Soliman Sara, Dogbey Pia, Pan Samuel
Internal Medicine, Waterbury Hospital, Waterbury, USA.
Infectious Diseases, Waterbury Hospital, Waterbury, USA.
Cureus. 2021 Dec 6;13(12):e20216. doi: 10.7759/cureus.20216. eCollection 2021 Dec.
Lymphogranuloma venereum (LGV) can present as a sexually transmitted anorectal syndrome and is caused by serotypes L1, L2, and L3. It was rare in the western world until a recent outbreak among men who have sex with men (MSM) in Europe and North America. Limited availability of diagnostic tests differentiating LGV from non-LGV can make the diagnosis challenging. We present a 33-year-old MSM with high-risk sexual behavior and anal atypical squamous cells of undetermined significance (ASCUS), who was evaluated for rectal pain, bleeding, constipation, and weight loss. Computed tomography of the abdomen and pelvis showed rectal wall thickening with pelvic adenopathy, concerning rectal carcinoma, also seen on colonoscopy as a 50% circumferential ulcerating rectal mass. The rectal swab was positive for by immunofluorescence assay. Pathology confirmed severe active proctitis, but no malignancy. He was treated for presumed LGV proctitis with marked improvement. The case highlights an unusual presentation of LGV with severe inflammation and mass formation mimicking rectal carcinoma. Early identification of possible LGV especially in high-risk patients allows early appropriate treatment.
性病性淋巴肉芽肿（LGV）可表现为一种性传播的肛门直肠综合征，由L1、L2和L3血清型引起。在西方世界，直到最近欧洲和北美的男男性行为者（MSM）中爆发疫情之前，该病都很罕见。区分LGV与非LGV的诊断测试可用性有限，这可能使诊断具有挑战性。我们报告一名33岁的有高危性行为且肛门出现意义不明确的非典型鳞状细胞（ASCUS）的男男性行为者，他因直肠疼痛、出血、便秘和体重减轻而接受评估。腹部和骨盆计算机断层扫描显示直肠壁增厚并伴有盆腔淋巴结肿大，怀疑为直肠癌，结肠镜检查也发现一个环绕直肠50%的溃疡性肿块。直肠拭子经免疫荧光测定呈阳性。病理证实为严重活动性直肠炎，但无恶性肿瘤。他接受了疑似LGV直肠炎的治疗，病情有明显改善。该病例突出了LGV的一种不寻常表现，即伴有严重炎症和肿块形成，酷似直肠癌。早期识别可能的LGV，尤其是在高危患者中，有助于早期进行适当治疗。
