Inflammatory bowel disease versus Chlamydia trachomatis infection: a case report and revision of the literature

Abstract

Infectious proctitis may mimic inflammatory bowel disease, particularly when limited to the rectum. The present case report includes findings from a 50-year-old man, soldier, referring to our Inflammatory Bowel Disease Unit with a diagnosis of rectal Crohn’s disease, refractory to conventional treatments. Mild anemia, hypergammaglobulinemia and HIV-antibodies seronegativity were detected. Entero-MRI and stool examinations were negative. Ileocolonoscopy detected few rectal ulcers with irregular edges. Endosonography showed marked thickening of the rectal wall and enlarged perirectal lymphnodes. Nodal and rectal fine needle aspirate did not show atypia (PAN CK-). Rectal biopsies showed flogistic granular tissue (PAN CK-): Warthin-Starry stain was negative. Previous Treponema pallidum infection was detected. Clinical history revealed habits at risk for sexually transmitted infection. Rectal swabs for RT-PCR for Chlamydia trachomatis, Neisseria gonorrhoeae, and Herpes Simplex Virus 1-2 lead to a diagnosis of lymphogranuloma venereum. Doxycycline 100 mg and Azitromicyn 500 mg t.i.d. were given for 21 days, followed by negativity for RT-PCR for Chlamydia trachomatis at rectal swabs. Complete disappearance of symptoms and mucosal healing occurred. Due to the increased frequency of infectious diseases, sexually transmitted infection (including lymphogranuloma venereum) should be considered as possible differential diagnosis when assessing patients with inflammatory bowel disease limited to the rectum.

Lymphogranuloma Venereum-Associated Proctitis Mimicking a Malignant Rectal Neoplasia: Searching for Diagnosis

“…Although an uncommon cause of acute proctitis, LGV has become a major cause of sexually transmitted proctitis, being endemic among MSM [ 5 , 6 , 17 ].…”

“…Patients can present with a wide range of symptoms including severe anorectal pain, rectal mucopurulent discharge, bleeding per rectum, tenesmus, and constipation due to mucosal and perirectal edema. In cases of severe inflammation, a prominent rectal wall thickening, rectal mass, or lymphadenopathy may occur, mimicking a rectal neoplasia [ 2 , 5 , 7 , 9 , 14 , 17 , 19 ].…”

“…The clinical, imaging, endoscopic, and/or histological findings may be similar to those caused by IBD and rectal adenocarcinoma or lymphoma. A high degree of clinical suspicion based on a detailed clinical history is essential to achieve the diagnosis of rectal LGV, particularly when a patient's HIV status is unknown [ 5 ].…”

“…On the other hand, infectious proctitis is also associated with nonsexually transmitted agents such as Escherichia coli , Shigella spp., Campylobacte r spp., and Clostridioides difficile . Sexually transmitted agents, such as Neisseria gonorrhoeae , Chlamydia trachomatis , Treponema pallidum , and Herpes simplex virus (HSV) are increasing in prevalence, especially in men who have sex with men (MSM) [ 1 , 2 , 3 , 4 , 5 ].…”

Lymphogranuloma venereum: an emerging problem in Poland

“…Mixed infections with D-K and L types are observed, which probably have resulted from DNA recombination. Recently, 25 LGV cases due to a new hybrid L2b/D-Da genovar were described in Portugal. All of these isolates were collected from MSM with proctitis [18].…”