La Rosa Luciana, Svidler López Laura, Entrocassi Andrea C, Santos Brian, Caffarena Dolores, Rodríguez Fermepin Marcelo
Centro Privado de Cirugía y Coloproctología, Buenos Aires, Argentina. E-mail:
División Cirugía, Hospital Fernández, Buenos Aires, Argentina.
Medicina (B Aires). 2018;78(3):207-210.
From 2003 to date there has been a rising number of reports from developed countries on cases of lymphogranuloma venereum with anorectal localization in HIV-infected men who have sex with men. This localization differs from the classical inguinal abscesses which are typical of the disease in the tropics. The objective of this work is to document the presence of anorectal lymphogranuloma venereum in Buenos Aires and to describe its varied clinical manifestations. In the context of a systematic survey of rectal chlamydial infection, in just one trimester, eight cases of lymphogranuloma venereum caused by Chlamydia trachomatis biovar LGV were identified in HIV-infected men who have sex with men. The most frequent anorectal manifestations were pus, tenesmus, rectal urgency, and mucous or haemopurulent discharge. The proctitis was mostly mild or moderate and, in some cases, it was accompanied by perianal lesions. Given the great polymorphism and unspecificity of the clinical manifestations of the disease, we warn on the presence of this form of rectal lymphogranuloma venereum in our setting. If Chlamydia trachomatis is detected, it should be genotyped, not only for the correct diagnosis and treatment but also for epidemiological surveillance. Where genotyping is not available, the disease must be considered as caused by the LGV biovar and treated accordingly.
从2003年至今，发达国家关于人类免疫缺陷病毒（HIV）感染的男男性行为者中出现肛门直肠部位性病性淋巴肉芽肿病例的报告数量一直在增加。这种发病部位不同于热带地区该病典型的腹股沟脓肿。本研究的目的是记录布宜诺斯艾利斯存在肛门直肠部位的性病性淋巴肉芽肿，并描述其多样的临床表现。在一项针对直肠衣原体感染的系统调查中，仅在一个季度内，就在HIV感染的男男性行为者中发现了8例由沙眼衣原体LGV生物变种引起的性病性淋巴肉芽肿病例。最常见的肛门直肠表现为脓性分泌物、里急后重、直肠紧迫感以及黏液或脓血样分泌物。直肠炎大多为轻度或中度，在某些情况下，伴有肛周病变。鉴于该病临床表现具有高度多态性和非特异性，我们警示在我们所处环境中存在这种形式的直肠性病性淋巴肉芽肿。如果检测到沙眼衣原体，应进行基因分型，这不仅是为了正确诊断和治疗，也是为了流行病学监测。在无法进行基因分型的情况下，必须将该病视为由LGV生物变种引起并相应进行治疗。
