditions and PUCAI score of 15.
CONCLUTION: Ulcerative colitis in children with HIV is a serious condition, but adequate management can improve patient outcome and quality of life. Ulcerative colitis can be caused by Clostridium difficile, CMV, Cryptosporidium, amoebiasis etc therefore diagnosis should include colonoscopy and biopsy. In this case we considered CMV as the cause of ulcerative colitis base on colon in loop, serology and prompt response to Ganciclovir therapy.

Keywords: HIV, colitis, CMV, GI bleeding, clostridium difficile
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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