Journal Pre-proof Lymphogranuloma Venereum Proctitis Cindy Law, MD, Vicky Bhagat, Anish Vinit Patel, MD
PII: DOI: Reference:
S1542-3565(19)31435-1 https://doi.org/10.1016/j.cgh.2019.12.009 YJCGH 56909
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 8 December 2019 Please cite this article as: Law C, Bhagat V, Patel AV, Lymphogranuloma Venereum Proctitis, Clinical Gastroenterology and Hepatology (2020), doi: https://doi.org/10.1016/j.cgh.2019.12.009. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 by the AGA Institute
IMAGE OF THE MONTH:
Lymphogranuloma Venereum Proctitis.
Cindy Law MD [1], Vicky Bhagat [1], Anish Vinit Patel MD [1].
[1] Rutgers Robert Wood Johnson Medical School, Division of Gastroenterology & Hepatology, New Brunswick, NJ, USA.
CONFLICTS OF INTEREST & FINANCIAL SUPPORT: None
ADDRESS CORRESPONDENCE: Anish Vinit Patel, MD Rutgers Robert Wood Johnson Medical School 51 French St, Medical Education Building #493, New Brunswick, NJ 08901. Tel: 469-235-9353 E-mail:
[email protected]
AUTHORS CONTRIBUTIONS: Conception and design (CL, VB, AVP) Drafting of the article (CL, VB, AVP) Critical revision of the article for important intellectual content (CL, VB, AVP) Final approval of the article (CL, VB, AVP)
IMAGE OF THE MONTH:
Lymphogranuloma Venereum Proctitis.
A 48 year-old Hispanic male with Human Immunodeficiency Virus (HIV) on antiviral therapy (CD4 count 1010 cells/mm) presented with two weeks of intermittent painless hematochezia. He denied fever, chills, nausea, vomiting and diarrhea. Hemoglobin was 16.3 g/dL. A colonoscopy was performed that showed multiple nodules with central ulceration in the rectum with surrounding edematous and erythematous mucosa (A, B). Biopsies showed acute cryptitis with chronic active colitis (C) and immunostaining was negative for cytomegalovirus and herpes simplex virus. A rectal swab returned positive for Chlamydia trachomatis and he was diagnosed with Lymphogranuloma Venereum (LGV) Proctitis. He was treated with a 21 day course of doxycycline therapy and his gastrointestinal symptoms resolved. LGV is a sexually transmitted disease caused by Chlamydia trachomatis (Serovars L1, L2 and L3), and the diagnosis is made by culture and nucleic acid amplification tests using rectal swab or biopsy following by genotyping. LGV may mimic inflammatory bowel disease, and if untreated can result in perirectal abscess, fistulas and strictures. The diagnosis is challenging and a high clinical suspicion should be maintained in high risk individuals who develop rectal ulcers, proctitis and lower gastrointestinal bleeding.