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A 42-year-old, male, human immunodeficiency virus (HIV)-infected late-presenter was admitted to our hospital with Pneumocystis jiroveci pneumonia (Pjp). At presentation, his CD4 count was 12/ll (6 %), and the viral load was 471,000 copies/ml. In addition to Pjp treatment, highly active antiretroviral treatment (HAART) was started with tenofovir/emtricitabine and nevirapine. After recovery, he presented to the outpatient department 2 months later. Fig. 1 Colonoscopy revealed diffuse erythema of the mucosa, bleeding by contact, and multiple aphthae. Histology showed graft-versus-host disease-like lesions in biopsies of colon and small bowel. a Severe crypt atrophy and crypt loss of colonic mucosa (arrow crypt abscesses), b small bowel with widespread epithelial cell apoptosis (arrow). c, d Mildly increased lymphocytic infiltrate in the lamina propria consisting of CD4-positive (c) and CD8positive (d) T cells. In view of the fact that human immunodeficiency virus infection leads to a massive depletion of CD4 T cells from the gut [3], the infiltration of the lamina propria with CD4 T cells in this late-presenter (c) is remarkable. Staining: a, b Hematoxylin–eosin, c, d immunohistochemistry. CD4 antibody was from Leica Biosystems, Wetzlar, Germany (1:10); CD8 antibody was from Thermo Fisher Scientific Inc. Rockford, IL (1:25)

Severe non-specific immune reconstitution inflammatory syndrome (IRIS) presenting with graft-versus-host disease-like colitis