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Dos Santos-Ferreira AC, Calanca R, Ardengh JC. Challenges in Diagnostic of the Ulcerative Rectitis by Lymphogranuloma venereum in Chlamydia trachomatis Infection and AIDS. Cureus 2023; 15:e35420. [PMID: 36987466 PMCID: PMC10040225 DOI: 10.7759/cureus.35420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
Lymphogranuloma venereum is a rare manifestation of Chlamydia trachomatis infection and may manifest with anorectal symptoms, rectitis, proctitis, and inguinal masses. The new outbreaks of Chlamydia infection have allowed the description of new cases with rectal symptoms (rectitis/proctitis), mainly in people living with HIV and men who have sex with men. The authors present the clinical findings in people living with HIV men who have sex with men with lymphogranuloma venereum with ulcerative rectitis identified by colonoscopy. Differentiation of proctitis was made from other causes of sexually transmitted infections, such as gonorrhea and herpes virus, inflammatory diseases (Crohn's disease), and neoplastic and opportunistic infections such as cytomegalovirus, tuberculosis, and histoplasmosis. The symptoms of the patient and the endoscopic lesions were suspected of lymphogranuloma venereum with ulcerative proctitis, which was confirmed by biopsy and performing the polymerase chain reaction. After appropriate treatment with doxycycline, the patient evolved favorably.
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Affiliation(s)
| | - Richard Calanca
- Gastroenterology, Instituto de Infectologia Emílio Ribas, São Paulo, BRA
| | - José C Ardengh
- Gastrointestinal Endoscopy Department, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, BRA
- Imaging Diagnosis Department, Federal University of São Paulo, São Paulo, BRA
- Gastroenterology, Instituto de Infectologia Emílio Ribas, São Paulo, BRA
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2
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Miller CQ, Saeed OAM, Collins K. Gastrointestinal histoplasmosis complicating pediatric Crohn disease: A case report and review of literature. World J Gastrointest Endosc 2022; 14:648-656. [PMID: 36303809 PMCID: PMC9593511 DOI: 10.4253/wjge.v14.i10.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/05/2022] [Accepted: 09/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Infection with Histoplasma capsulatum (H. capsulatum) can lead to disseminated disease involving the gastrointestinal tract presenting as diffuse abdominal pain and diarrhea which may mimic inflammatory bowel disease (IBD).
CASE SUMMARY We report a case of 12-year-old boy with presumptive diagnosis of Crohn disease (CD) that presented with several months of abdominal pain, weight loss and bloody diarrhea. Colonoscopy showed patchy moderate inflammation characterized by erythema and numerous pseudopolyps involving the terminal ileum, cecum, and ascending colon. Histologic sections from the colon biopsy revealed diffuse cellular infiltrate within the lamina propria with scattered histiocytic aggregates, and occasional non-necrotizing granulomas. Grocott-Gomori’s Methenamine Silver staining confirmed the presence of numerous yeast forms suggestive of Histoplasma spp., further confirmed with positive urine Histoplasma antigen (6.58 ng/mL, range 0.2-20 ng/mL) and serum immunoglobulin G antibodies to Histoplasma (35.9 EU, range 10.0-80.0 EU). Intravenous amphotericin was administered then transitioned to oral itraconazole. Follow-up computed tomography imaging showed a left lower lung nodule and mesenteric lymphadenopathy consistent with disseminated histoplasmosis infection.
CONCLUSION Gastrointestinal involvement with H. capsulatum with no accompanying respiratory symptoms is exceedingly rare and recognition is often delayed due to the overlapping clinical manifestations of IBD. This case illustrates the importance of excluding infectious etiologies in patients with “biopsy-proven” CD prior to initiating immunosuppressive therapies. Communication between clinicians and pathologists is crucial as blood cultures and antigen testing are key studies that should be performed in all suspected cases of histoplasmosis to avoid misdiagnosis and inappropriate treatment.
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Affiliation(s)
- C Quinn Miller
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Omer A M Saeed
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Katrina Collins
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
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3
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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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4
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Gravett RM, Marrazzo J. What’s Old Is New: the Evolution of Lymphogranuloma Venereum Proctitis in Persons Living with HIV. Curr Infect Dis Rep 2022. [DOI: 10.1007/s11908-022-00781-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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5
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Arévalo F, Rayme S, Zurita F, Ramírez R, Franco D, Montes P, Fustamante J, Monge E. Immunohistochemical detection of chlamydia trachomatis in sexually transmitted infectious proctitis. BMC Gastroenterol 2022; 22:171. [PMID: 35395750 PMCID: PMC8991980 DOI: 10.1186/s12876-022-02233-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/16/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Since 2003, a progressive increase in sexually transmitted infections (STI), presented as proctitis, has been described in homosexual men. In 2013 Arnold et al. described microscopic features that enable pathologists to formulate a histological diagnosis of STI related proctitis. The aim of this study is to identify the presence of Chlamydia trachomatis by immunohistochemistry in a group of patients with male to male sexual activity and pathology compatible with STI proctitis. Methods Cross-sectional study. The study included 54 patients with risky sexual activity and histopathology compatible with STI-proctitis according to Arnold´s recommendations. The Chlamydia trachomatis identification was carried out retrospectively on paraffin blocks using mouse monoclonal antibodies from Santa Cruz biotechnology.
Results all patients were young men with male to male sexual activity, 69% were positive for HIV. The most common endoscopic presentation was rectal ulcer (61%). Basal lymphoplasmacytic inflammation and mild crypt distortion were the most common histological findings. The immunohistochemical study identified positivity for Chlamydia trachomatis in 40% (18 of 45 tested) of STI proctitis cases. Discussion The epidemiological and endoscopic characteristics of the patients studied are similar to those previously reported. In accordance with Arnold et al., the most common histological findings were (a) mild distortion of the crypts; (b) dense and basal lymphoplasmacytic infiltrate and (c) scarcity of eosinophils. The positivity of chlamydia trachomatis in immunohistochemistry was lower than others studies that used PCR for this purpose. We did not find similar published studies to compare our results. Conclusions In summary, 54 cases of patients with STI related proctitis are presented, all of them with distinctive histological characteristics and third of the cases tested positive by IHC for Chlamydia trachomatis. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02233-w.
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Affiliation(s)
- Fernando Arévalo
- Hospital Nacional Daniel A Carrión, Callao, Bellavista, Peru. .,Universidad Nacional Mayor de San Marcos, Lima, Peru.
| | - Soledad Rayme
- Hospital Nacional Daniel A Carrión, Callao, Bellavista, Peru
| | - Fiorella Zurita
- Hospital Nacional Daniel A Carrión, Callao, Bellavista, Peru
| | - Rocio Ramírez
- Hospital Nacional Daniel A Carrión, Callao, Bellavista, Peru
| | | | - Pedro Montes
- Hospital Nacional Daniel A Carrión, Callao, Bellavista, Peru
| | - Jaime Fustamante
- Hospital Nacional Daniel A Carrión, Callao, Bellavista, Peru.,Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Eduardo Monge
- Hospital Nacional Daniel A Carrión, Callao, Bellavista, Peru.,Universidad Nacional Mayor de San Marcos, Lima, Peru.,Universidad Particular Cayetano Heredia, Lima, Peru
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6
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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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7
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Shojaei E, Walsh JC, Sangle N, Yan B, Silverman MS, Hosseini-Moghaddam SM. Gastrointestinal Histoplasmosis Mimicking Crohn's Disease. Open Forum Infect Dis 2021; 8:ofab249. [PMID: 34262987 PMCID: PMC8274358 DOI: 10.1093/ofid/ofab249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
Disseminated histoplasmosis is a life-threatening disease usually seen in immunocompromised patients living in endemic areas. We present an apparently immunocompetent patient with gastrointestinal histoplasmosis who was initially diagnosed with biopsy-proven Crohn's disease. Following discontinuation of anti-inflammatory drugs and institution of antifungal therapy, his gastrointestinal illness completely improved. Specific fungal staining should be routinely included in histopathologic assessment of tissue specimens diagnosed as Crohn's disease.
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Affiliation(s)
- Esfandiar Shojaei
- Division of Infectious Diseases, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Joanna C Walsh
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nikhil Sangle
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Brian Yan
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael S Silverman
- Division of Infectious Diseases, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Seyed M Hosseini-Moghaddam
- Division of Infectious Diseases, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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A Comprehensive Review of Infectious Granulomatous Diseases of the Gastrointestinal Tract. Gastroenterol Res Pract 2021; 2021:8167149. [PMID: 33628227 PMCID: PMC7886506 DOI: 10.1155/2021/8167149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/01/2021] [Accepted: 01/28/2021] [Indexed: 12/21/2022] Open
Abstract
A granuloma is defined as a localized inflammatory reaction or a hypersensitive response to a nondegradable product leading to an organized collection of epithelioid histiocytes. Etiologies of granulomatous disorders can be divided into two broad categories: infectious and noninfectious (autoimmune conditions, toxins, etc.) causes. The endless list of causalities may prove challenging for gastroenterologists and pathologists to formulate a list of clearly defined differentials. This is true when distinguishing these etiologies based on various clinical presentations and endoscopic and histological findings. We aim to provide a comprehensive review of some of the frequent and rare infectious granulomatous diseases of the gastrointestinal tract documented in the literature to date. We provide an overview of each infectious pathology with an emphasis on epidemiology, clinical presentation, and endoscopic and histologic findings, in addition to treatment.
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9
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Sullivan B, Glaab J, Gupta RT, Wood R, Leiman DA. Lymphogranuloma venereum (LGV) proctocolitis mimicking rectal lymphoma. Radiol Case Rep 2019; 13:1119-1122. [PMID: 30792826 PMCID: PMC6372233 DOI: 10.1016/j.radcr.2018.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 11/26/2022] Open
Abstract
Lymphogranuloma venereum is a sexually transmitted
infection caused by serotypes L1-3 of Chlamydia
trachomatis and may present as hemorrhagic proctocolitis. The
diagnosis of an active infection is difficult to establish, as confirmatory
testing can be unreliable or unavailable. Imaging findings can be nonspecific
and mimic malignancy or other chronic infectious and inflammatory disorders. In
this report, we present a case of lymphogranuloma venereum proctocolitis and its
computed tomography features to highlight the relevant imaging findings and
importance of timely diagnosis.
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Affiliation(s)
- Brian Sullivan
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, 2400 Pratt Street, Suite 8007, Durham, NC 27710, USA
| | - Jonathan Glaab
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC 27710, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC 27710, USA
| | - Richard Wood
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, 2400 Pratt Street, Suite 8007, Durham, NC 27710, USA
| | - David A Leiman
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, 2400 Pratt Street, Suite 8007, Durham, NC 27710, USA
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10
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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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11
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Freitag AP, Cusenza A, Koushk-Jalali B, Tigges C, Oellig F, Kreuter A. [Unilateral painful lump of the groin following unprotected intercourse]. Hautarzt 2019; 70:145-147. [PMID: 30683967 DOI: 10.1007/s00105-018-4348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ana Paula Freitag
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Josefstr. 3, 46045, Oberhausen, Deutschland.
| | - Antonino Cusenza
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Josefstr. 3, 46045, Oberhausen, Deutschland
| | - Bijan Koushk-Jalali
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Josefstr. 3, 46045, Oberhausen, Deutschland
| | - Christian Tigges
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Josefstr. 3, 46045, Oberhausen, Deutschland
| | - Frank Oellig
- Pathologie Rhein-Ruhr, Mülheim an der Ruhr, Deutschland
| | - Alexander Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Josefstr. 3, 46045, Oberhausen, Deutschland
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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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13
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Bancil AS, Alexakis C, Pollok R. Delayed diagnosis of lymphogranuloma venereum-associated colitis in a man first suspected to have rectal cancer. JRSM Open 2017; 8:2054270416660933. [PMID: 28203380 PMCID: PMC5298471 DOI: 10.1177/2054270416660933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Lymphogranuloma venereum-associated colitis is a diagnosis that should not be missed. The following case represents the importance of a thorough history, including the importance of the sexual history to prevent the misdiagnosis of these patients.
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14
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Abstract
Syphilitic proctitis is a rare disease that usually presents as proctitis, ulcer, and neoplasm but lacks pathognomonic clinical symptoms. It is thus difficult to diagnose and may be treated inappropriately. We report a 31-year-old man who had a hard, ulcerated mass that occupied the rectal and sigmoid colon wall and mimicked a tumor. Fortunately, a biopsy of the mass demonstrated Treponema pallidum organisms consistent with syphilitic proctitis. The patient was successfully treated with intravenous benzyl penicillin, resulting in improvement in his proctitis.
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Affiliation(s)
- Juliana F Yang
- Division of Digestive and Liver Disease (Yang, Mayorga) and the Department of Pathology (Peng), the University of Texas Southwestern Medical Center, Dallas, Texas; and the Division of Digestive and Liver Disease, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (Siddiqui)
| | - Lan Peng
- Division of Digestive and Liver Disease (Yang, Mayorga) and the Department of Pathology (Peng), the University of Texas Southwestern Medical Center, Dallas, Texas; and the Division of Digestive and Liver Disease, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (Siddiqui)
| | - Ali A Siddiqui
- Division of Digestive and Liver Disease (Yang, Mayorga) and the Department of Pathology (Peng), the University of Texas Southwestern Medical Center, Dallas, Texas; and the Division of Digestive and Liver Disease, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (Siddiqui)
| | - Christian A Mayorga
- Division of Digestive and Liver Disease (Yang, Mayorga) and the Department of Pathology (Peng), the University of Texas Southwestern Medical Center, Dallas, Texas; and the Division of Digestive and Liver Disease, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (Siddiqui)
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15
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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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Abstract
Lymphogranuloma venereum is a sexually transmitted disease caused by L1, L2, and L3 serovars of Chlamydia trachomatis. In the last 10 years outbreaks have appeared in North America, Europe, and Australia in the form of proctitis among men who have sex with men. Three stages of disease have been described. The disease in primary stage may go undetected when only a painless papule, pustule, or ulceration appears. The diagnosis is difficult to establish on clinical grounds alone and frequently relies upon either serologic testing, culture, or more recently, nucleic acid amplification testing of direct specimens. A proper treatment regimen cures the infection and prevents further damage to tissues. Lymphogranuloma venereum causes potentially severe infections with possibly irreversible sequels if adequate treatment is not begun promptly. Early and accurate diagnosis is essential. Doxycycline is the drug of choice. Pregnant and lactating women should be treated with erythromycin or azithromycin. Patient must be followed up during the treatment, until disease signs and symptoms have resolved. Repeated testing for syphilis, hepatitis B and C, and HIV to detect early infection should be performed.
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Affiliation(s)
- Romana Ceovic
- Department of Dermatology and Venereology, University Hospital Center Zagreb and School of Medicine, Zagreb, Croatia
| | - Sandra Jerkovic Gulin
- Department of Dermatology and Venereology, General Hospital Sibenik, Sibenik, Croatia
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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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