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Coelho R, Gonçalves R, Mendes F, Macedo G. Gastroenterology healthcare in LGBTQ+ individuals. Eur J Gastroenterol Hepatol 2024; 36:1059-1067. [PMID: 38916210 DOI: 10.1097/meg.0000000000002808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Lesbian, gay, bisexual, transgender, queer, or questioning individuals, as well as those with another diverse identity (LGBTQ+), present specific nuances in healthcare that physicians must consider in clinical practice. Particularly, gastroenterologists are nowadays facing different issues in several fields regarding LGBTQ+ healthcare, such as endoscopy, inflammatory bowel disease, hepatology, and proctology. In this study, the authors provide a practice-oriented and up-to-date review reinforcing the importance of some of the most prevalent pathologies associated with sexuality that gastroenterologists may encounter in their clinical practice. In terms of endoscopy, authors describe the endoscopic findings related to human papillomavirus (HPV) infection: the esophageal squamous papilloma and cell carcinoma; also highlight the importance of retroflexion maneuver during a routine colonoscopy that allows detection of anal intraepithelial neoplasia lesions that can be anal cancer precursors. Regarding inflammatory bowel disease, some considerations are made about the differential diagnosis with infectious proctitis, and the topic of the risk of anal cancer due to HPV infection, in this specific population, is also addressed. Considering hepatology, the authors review the most important issues related to hepatotropic sexually transmitted infections. The authors also make some comments regarding the possibility of drug-induced liver injury in gender-affirming hormone therapy and pre-exposure prophylaxis for HIV prevention. Finally, considering the proctology field, an up-to-date review is performed regarding anal cancer screening, HPV infection and related diseases, and infectious proctitis management.
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Affiliation(s)
- Rosa Coelho
- Gastroenterology Department, Centro Hospitalar Universitário de São João
- Gastroenterology Department, World Gastroenterology Organization Training Center
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Raquel Gonçalves
- Gastroenterology Department, Centro Hospitalar Universitário de São João
- Gastroenterology Department, World Gastroenterology Organization Training Center
| | - Francisco Mendes
- Gastroenterology Department, Centro Hospitalar Universitário de São João
- Gastroenterology Department, World Gastroenterology Organization Training Center
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João
- Gastroenterology Department, World Gastroenterology Organization Training Center
- Faculty of Medicine, University of Porto, Porto, Portugal
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2
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Paulus-Andres JA, Lavery MM. Acute Infectious Proctitis Caused by Anorectal Sexually Transmitted Infections. Dis Colon Rectum 2023; 66:1157-1159. [PMID: 37339280 DOI: 10.1097/dcr.0000000000002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
- Jordan A Paulus-Andres
- Department of Colon and Rectal Surgery, Swedish Medical Center, Swedish Medical Center First Hill Campus, Seattle, Washington
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3
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Strobel TM, Desai NA, Arrington-Sanders R. Acute Infectious Proctitis in Adolescents. Pediatr Rev 2023; 44:491-497. [PMID: 37653133 DOI: 10.1542/pir.2022-005862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The diagnosis of acute proctitis requires understanding who is at risk, being aware of symptoms, and leveraging a thorough sexual history with appropriate risk stratification to make the diagnosis. Cases have been concentrated in adolescents (ages 15-19 years), young adults (ages 20-24 years), men and transgender women who have sex with men, and those with a history of human immunodeficiency virus infection. Black adolescents experience a disproportionately high number of cases of proctitis due to an intersection of concentrated cases in sexual networks and delayed screening/diagnosis due to health care access barriers. Signs and symptoms include purulent discharge, bleeding, pain, tenesmus, pruritus, diarrhea or constipation, weight loss, or fever. Multisite sexually transmitted infection testing should be offered based on risk stratification (eg, history of condomless anal sex, oral intercourse, number of sex partners). Further management includes promotion of barrier protection and preexposure prophylaxis, routine surveillance, partner notification, and routine access to preventive immunizations.
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Affiliation(s)
| | - Neerav A Desai
- Division of Adolescent and Young Adult Health, Vanderbilt University Medical Center, Nashville, TN
| | - Renata Arrington-Sanders
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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4
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Inflammatory Bowel Disease in Adult HIV-Infected Patients-Is Sexually Transmitted Infections Misdiagnosis Possible? J Clin Med 2022; 11:jcm11185324. [PMID: 36142970 PMCID: PMC9506593 DOI: 10.3390/jcm11185324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background. The aim of our study was to describe 50 cases of inflammatory bowel disease (IBD) and HIV co-existence that are under medical supervision in Warsaw. Methods. This was a retrospective descriptive study. Fifty HIV-infected patients, diagnosed with IBD during the years 2001–2019, were identified. IBD was diagnosed endoscopically and then confirmed by biopsy. All data was obtained from medical records. Results. All studied patients were male with a median age of 33 years old (range 20–58 years). All, except one, were men who have sex with men (MSM). The median CD4 cell count was 482 cells/µL (range 165–1073 cells/µL). Crohn’s disease (CD) was diagnosed in 7 patients (14%), ulcerative colitis (UC) in 41 patients (82%), and 2 patients (4%) had indeterminate colitis. Forty-nine patients (98%) reported a history of unprotected receptive anal intercourse and different sexual transmitted infections (STIs). Only in 10 patients (20%) were one or more IBD relapses observed. Conclusions. We recommend HIV testing for every MSM with IBD suspicion. Moreover, STIs testing should be performed in every IBD patient with colorectal inflammation, using molecular and serological methods. Persons who reported unprotected receptive anal intercourse seem to have the biggest risk of STI-associated proctitis or proctocolitis mimicking IBD.
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Cox BK, Larson BK, Hutchings DA, Morgan M, Balzer BL, Waters KM. The Histopathology of Anorectal Neisseria gonorrhoeae Infection. Am J Clin Pathol 2022; 158:559-563. [PMID: 35938627 DOI: 10.1093/ajcp/aqac089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/07/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Neisseria gonorrhoeae infection of the anorectal tract is often asymptomatic and infrequently biopsied, but pathologists can be tasked with identifying the histologic features of possible infection. The study was undertaken to better characterize clinical and morphologic features of confirmed anorectal gonococcal infection. METHODS From 2011 to 2020, 201 positive gonococcal nucleic acid amplification testing samples from 174 patients collected from the distal colorectum and/or anus were matched to eight patients with concurrent biopsy specimens of the distal anorectum. Complete demographic, clinical, and infectious information was collected for each biopsied patient. The histomorphologic features of each biopsy were systematically tabulated. RESULTS All eight gonococcal cases were obtained from men who have sex with men. Each case showed at least mild acute inflammation with moderate activity identified in one case with concurrent cytomegalovirus infection. Intense lymphoplasmacytic infiltration was not commonly seen (two of eight). Half of the cases showed mucosal ulceration, and seven of eight cases demonstrated lymphoid aggregates. CONCLUSIONS The microscopic features are mild compared with other well-described types of infectious proctitis, with most cases displaying mild acute inflammation and scattered lymphoid aggregates. These findings highlight the importance of obtaining a complete patient history and recommending additional infectious workup even when only subtle changes are present.
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Affiliation(s)
- Brian K Cox
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Brent K Larson
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Danielle A Hutchings
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Margie Morgan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bonnie L Balzer
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kevin M Waters
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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6
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Gupta S, Allegretti JR. Mimics of Crohn's Disease. Gastroenterol Clin North Am 2022; 51:241-269. [PMID: 35595413 DOI: 10.1016/j.gtc.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Crohn's disease is a chronic inflammatory disease that can affect any portion of the gastrointestinal tract. Associated symptoms can vary based on the severity of disease, extent of involvement, presence of extraintestinal manifestations, and development of complications. Diagnosis is based on a constellation of findings. Many diseases can mimic Crohn's disease and lead to diagnostic conundrums. These include entities associated with the gastrointestinal luminal tract, vascular disease, autoimmune processes, various infections, malignancies and complications, drug- or treatment-induced conditions, and genetic diseases. Careful consideration of possible causes is necessary to establish the correct diagnosis.
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Affiliation(s)
- Sanchit Gupta
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 850 Boyslton Street, Suite 201, Chestnut Hill, MA 02467, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 850 Boyslton Street, Suite 201, Chestnut Hill, MA 02467, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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7
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Feakins R, Torres J, Borralho-Nunes P, Burisch J, Cúrdia Gonçalves T, De Ridder L, Driessen A, Lobatón T, Menchén L, Mookhoek A, Noor N, Svrcek M, Villanacci V, Zidar N, Tripathi M. ECCO Topical Review on Clinicopathological Spectrum and Differential Diagnosis of Inflammatory Bowel Disease. J Crohns Colitis 2022; 16:343-368. [PMID: 34346490 DOI: 10.1093/ecco-jcc/jjab141] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Many diseases can imitate inflammatory bowel disease [IBD] clinically and pathologically. This review outlines the differential diagnosis of IBD and discusses morphological pointers and ancillary techniques that assist with the distinction between IBD and its mimics. METHODS European Crohn's and Colitis Organisation [ECCO] Topical Reviews are the result of an expert consensus. For this review, ECCO announced an open call to its members and formed three working groups [WGs] to study clinical aspects, pathological considerations, and the value of ancillary techniques. All WGs performed a systematic literature search. RESULTS Each WG produced a draft text and drew up provisional Current Practice Position [CPP] statements that highlighted the most important conclusions. Discussions and a preliminary voting round took place, with subsequent revision of CPP statements and text and a further meeting to agree on final statements. CONCLUSIONS Clinicians and pathologists encounter a wide variety of mimics of IBD, including infection, drug-induced disease, vascular disorders, diverticular disease, diversion proctocolitis, radiation damage, and immune disorders. Reliable distinction requires a multidisciplinary approach.
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Affiliation(s)
- Roger Feakins
- Department of Cellular Pathology, Royal Free Hospital, London, and University College London, UK
| | - Joana Torres
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Paula Borralho-Nunes
- Department of Pathology, Hospital Cuf Descobertas, Lisboa and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Johan Burisch
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Tiago Cúrdia Gonçalves
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal.,School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Lissy De Ridder
- Department of Paediatric Gastroenterology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands
| | - Ann Driessen
- Department of Pathology, University Hospital Antwerp, University Antwerp, Edegem, Belgium
| | - Triana Lobatón
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Luis Menchén
- Department of Digestive System Medicine, Hospital General Universitario-Insitituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Department of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain
| | - Aart Mookhoek
- Department of Pathology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nurulamin Noor
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Magali Svrcek
- Department of Pathology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Vincenzo Villanacci
- Department of Histopathology, Spedali Civili and University of Brescia, Brescia, Italy
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Monika Tripathi
- Department of Histopathology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Mascarenhas Saraiva M, Ribeiro TF, Macedo G. Infectious Proctitis in Ulcerative Colitis: The Importance of an Accurate Differential Diagnosis. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:354-359. [PMID: 34604467 DOI: 10.1159/000510784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/07/2020] [Indexed: 11/19/2022]
Abstract
The authors present the case of a 62-year-old male presenting with a relapse of ulcerative colitis. He had unprotected anal intercourse with other men and his medical record was remarkable for HIV infection. He was admitted to the emergency department with bloody diarrhea, tenesmus, urgency, and recent weight loss. Laboratory workup revealed de novo mild anemia and mild elevation of inflammation parameters. Endoscopic evaluation displayed loss of normal vascular pattern, edema, erythema, exudation, and superficial ulceration in the distal rectum. Biopsies showed chronic proctitis with mild to moderate activity. The patient was treated with intravenous glucocorticoids, but symptoms persisted. Extensive microbial study allowed the identification of multiple infectious agents with potential for infectious proctitis: cytomegalovirus, Chlamydia trachomatis, and Blastocystis hominis. This case highlights the importance of careful microbial investigation, supporting a detailed clinical history, in patients presenting with symptoms of inflammatory bowel disease flare, particularly in risk groups such as that with sexual risk.
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Affiliation(s)
| | - Tiago Filipe Ribeiro
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
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9
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Romero Estarlich V, Grau Herrera A, Kestler Hernández M, Serra Rexach JA. [Chlamydia trachomatis proctitis in octogenary male]. Rev Esp Geriatr Gerontol 2021; 57:53-54. [PMID: 34304926 DOI: 10.1016/j.regg.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | - Ana Grau Herrera
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Martha Kestler Hernández
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Jose Antonio Serra Rexach
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España
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10
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Costales-Cantrell JK, Dong EY, Wu BU, Nomura JH. Syphilitic Proctitis Presenting as a Rectal Mass: a Case Report and Review of the Literature. J Gen Intern Med 2021; 36:1098-1101. [PMID: 33469766 PMCID: PMC8042098 DOI: 10.1007/s11606-020-06414-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Jessica K Costales-Cantrell
- Division of Infectious Diseases, University of California Irvine Medical Center, 101 City Drive South, City Tower Suite 400, Orange, CA, 92868, USA.
| | - Elizabeth Y Dong
- Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Bechien U Wu
- Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Jim H Nomura
- Division of Infectious Diseases, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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11
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Abstract
Sexually transmitted infections (STIs) are diseases that are transmitted from one person to another person through acts of vaginal, anal, or oral intercourse. The increased presence of STIs among men who have sex with men (MSM) results in a higher rate of STI-related diagnoses, such as proctitis. Proctitis is a common, but often misdiagnosed condition experienced by MSM who present to primary care, urgent care, and emergency settings. It is important that health care providers be knowledgeable of the pathophysiology, risk factors, and clinical presentation of proctitis among MSM for accurate and timely management.
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Affiliation(s)
- Julia M Steed
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
| | - Queen Henry-Okafor
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA
| | - Courtney J Pitts
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA
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12
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Dababneh Y, Brahmbhatt B, Mousa OY. Granulomas, Proctitis, and HIV: Complex Diagnosis with a Simple Treatment. Gastroenterology 2020; 158:1546-1547. [PMID: 32017908 DOI: 10.1053/j.gastro.2020.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Yara Dababneh
- Department of Medicine, The Hashemite University, Zarqa, Jordan.
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Omar Y Mousa
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota; Division of Gastroenterology and Hepatology, Mayo Clinic Health System, Mankato, Minnesota
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13
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Rizza S, Mistrangelo M, Ribaldone DG, Morino M, Astegiano M, Saracco GM, Pellicano R. Proctitis: a glance beyond inflammatory bowel diseases. MINERVA GASTROENTERO 2020; 66:252-266. [PMID: 32218425 DOI: 10.23736/s1121-421x.20.02670-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Proctitis is an inflammation involving the anus and the distal part of the rectum, frequently diagnosed in the context of inflammatory bowel diseases (IBD). Nevertheless, when the standard therapy for IBD is ineffective, it becomes necessary for the clinician to review alternative etiologies, beginning from the broad chapter of infectious causes up to rare causes such as radiation, ischemia, diversion and traumatisms. While it is possible to find infectious proctitides caused by pathogens generally inducing extensive colitis, the growing incidence of both sexually transmitted infections and isolated proctitis reported in the recent years require a lot of attention. The risk appears to be higher in individuals participating in anal intercourse, especially men having sex with men (MSM) or subjects who use sex toys and participate to sex parties, dark rooms and so on. The commonest implicated pathogens are Neysseria gonorrhoeae, Chlamydia trachomatis, Herpes Simplex virus and Treponema pallidum. Herpes and Chlamydia infections mainly occur in HIV-positive MSM patients. Since symptoms and signs are common independently from etiology, performing a differential diagnosis based on clinical manifestations is complicated. Therefore, the diagnosis is supported by the combination of clinical history and physical examination and, secondly, by endoscopic, serologic and microbiologic findings. Particular emphasis should be given to simultaneous infections by multiple organisms. The involvement of experts in infectious diseases and in sexual health is crucial for the diagnostic and therapeutic management. The available therapies, empirically initiated or specific, in many cases are able to guarantee a good prognosis and to prevent relapses.
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Affiliation(s)
- Stefano Rizza
- Unit of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Davide G Ribaldone
- Unit of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Marco Astegiano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giorgio M Saracco
- Unit of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy.,Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
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14
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Neri B, Stingone C, Romeo S, Sena G, Gesuale C, Compagno M, De Cristofaro E, Baciorri F, Del Vecchio Blanco G, Palmieri G, Sarmati L, Biancone L. Inflammatory bowel disease versus Chlamydia trachomatis infection: a case report and revision of the literature. Eur J Gastroenterol Hepatol 2020; 32:454-457. [PMID: 31851086 DOI: 10.1097/meg.0000000000001605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Infectious proctitis may mimic inflammatory bowel disease, particularly when limited to the rectum. The present case report includes findings from a 50-year-old man, soldier, referring to our Inflammatory Bowel Disease Unit with a diagnosis of rectal Crohn's disease, refractory to conventional treatments. Mild anemia, hypergammaglobulinemia and HIV-antibodies seronegativity were detected. Entero-MRI and stool examinations were negative. Ileocolonoscopy detected few rectal ulcers with irregular edges. Endosonography showed marked thickening of the rectal wall and enlarged perirectal lymphnodes. Nodal and rectal fine needle aspirate did not show atypia (PAN CK-). Rectal biopsies showed flogistic granular tissue (PAN CK-): Warthin-Starry stain was negative. Previous Treponema pallidum infection was detected. Clinical history revealed habits at risk for sexually transmitted infection. Rectal swabs for RT-PCR for Chlamydia trachomatis, Neisseria gonorrhoeae, and Herpes Simplex Virus 1-2 lead to a diagnosis of lymphogranuloma venereum. Doxycycline 100 mg and Azitromicyn 500 mg t.i.d. were given for 21 days, followed by negativity for RT-PCR for Chlamydia trachomatis at rectal swabs. Complete disappearance of symptoms and mucosal healing occurred. Due to the increased frequency of infectious diseases, sexually transmitted infection (including lymphogranuloma venereum) should be considered as possible differential diagnosis when assessing patients with inflammatory bowel disease limited to the rectum.
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Affiliation(s)
- Benedetto Neri
- Department of Systems Medicine, Unit of Gastroenterology, University 'Tor Vergata' of Rome
| | - Christof Stingone
- Department of Systems Medicine, Unit of Infectious Diseases, University 'Tor Vergata' of Rome, Rome
| | - Samanta Romeo
- Department of Systems Medicine, Unit of Gastroenterology, University 'Tor Vergata' of Rome
- AAST Ospedale Maggiore di Crema, Scienze mediche, Unità di Gastroenterologia ed Endoscopia Digestiva, Crema
| | - Giorgia Sena
- Department of Systems Medicine, Unit of Gastroenterology, University 'Tor Vergata' of Rome
| | - Cristina Gesuale
- Department of Systems Medicine, Unit of Gastroenterology, University 'Tor Vergata' of Rome
| | - Mirko Compagno
- Department of Systems Medicine, Unit of Infectious Diseases, University 'Tor Vergata' of Rome, Rome
| | - Elena De Cristofaro
- Department of Systems Medicine, Unit of Gastroenterology, University 'Tor Vergata' of Rome
| | | | | | | | - Loredana Sarmati
- Department of Systems Medicine, Unit of Infectious Diseases, University 'Tor Vergata' of Rome, Rome
| | - Livia Biancone
- Department of Systems Medicine, Unit of Gastroenterology, University 'Tor Vergata' of Rome
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15
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Tian M, Chang C, Wu P, Chen M. Diagnosis of syphilitic proctitis mimicking ulcerative colitis—A case report. ADVANCES IN DIGESTIVE MEDICINE 2019. [DOI: 10.1002/aid2.13165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ming‐Hung Tian
- Division of Gastroenterology and Hepatology, Department of Internal MedicineMacKay Memorial Hospital Taipei Taiwan
| | - Chen‐Wang Chang
- Division of Gastroenterology and Hepatology, Department of Internal MedicineMacKay Memorial Hospital Taipei Taiwan
- Department of NursingMacKay Junior College of Medicine, Nursing, and Management Taipei Taiwan
- Department of MedicineMacKay Medical College New Taipei City Taiwan
| | - Pao‐Shu Wu
- Department of PathologyMacKay Memorial Hospital Taipei Taiwan
| | - Ming‐Jen Chen
- Division of Gastroenterology and Hepatology, Department of Internal MedicineMacKay Memorial Hospital Taipei Taiwan
- Department of NursingMacKay Junior College of Medicine, Nursing, and Management Taipei Taiwan
- Department of MedicineMacKay Medical College New Taipei City Taiwan
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16
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Abstract
This article provides a practical overview for the management of nonviral sexually transmitted diseases affecting the perianal and anorectal regions. Clinical manifestations, diagnosis, and treatment of syphilis, gonorrhea, chancroid, donovanosis, and lymphogranuloma venereum are individually addressed.
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Affiliation(s)
- Kyle G. Cologne
- Division of Colon and Rectal Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Christine Hsieh
- Division of Colon and Rectal Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, California
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17
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Egal A, London J, Lidove O, Atienza P, Etienney I. [Anorectal manifestations in systemic diseases]. Rev Med Interne 2019; 40:729-732. [PMID: 31400822 DOI: 10.1016/j.revmed.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/08/2019] [Accepted: 07/17/2019] [Indexed: 11/25/2022]
Abstract
Numerous systemic diseases (vasculitis, connective tissue disease or sarcoidosis) can display an involvement of the perianal skin, the rectum and/or the anus. Such knowledge is important in order to treat these complications specifically when possible. Lesions of the anorectum arising from systemic diseases can sometimes cause perforations in the peritoneal cavity (if concerning the higher portion of the rectum) and/or fistulization to the anal margin. Differential diagnosis, mostly infectious or inflammatory (Crohn's disease) must be ruled out in every case. Other systemic diseases can display specific manifestations as this is the case in scleroderma which can lead to anal incontinence. Despite the relative rarity of these manifestations, their ignorance would forbid global management of these complex diseases. It should thus be detected in each consultation and a regular follow-up must be provided with a proctologist and/or a gastroenterologist when needed.
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Affiliation(s)
- A Egal
- Service de proctologie chirurgicale, hôpital Croix Saint-Simon, 75020 Paris, France.
| | - J London
- Service de médecine interne, hôpital Croix Saint-Simon, 75020 Paris, France
| | - O Lidove
- Service de médecine interne, hôpital Croix Saint-Simon, 75020 Paris, France
| | - P Atienza
- Service de proctologie chirurgicale, hôpital Croix Saint-Simon, 75020 Paris, France
| | - I Etienney
- Service de proctologie chirurgicale, hôpital Croix Saint-Simon, 75020 Paris, France
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Chen HW, Lee CH, Chang KC. Rectal mass in a patient with HIV infection. J Clin Pathol 2019; 72:648. [PMID: 31113826 DOI: 10.1136/jclinpath-2018-205558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 11/12/2018] [Accepted: 12/18/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Hui-Wen Chen
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kung-Chao Chang
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Di Altobrando A, Tartari F, Filippini A, D'Antuono A, Patrizi A, Filippi F, Sechi A, Cuicchi D, Salfi NCM, Gaspari V. Lymphogranuloma venereum proctitis mimicking inflammatory bowel diseases in 11 patients: a 4-year single-center experience. CROHN'S & COLITIS 360 2019. [DOI: 10.1093/crocol/otz004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
ABSTRACT
Lymphogranuloma venereum (LGV) is a sexually transmitted disease caused by Chlamydia trachomatis (CT) serovars L1–L3. Our study wants to underline the similarities between rectal LGV and idiopathic inflammatory bowel diseases (IBD), which can share clinical, endoscopic and histopathological findings.
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Affiliation(s)
- Ambra Di Altobrando
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Federico Tartari
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Andrea Filippini
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Universita degli Studi di Bologna Scuola di Medicina e Chirurgia, Bologna, Italy
| | - Antonietta D'Antuono
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Federica Filippi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Andrea Sechi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Dajana Cuicchi
- Surgery of the Alimentary Tract, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Valeria Gaspari
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Abstract
Syphilis, a sexually transmitted infection caused by the Gram-negative bacterium Treponema pallidum, is increasing in prevalence in the United States. It has been our experience that primary and secondary syphilis of the aerodigestive tract can afflict a large age spectrum with varied clinical and histopathologic findings, which can lead to diagnostic problems and frequent misdiagnosis. In this study, we describe the histopathologic patterns of syphilis of the aerodigestive tract to expand awareness of its varied appearance. We identify 3 patterns of inflammatory response to syphilis: plasma cell-rich, lymphohistiocytic, and lymphoma-like. We also report the presence of immunoglobulin G4-predominant plasma cells in the inflammatory response as a potential mimicker of immunoglobulin G4-related disease. Lastly, we found that use of T. pallidum immunohistochemical stain is more reliable than Steiner silver stain at the identification of spirochetes. Our study highlights that despite convention, plasma cells are not always abundant in syphilis. Awareness of the histopathologic range of syphilis in the aerodigestive tract by the surgical pathologist can lead to the correct diagnosis and guide appropriate treatment.
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Santos AL, Coelho R, Silva M, Rios E, Macedo G. Infectious proctitis: a necessary differential diagnosis in ulcerative colitis. Int J Colorectal Dis 2019; 34:359-362. [PMID: 30402768 DOI: 10.1007/s00384-018-3185-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In the last years, there was a rising in the incidence of sexually transmitted infections, including proctitis. Infectious proctitis (IP), mainly caused by agents like Neisseria gonorrhea and Chlamydia trachomatis, is an entity that should be considered when patients with suspected inflammatory bowel disease (IBD) are approached, mainly if they have risk factors such as anal intercourse. CLINICAL CASES/DISCUSSION The symptoms of IP, like rectal blood, mucous discharge, and anorectal pain, may appear in other causes of proctitis, like IBD. Therefore, to establish the diagnosis, it is crucial to take a detailed history and perform a physical examination, with the diagnosis being supported by complementary tests such as rectosigmoidoscopy, histology, serology, and culture. Depending on the etiology, treatment of IP is based in antibiotics or antivirals, which may be empirically initiated. Co-infections, mainly those that are sexually transmitted, and HIV should be tested and sexual partners should be treated, accordingly. In this article, the authors report three cases of IP, referent to three different patients, and review the initial approach required in cases where there is a clinical and/or endoscopic suspicion of this pathology.
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Affiliation(s)
- Ana L Santos
- Gastroenterology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-019, Porto, Portugal. .,WGO Oporto Training Center, Porto Medical School, University of Porto, Porto, Portugal. .,Pathology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-019, Porto, Portugal.
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-019, Porto, Portugal.,WGO Oporto Training Center, Porto Medical School, University of Porto, Porto, Portugal.,Pathology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-019, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-019, Porto, Portugal.,WGO Oporto Training Center, Porto Medical School, University of Porto, Porto, Portugal.,Pathology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-019, Porto, Portugal
| | - Elisabete Rios
- Gastroenterology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-019, Porto, Portugal.,WGO Oporto Training Center, Porto Medical School, University of Porto, Porto, Portugal.,Pathology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-019, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-019, Porto, Portugal.,WGO Oporto Training Center, Porto Medical School, University of Porto, Porto, Portugal.,Pathology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-019, Porto, Portugal
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López Álvarez M, Souto Ruzo J, Guerrero Montañés A. Rectal syphilitic ulcer. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 110:597. [PMID: 30032631 DOI: 10.17235/reed.2018.5592/2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Shyphilis is a chronic infectious disease caused by Treponema Pallidum bacteria. Syphilis is most commonly spread through sexual activity, by direct contact with the inoculation point of the spirochete. It has been demonstrated that the desease is more prevalent in men who have sex with men. In primary syphilis, the chancre appears 2-3 weeks after the initial exposure mostly in genitals, but also in oral cavity, pharynx or anus. Secondary syphilis is a systemic disease. It occurs weeks or months later in about 25% of people with primary syphilis that has not been treated. Although many people who present with secondary syphilis do not report previosly having had the classic chancre of primary syphilis.
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Gecse KB, Vermeire S. Differential diagnosis of inflammatory bowel disease: imitations and complications. Lancet Gastroenterol Hepatol 2018; 3:644-653. [PMID: 30102183 DOI: 10.1016/s2468-1253(18)30159-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 12/16/2022]
Abstract
Inflammatory bowel disease (IBD) is characterised by episodes of relapse and periods of remission. However, the clinical features, such as abdominal pain, diarrhoea, and rectal bleeding, are not specific. Therefore, the differential diagnosis can include a broad spectrum of inflammatory or infectious diseases that mimic IBD, as well as others that might complicate existing IBD. In this Review, we provide an overview of ileocolitis of diverse causes that are relevant in the differential diagnosis of IBD. We highlight the importance of accurate patient profiling and give a practical approach to identifying factors that should trigger the search for a specific cause of intestinal inflammation. Mimics of IBD include not only infectious causes of colitis-and particular attention is required for patients from endemic areas of tuberculosis-but also vascular diseases, diversion colitis, diverticula or radiation-related injuries, drug-induced inflammation, and monogenic diseases in very-early-onset refractory disease. A superinfection with cytomegalovirus or Clostridium difficile can aggravate intestinal inflammation in IBD, especially in patients who are immunocompromised. Special consideration should be made to the differential diagnosis of perianal disease.
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Affiliation(s)
- Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
| | - Severine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
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Abstract
We describe a 60-year-old man who presented with rectal pain and bleeding of a month's duration. His presentation was highly suggestive of lymphogranuloma venereum (LGV) proctitis. Nucleic acid amplification for chlamydia and gonorrhea via rectal swab revealed evidence supportive of anorectal chlamydia. Treatment with doxycycline resulted in complete resolution of his symptoms.
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Affiliation(s)
- Tucker Harrison
- Division of Cardiology (Harrison), Department of Internal Medicine (Som, Stroup), Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Mo Som
- Division of Cardiology (Harrison), Department of Internal Medicine (Som, Stroup), Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Jeff Stroup
- Division of Cardiology (Harrison), Department of Internal Medicine (Som, Stroup), Oklahoma State University Medical Center, Tulsa, Oklahoma
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Jawale R, Lai KK, Lamps LW. Sexually transmitted infections of the lower gastrointestinal tract. Virchows Arch 2017; 472:149-158. [PMID: 29124332 DOI: 10.1007/s00428-017-2261-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/22/2017] [Accepted: 10/26/2017] [Indexed: 11/25/2022]
Abstract
The World Health Organization estimates that there is greater than one million new cases of sexually transmitted infections (STIs) every day. In many countries, STIs are at an unprecedented high, including the USA, where nearly 20 million new cases were reported in 2016. Although morbidity associated with STIs is usually seen in the context of genitourinary disease, these pathogens may also affect the gastrointestinal tract and cause anal pain, abdominal pain, or diarrhea. It is important to recognize patterns of injury associated with these pathogens, especially those that may mimic other gastrointestinal diseases, such as idiopathic inflammatory bowel disease (IBD). This review focuses upon STIs of the lower gastrointestinal tract, organized by the most common site of involvement: the anus, rectum, and colon.
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Affiliation(s)
- Rahul Jawale
- Department of Pathology, Baystate Medical Center, Springfield, MA, USA
| | - Keith K Lai
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Avenue, L-25, Cleveland, OH, 44195, USA.
| | - Laura W Lamps
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
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Groome M, Robinson EM, Mowat C, Morieux AML, Allstaff S. Are patients in the IBD clinic at risk of proctitis secondary to sexually transmitted infections? Frontline Gastroenterol 2017; 8:267-271. [PMID: 29067152 PMCID: PMC5641844 DOI: 10.1136/flgastro-2016-100790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/11/2017] [Accepted: 01/19/2017] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To gauge the potential risk of sexually transmitted infection (STI) as a cause of proctitis in a cohort of patients with inflammatory bowel disease (IBD) and to gauge whether this cohort could benefit from STI testing in the future. DESIGN Patients attending the IBD clinic were given an anonymous questionnaire recording demographics, sexual behaviour, rectal symptoms, history of receptive anal intercourse (RAI), STIs and attitudes towards sexual health screening. SETTING A gastroenterology teaching hospital IBD clinic. PATIENTS 280 consecutive patients attending a teaching hospital IBD clinic over a consecutive 6-week period. All patients had an endoscopic, radiological and/or histological diagnosis of IBD. RESULTS 280 questionnaires were distributed and 274 analysed (3 incomplete, 2 not returned, 1 no sexual activity). 167 female (median: 46 years, range 17-81 years) and 107 males. Two males disclosed RAI and were used as a control. Of the 167 females, 96% were heterosexual, 2.4% were same-sex partners and 1.2% were bisexual. 14% had a history of RAI-this group had more previous STIs (40%) versus those with no history RAI (5%) (p<0.0001; relative risk (RR) 13.41). Chronic rectal pain was more frequent in women with RAI (RR 2.4; p≤0.03). No difference in rectal discharge (RR 1.75; p=0.72) or bleeding (p=0.3). CONCLUSIONS This is the first report of sexual behaviours in a non-genitourinary medicine clinic; giving a unique insight into sexual practices in a cohort of patients with IBD. A past history of STI and RAI can identify risk and we propose testing for those with a history of STI, RAI, men who have sex with men and women aged under 25 years.
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Affiliation(s)
- Maximillian Groome
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK
| | - Emma M Robinson
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK
| | - Craig Mowat
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK
| | | | - Sarah Allstaff
- Tayside Sexual and Reproductive Health Service, Ninewells Hospital and Medical School, Dundee, UK
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Ischemic Proctitis Presenting as Rectal Pain and Bloody Diarrhea with No Apparent Cause. ACG Case Rep J 2017; 4:e88. [PMID: 28761891 PMCID: PMC5519404 DOI: 10.14309/crj.2017.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 06/15/2017] [Indexed: 11/17/2022] Open
Abstract
Acute ischemic proctitis is a rare condition usually resulting from severe vascular disease or an acute vascular occlusion. The diagnosis is made on endoscopy, and mortality rates approach 20-40%. Many patients will require a proctectomy as the definitive treatment, especially for gangrenous proctitis. We describe an unusual presentation of acute ischemic proctitis in a patient without preexisting vascular disease or other precipitants. Furthermore, our patient recovered entirely with conservative management and intravenous antibiotics alone. We review the existing literature on ischemic proctitis and highlight the need for future research to better diagnose and manage this rare condition.
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Herpes Simplex Proctitis Mimicking Inflammatory Bowel Disease in a Teenaged Male. Case Rep Pediatr 2017; 2017:3547230. [PMID: 28473937 PMCID: PMC5394410 DOI: 10.1155/2017/3547230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/28/2017] [Indexed: 01/02/2023] Open
Abstract
We report the case of a 17-year-old male who was initially assessed for pain with defecation, bloody rectal discharge, and diarrhea, consistent with proctitis. Though proctitis is most commonly due to inflammatory bowel disease (IBD), infectious etiologies must also be considered, including sexually transmitted causes of infectious proctitis. In discussion of his sexual history, he identified as homosexual and acknowledged engaging in receptive anal intercourse. Rectal biopsies obtained via colonoscopy were culture-positive for herpes simplex virus (HSV), leading to a diagnosis of HSV proctitis and treatment with an appropriate antiviral medication. HSV proctitis is more common in individuals with high-risk sexual practices, including men who have sex with men. While this may be an uncommon diagnosis for pediatricians to make in practice, a high clinical index of suspicion for sexually transmitted infectious proctitis in those with risk factors must be maintained in order to facilitate appropriate testing, treatment, and counseling of affected individuals.
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Zhang S, Cao X, Huang H. Sampling Strategies for Three-Dimensional Spatial Community Structures in IBD Microbiota Research. Front Cell Infect Microbiol 2017; 7:51. [PMID: 28286741 PMCID: PMC5323387 DOI: 10.3389/fcimb.2017.00051] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/10/2017] [Indexed: 12/12/2022] Open
Abstract
Identifying intestinal microbiota is arguably an important task that is performed to determine the pathogenesis of inflammatory bowel diseases (IBD); thus, it is crucial to collect and analyze intestinally-associated microbiota. Analyzing a single niche to categorize individuals does not enable researchers to comprehensively study the spatial variations of the microbiota. Therefore, characterizing the spatial community structures of the inflammatory bowel disease microbiome is critical for advancing our understanding of the inflammatory landscape of IBD. However, at present there is no universally accepted consensus regarding the use of specific sampling strategies in different biogeographic locations. In this review, we discuss the spatial distribution when screening sample collections in IBD microbiota research. Here, we propose a novel model, a three-dimensional spatial community structure, which encompasses the x-, y-, and z-axis distributions; it can be used in some sampling sites, such as feces, colonoscopic biopsy, the mucus gel layer, and oral cavity. On the basis of this spatial model, this article also summarizes various sampling and processing strategies prior to and after DNA extraction and recommends guidelines for practical application in future research.
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Affiliation(s)
- Shaocun Zhang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin UniversityTianjin, China; Key Laboratory of Systems Bioengineering, Ministry of Education, Tianjin UniversityTianjin, China; Collaborative Innovation Center of Chemical Science and EngineeringTianjin, China
| | - Xiaocang Cao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital; Tianjin Medical University Tianjin, China
| | - He Huang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin UniversityTianjin, China; Key Laboratory of Systems Bioengineering, Ministry of Education, Tianjin UniversityTianjin, China; Collaborative Innovation Center of Chemical Science and EngineeringTianjin, China
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Díaz-Jaime F, Satorres Paniagua C, Bustamante Balén M. Primary chancre in the rectum: an underdiagnosed cause of rectal ulcer. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:236-237. [DOI: 10.17235/reed.2017.4457/2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Phadke VK, Friedman-Moraco RJ, Quigley BC, Farris AB, Norvell JP. Concomitant herpes simplex virus colitis and hepatitis in a man with ulcerative colitis: Case report and review of the literature. Medicine (Baltimore) 2016; 95:e5082. [PMID: 27759636 PMCID: PMC5079320 DOI: 10.1097/md.0000000000005082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Herpesvirus infections often complicate the clinical course of patients with inflammatory bowel disease; however, invasive disease due to herpes simplex virus is distinctly uncommon. METHODS We present a case of herpes simplex virus colitis and hepatitis, review all the previously published cases of herpes simplex virus colitis, and discuss common clinical features and outcomes. We also discuss the epidemiology, clinical manifestations, diagnosis, and management of herpes simplex virus infections, focusing specifically on patients with inflammatory bowel disease. RESULTS A 43-year-old man with ulcerative colitis, previously controlled with an oral 5-aminosalicylic agent, developed symptoms of a colitis flare that did not respond to treatment with systemic corticosteroid therapy. One week later he developed orolabial ulcers and progressive hepatic dysfunction, with markedly elevated transaminases and coagulopathy. He underwent emergent total colectomy when imaging suggested bowel micro-perforation. Pathology from both the colon and liver was consistent with herpes simplex virus infection, and a viral culture of his orolabial lesions and a serum polymerase chain reaction assay also identified herpes simplex virus. He was treated with systemic antiviral therapy and made a complete recovery. CONCLUSIONS Disseminated herpes simplex virus infection with concomitant involvement of the colon and liver has been reported only 3 times in the published literature, and to our knowledge this is the first such case in a patient with inflammatory bowel disease. The risk of invasive herpes simplex virus infections increases with some, but not all immunomodulatory therapies. Optimal management of herpes simplex virus in patients with inflammatory bowel disease includes targeted prophylactic therapy for patients with evidence of latent infection, and timely initiation of antiviral therapy for those patients suspected to have invasive disease.
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MESH Headings
- Adult
- Colitis/complications
- Colitis/diagnosis
- Colitis/virology
- Colitis, Ulcerative/complications
- Colitis, Ulcerative/diagnosis
- Colonoscopy
- DNA, Viral/analysis
- Hepatitis, Viral, Human/complications
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/virology
- Herpes Simplex/complications
- Herpes Simplex/diagnosis
- Herpes Simplex/virology
- Humans
- Male
- Simplexvirus/genetics
- Tomography, X-Ray Computed
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Affiliation(s)
- Varun K. Phadke
- Division of Infectious Diseases, Emory University School of Medicine
- Correspondence: Varun K. Phadke, 49 Jesse Hill Jr. Drive, Atlanta 30303, GA (e-mail: )
| | | | - Brian C. Quigley
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital
| | - Alton B. Farris
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital
| | - J. P. Norvell
- Division of Digestive Diseases, Emory University School of Medicine
- Emory Transplant Center, Atlanta, GA
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Gonzalez de Alba CE, Estrada Fajardo L, Molina Berganza F, Fergie J. A 19-Year-Old Girl With Rectal Bleeding: Broadening Pediatricians' Differential Diagnoses. Clin Pediatr (Phila) 2016; 55:890-1. [PMID: 26416984 DOI: 10.1177/0009922815608280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Jaime Fergie
- Driscoll Children's Hospital, Corpus Christi, TX, USA
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34
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Escobar-Sevilla J, Hidalgo-Tenorio C, Navarro-Marí JM, Gutiérrez-Fernández J. Proctitis en varón con relaciones sexuales con hombres e infectado por el virus de la inmunodeficiencia humana. Med Clin (Barc) 2016; 146:468-9. [DOI: 10.1016/j.medcli.2015.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 11/13/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
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35
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Lee KJ, Kim J, Shin DH, Jung JO, Koh S, Kim KY, Lee JM. Chlamydial Proctitis in a Young Man Who Has Sex with Men: Misdiagnosed as Inflammatory Bowel Disease. Chonnam Med J 2015; 51:139-41. [PMID: 26730366 PMCID: PMC4697115 DOI: 10.4068/cmj.2015.51.3.139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 11/15/2022] Open
Abstract
We report the case of a 20-year-old man with a 2-month history of anal pain and bloody rectal discharge. He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD). The colonoscopy showed mucosal nodularities on the rectum and an anal tag. Because the colonoscopic findings were not consistent with the typical manifestations of IBD, we took an additional sexual history and performed studies for infectious proctitis, including serologic tests for Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. He had homosexual experience, and the serologic tests and PCR of a rectal swab were positive for C. trachomatis infection. Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.
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Affiliation(s)
- Kyung Jin Lee
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Jaeyeon Kim
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Dong Hwan Shin
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Jun Oh Jung
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Seokyoung Koh
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Ka Young Kim
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Jae Min Lee
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
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Dawson H, Serra S. Tumours and inflammatory lesions of the anal canal and perianal skin revisited: an update and practical approach. J Clin Pathol 2015; 68:971-81. [DOI: 10.1136/jclinpath-2015-203056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tumours of the anal and perianal region are relatively rare, and clinically often interpreted as innocuous lesions, leading to frequent delays in diagnosis and adequate treatment. Although squamous cell neoplasia represents the most common entity encountered in this anatomically complex area, many conditions, both neoplastic and inflammatory, may occur. Adding to the challenge of correct diagnosis and patient management, recent years have seen major updates in the terminology of squamous cell neoplasia, created to reflect advances in our understanding of the role of human papilloma virus and unify previous terminologies used for different sites in the anogenital tract. However, squamous cell neoplasia in the anal canal and perianal region may differ in terms of histology, biological behaviour, staging and treatment. The aim of this review is to present an overview of neoplastic and non-neoplastic lesions that may be seen in this area, an update on important developments and terminology, potential pitfalls that may be encountered in routine pathology practice and a practical approach on how to resolve these issues.
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Burgener A, McGowan I, Klatt NR. HIV and mucosal barrier interactions: consequences for transmission and pathogenesis. Curr Opin Immunol 2015; 36:22-30. [DOI: 10.1016/j.coi.2015.06.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/16/2015] [Indexed: 02/07/2023]
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Pathogenesis, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis. Inflamm Bowel Dis 2015; 21:703-15. [PMID: 25687266 DOI: 10.1097/mib.0000000000000227] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic proctitis refers to persistent or relapsing inflammation of the rectum, which results from a wide range of etiologies with various pathogenic mechanisms. The patients may share similar clinical presentations. Ulcerative proctitis, chronic radiation proctitis or proctopathy, and diversion proctitis are the 3 most common forms of chronic proctitis. Although the diagnosis of these disease entities may be straightforward in the most instances based on the clinical history, endoscopic, and histologic features, differential diagnosis may sometimes become problematic, especially when their etiologies and the disease processes overlap. The treatment for the 3 forms of chronic proctitis is different, which may shed some lights on their pathogenetic pathway. This article provides an overview of the latest data on the clinical features, etiologies, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis.
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Colorectal emergencies and related complications: a comprehensive imaging review--imaging of colitis and complications. AJR Am J Roentgenol 2015; 203:1205-16. [PMID: 25415697 DOI: 10.2214/ajr.13.12250] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Colorectal emergencies are a common presentation in the emergency medicine setting and their timely diagnosis plays a crucial role in avoiding dreaded complications. The quintessential role of a radiologist lies in identifying the cause, narrowing the differential diagnosis according to imaging features, and, most importantly, identifying the associated complications. CONCLUSION This review focuses on imaging features of the spectrum of colitides and the complications related to colitides.
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Ali MA, Arnold CA, Singhi AD, Voltaggio L. Clues to uncommon and easily overlooked infectious diagnoses affecting the GI tract and distinction from their clinicopathologic mimics. Gastrointest Endosc 2014; 80:689-706. [PMID: 25070906 DOI: 10.1016/j.gie.2014.04.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 04/29/2014] [Indexed: 02/07/2023]
Affiliation(s)
- M Aamir Ali
- Department of Gastroenterology, George Washington University Hospital, Washington, District of Columbia, USA
| | | | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lysandra Voltaggio
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Mayser P, Imirzalioglu C, Straube E. Stenosing proctitis with subsequent colostomy placement. J Dtsch Dermatol Ges 2014; 12:1054-6. [PMID: 24903403 DOI: 10.1111/ddg.12384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Peter Mayser
- Department of Dermatology, Venereology, and Allergology - University Hospital Gießen and Marburg, Campus Gießen
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Foschi C, Marangoni A, D'Antuono A, Nardini P, Compri M, Bellavista S, Filippini A, Bacchi Reggiani ML, Cevenini R. Prevalence and predictors of Lymphogranuloma venereum in a high risk population attending a STD outpatients clinic in Italy. BMC Res Notes 2014; 7:225. [PMID: 24716676 PMCID: PMC3984434 DOI: 10.1186/1756-0500-7-225] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated LGV prevalence and predictors in a high risk population attending a STI Outpatients Clinic in the North of Italy. Methods A total of 108 patients (99 MSM and 9 women), with a history of unsafe anal sexual intercourses, were enrolled. Anorectal swabs and urine samples were tested for Chlamydia trachomatis (CT) DNA detection by Versant CT/GC DNA 1.0 Assay (Siemens Healthcare Diagnostics Terrytown, USA). RFLP analysis was used for CT molecular typing. Results L2 CT genotype was identified in 13/108 (12%) rectal swabs. All LGV cases were from MSM, declaring high-risk sexual behaviour and complaining anorectal symptoms. Patients first attending the STI Outpatient Clinic received a significant earlier LGV diagnosis than those first seeking care from general practitioners or gastroenterologists (P = 0.0046). LGV prevalence and characteristics found in our population are in agreement with international reports. Statistical analysis showed that LGV positive patients were older (P = 0.0008) and presented more STIs (P = 0.0023) than LGV negative ones, in particular due to syphilis (P < 0.001), HIV (P < 0.001) and HBV (P = 0.001). Multivariate logistic regression analysis revealed that HIV and syphilis infections are strong risk factors for LGV presence (respectively, P = 0.001 and P = 0.010). Conclusions Even if our results do not provide sufficient evidence to recommend routine screening of anorectal swabs in high-risk population, they strongly suggest to perform CT NAAT tests and genotyping on rectal specimens in presence of ulcerative proctitis in HIV and/or syphilis-positive MSM. In this context, CT DNA detection by Versant CT/GC DNA 1.0 Assay, followed by RFLP analysis for molecular typing demonstrated to be an excellent diagnostic algorithm for LGV identification.
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Affiliation(s)
| | - Antonella Marangoni
- Microbiology, DIMES, University of Bologna, St, Orsola Hospital, Via Massarenti, 9, 40138 Bologna, Italy.
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Voltaggio L, Montgomery EA, Ali MA, Singhi AD, Arnold CA. Sex, lies, and gastrointestinal tract biopsies: a review of selected sexually transmitted proctocolitides. Adv Anat Pathol 2014; 21:83-93. [PMID: 24508691 DOI: 10.1097/pap.0000000000000014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are many insults that result in gastrointestinal tract inflammation. Infections can be particularly challenging because (1) only a limited number of organisms provoke a specific endoscopic and/or histologic appearance; and (2) although some organisms may be present on biopsies, the findings may be so subtle or organisms so few that they are easily missed if the reviewer is not performing a specific search for the offender. Sexually transmitted infections (STI) are rarely a consideration at the time of GI biopsy examination and clinicians rarely inquire about sexual behavior at the time of initial patient interview. Although establishing a definitive STI diagnosis is not possible on histology alone, these infections are associated with inflammatory patterns that may help raise this diagnostic possibility. Becoming familiar with these patterns is necessary as worldwide outbreaks of these infections are being reported. This review aims to provide the pathologist with histologic clues associated with the most frequently encountered bacterial pathogens in the setting of STI proctitis, namely, Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum.
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Solomon ML, Middleman AB. Abdominal pain, constipation, and tenesmus in an adolescent female: consider Chlamydia proctitis. J Pediatr Adolesc Gynecol 2013; 26:e77-9. [PMID: 23518359 DOI: 10.1016/j.jpag.2013.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/03/2013] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Rectal Chlamydia trachomatis (CT) infection and proctitis, once thought to be exclusive to the population of men who have sex with men, is being detected with increased frequency among heterosexual females. CASE A 16-year-old female presented with 5 months of chronic, episodic abdominal pain of increasing severity with associated mucoid stools, constipation, encopresis, and a 15-25 lb weight loss. A thorough social history revealed high risk sexual behavior and sexual assault 6 months prior to presentation. Laboratory and diagnostic testing were positive for CT infection of the rectal mucosa. SUMMARY AND CONCLUSION Clinicians should be increasingly aware of the potential for rectal infection and disease associated with chlamydia among women. Sexually active females presenting with rectal pain and complaints should be screened for CT infection of the rectum.
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Affiliation(s)
- Michelle L Solomon
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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