P-011 Rare case of Rectal Ulcers Secondary to “Lymphogranuloma Venereum” in HIV Patient

Abstract

BACKGROUND: Introduction: Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis serovars L1- L3. In HIV patients it can cause proctocolitis, anal pain and tenesmus. LGV associated rectal ulcers are very rare. Case: Fifty-six year old male with Human immunodeficiency Virus infection with recent CD4 count of 645, currently on antiretroviral therapy presented with painless profuse rectal bleeding. Patient denied any abdominal pain, nausea, vomiting or diarrhea. His colonoscopy done 4 years ago was unremarkable. Patient was noted to have acute blood loss anemia. Colonoscopy was performed which showed large geographic clean based ulcers occupying the distal half of the rectum with rest of colon being normal. Biopsies from rectal ulcers showed only dense inflammation and were negative for Cytomegalovirus, malignancy or inflammatory bowel disease. Serological work up for inflammatory bowel disease was also negative. Patient continued to have intermittent rectal bleeding. Later a rectal swab was done, which came back positive for Chlamydia DNA suggesting lymphogranuloma venereum as etiology for the rectal ulcers in this patient with a history of HIV. Patient was started on Doxycycline and showed improvement in his symptoms. He is scheduled for follow up sigmoidoscopy. Discussion: Lymphogranuloma venereum is a sexually transmitted disease especially among HIV-positive men who have sex with men (MSM). The initial presentation is usually a painless ulcerated papule on the genitalia. The progression of the infection can lead to major complications like rectal strictures, intestinal obstruction or perforation. Early treatment is important as it can prevent major complications. An important manifestation of LGV is rectal ulcers with clinical presentation and endoscopic findings resembling those of inflammatory bowel diseases. LGV should be suspected if a patient with HIV or positive Chlamydia test fails to respond to IBD therapy. METHODS: NA. RESULTS: NA. CONCLUSIONS: NA.