Chonnam Med J.  2015 Dec;51(3):139-141. 10.4068/cmj.2015.51.3.139.

Chlamydial Proctitis in a Young Man Who Has Sex with Men: Misdiagnosed as Inflammatory Bowel Disease

• Lee KJ
• Kim J
• Shin DH
• Jung JO
• Koh S
• Kim KY
• Lee JM

• KMID: 2172131
• DOI: http://doi.org/10.4068/cmj.2015.51.3.139

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.

Keyword

Proctitis; Chlamydia trachomatis; Inflammatory bowel diseases; Lymphogranuloma venereum; Sexually transmitted diseases

MeSH Terms

Ceftriaxone
Chlamydia trachomatis
Colonoscopy
Doxycycline
Gastroenterology
Homosexuality
Humans
Inflammatory Bowel Diseases*
Lymphogranuloma Venereum
Male
Neisseria gonorrhoeae
Polymerase Chain Reaction
Proctitis*
Rectum
Serologic Tests
Sexually Transmitted Diseases
Treponema pallidum
Young Adult
Ceftriaxone
Doxycycline

Figure

• 

  FIG. 1 Colonoscopic and histologic findings of the rectum. (A) Granular and hyperemic mucosal nodularities were observed from the anus to the rectum. (B) Histologic findings showed lymphocyte aggregations (H&E statin, ×40). (C) There were large lymphoid follicles with hemorrhage. Cryptitis or crypt distortion was not observed (H&E stain, ×100).

• 

  FIG. 2 Colonoscopic findings 2 months after treatment with doxycycline. There were still granular and hyperemic mucosal nodularities from the anus to the rectum. However, compared to Fig. 1A, the size and the extent of the nodular lesions were decreased.

Reference

1. Hoentjen F, Rubin DT. Infectious proctitis: when to suspect it is not inflammatory bowel disease. Dig Dis Sci. 2012; 57:269–273.

2. Ward H, Alexander S, Carder C, Dean G, French P, Ivens D, et al. The prevalence of lymphogranuloma venereum infection in men who have sex with men: results of a multicentre case finding study. Sex Transm Infect. 2009; 85:173–175.

3. Gallegos M, Bradly D, Jakate S, Keshavarzian A. Lymphogranuloma venereum proctosigmoiditis is a mimicker of inflammatory bowel disease. World J Gastroenterol. 2012; 18:3317–3321.

4. Høie S, Knudsen LS, Gerstoft J. Lymphogranuloma venereum proctitis: a differential diagnose to inflammatory bowel disease. Scand J Gastroenterol. 2011; 46:503–510.

5. Kim DD. Rectal lymphogranuloma venereum in a man who had sex with men. J Korean Soc Coloproctol. 2010; 26:152–156.

6. Quinn TC, Goodell SE, Mkrtichian E, Schuffler MD, Wang SP, Stamm WE, et al. Chlamydia trachomatis proctitis. N Engl J Med. 1981; 305:195–200.

7. Martin-Iguacel R, Llibre JM, Nielsen H, Heras E, Matas L, Lugo R, et al. Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries. Eur J Clin Microbiol Infect Dis. 2010; 29:917–925.

8. de Vries HJ, Smelov V, Middelburg JG, Pleijster J, Speksnijder AG, Morré SA. Delayed microbial cure of lymphogranuloma venereum proctitis with doxycycline treatment. Clin Infect Dis. 2009; 48:e53–e56.

9. López-Vicente J, Rodríguez-Alcalde D, Hernández-Villalba L, Moreno-Sánchez D, Lumbreras-Cabrera M, Barros-Aguado C, et al. Proctitis as the clinical presentation of lymphogranuloma venereum, a re-emerging disease in developed countries. Rev Esp Enferm Dig. 2014; 106:59–62.

10. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2010. MMWR Recomm Rep. 2010; 59(RR-12):1–78.